Interceptive Orthodontics Flashcards
define interceptive orthodontics
any tx that eliminates or reduces severity of developing malocclusion
under the GDC, what should you be able to assess for orthodontically?
- normal and abnormal facial growth
- developmental or acquired occlusal abnormalities
- identify and explain the principles of interceptive treatment
- explain the range of ortho treatment options - impact, outcome, limitations and risks
what are the aims of interceptive orthodontics?
- 3 maintains
- 1 prevention
- 2 minimisations
- maintain the centreline
- maintain class I incisor relationship
- maintain vertical and transverse relationship
- eliminate any crossbites
- prevent trauma
- minimise crowding
- minimise bullying from teeth
what is asked in the history?
MH
SH
DH
- pt perception of problem
- any habits
- growth status
- the pts motivation for tx
what are the 3 planes of assessment, describe each and other clinical assessments EO and IO
- anteroposterior (profile)
- EO - class I,II,III relationship
- IO - incisal classification, canine and molar relationships, any anterior crossbites - vertical
- EO - facial thirds, angle of lower border of mandible to maxilla
- IO - OB, AOB, LOB - transverse
- EO - facial symmetry
- IO - C/L , posterior crossbites
EO
- smile aesthetics
- soft tissues and TMJ
IO
- teeth present, crowing/spacing
- tooth quality
- perio health
when is interceptive orthodontics undertaken?
- failed/delayed eruption - no teeth
- crossbites
- trauma to permanent teeth
- poor prognosis teeth
- severe skeletal patterns that can be changed with tx
give examples of failed/unerupted teeth cases
- impacted first molars
- unerupted central incisors
- infra-occluded first molars
- unerupted upper canine
failed eruption - impacted first molars
- epidemiology
- aetiology
- further issues
- management
epidemiology - M>F
aetiologies can be multifactorial
- genetic
- increased eruption angle
- increased m-d width
- crowding in the posterior maxilla
issues
- caries in the 6s
- caries in the E’s
- root resorption of the E
- space loss if the E is lost
management
- reversible - 90% will correct itself by age 7
- may be irreversible - assess if E is viable, if so, disimpact the 6 by placing separator between E and 6
- if E = non-viable, may need to distalise the 6 once erupted
failed eruption - unerupted central incisors
- epidemiology
- aetiology
- management
epidemiology
- rare
- M>F
aetiology
- developmental - supernumeraries
- genetic - holoprosencephaly
- environmental - dilaceration (bend in the root)
management
- create space and give time for eruption
- may attach gold chain to tooth to bring it down
failed eruption - infra occluded deciduous teeth
- epidemiology
- aetiologies
- why is intervention required
rare
aetiology
- genetic
- disturbed local metabolism
- gaps in periodontal membrane
- local mechanical trauma
- local infection
intervention is required to prevent:
- tipping of adjacent teeth
- space loss
- displacement of successor tooth
- over eruption of tooth in opposing
- periodontal problems
- alveolar ridge defects
- caries
- gingival hyperplasia
how is the severity of a infra-occluded primary molar classified into mild, moderate and severe?
mild
- occlusal surface = 1mm below expected occlusal plane
mod
- occlusal surface = level with the contact point
severe
- occlusal surface = level or below interproximal gingival tissue
how are infra-occluded primary molars managed?
depends on:
- severity
- presence of successor
- the prognosis of the primary molar
- if there is any malocclusion
if it is mild - monitor
if it is moderate and there IS a successor - monitor
if it is mod, no successor and no malocclusion- monitor
if it is severe and there is or isn’t a permanent successor - orthodontic referral
failed eruption - unerupted upper canine
- investigation and warning signs
- aetiologies
- management
investigations:
- palpate the canine bulge at 9 years old
- if not palpable by age 10, must investigate further
- warning signs - prolonged retention of C, lack of palpable canine, loss of vitality in U2/1s
aetiologies
- long path of eruption
- delayed exfoliation of UC
- small/absent 2s
- presence of supernumeraries
- crowding
- polygenic inheritence
management
1. no active tx and monitor
- may have root resorption or cyst formation problems
2. interceptive tx - extract UC
3. surgical exposure and ortho alignment
4. surgical repositioning
5. extraction
crossbite
- types
- aetiologies
- management
- when is tx carried out early?
types
- anterior and posterior
- anterior - the bottom teeth sit forward to the top
aetiologies
- local causes
- skeletal
- soft tissues
- trauma
management
- removal appliance
- quadhelix
- 2x4 appliance - fixed appliance
tx is carried out early to:
- eliminate displacement
- preserve the permanent dentition
- prevent periodontal breakdown/wear
if a deciduous tooth has poor prognosis
- what are the aetiologies
- what problems may they cause
- how are they managed
aetiologies
- caries or trauma
problems
- change the centreline shift
- create pre-existing crowding
management
- depends on age, existing space rqts, tooth type
whats the management of the contralateral teeth if these deciduous teeth are extracted?
A or B
- Xla has minimal effect on the midline
- contralateral teeth don’t require tx
C
- balance and extract contralateral
D
- spaced arch - no tx
- crowded arch - balance and extract contralateral
E
- no tx
C always, D sometimes, E never
if a first permanent molar has poor prognosis…
- whats the aetiologies
- what problem may it cause?
aetiologies
- caries or molar-incisor hypomineralisation
problems
- spacing
- occlusal interference
- anchorage concerns - first molar is needed for braces
- alveolar defect
- tipping of teeth
if you’re extracting a first permanent molar, what criteria meets the best occlusal results and what would be recommend?
best occlusal results
- pt is aged 8-10
- after eruption of lateral incisor and before eruption of second permanent molar
- pt has class I occlusion
- all permanent teeth are present - can be in the radiograph
- minimal crowding
if taking out a mandibular first molar, it is recommended to balance and take out the maxillary first molar as it may overerupt
- seek orthodontic opinion
what is the management of early loss of the maxillary central incisor?
immediate intervention
- reimplantation - to maintain the space - can have further prosthesis
- if needs to be extracted
- need a space maintainer/premolar/orthodontic space closure
long term management
- denture, bridge or implant
why may a space maintainer be provided following an extraction
to reduce the length of following tx and makes it less complex
what severe skeletal pattens may a pt have that may require tx?
class II malocclusion
class II occlusion
- aetiologies
- management
aetiologies
- skeletal, soft tissues or habits - thumb sucking
management
- trauma limitation
- psycho-social benefit
- digit sucking dissuasion
digit sucking
- what effect does it have on malocclusion
malocclusion
- depends on frequency, intensity and duration
management
- conservative - encouragement, positive reinforcement, bitter nail varnish, gloves to bed
- if habits persist - removable or fixed palatal arch with dissuader
what are the characteristic features of digit sucking?
- upper incisors = proclined
- lower incisors = retroclined
- asymmetrical anterior open bite
- narrow upper arch
- posterior cross bite
