Interceptive orthodontics Flashcards
what is interceptive orthodontics?
any tx which eliminates or reduces the severity of a developing malocclusion
it should eliminate or simplify the need for future tx
list the 7 aims of interceptive orthodontics
what sorts of questions should we ask in the history
During clinical examination what 3 planes are we assessing?
- AP
- Vertical
- transverse
In EOE, what are we looking for in AP ?
class 1 2 or 3
In EOE, what are we looking for vertically?
facial thirds
angle of lower border of mandible to maxilla
in EOE, what are we looking for transversely ?
facial symmetry
what else can we look for EOly
smile aesthetics
TMJ
soft tissues
In IOE, what are we looking for APly?
incisal classification
Overjet
canine guidance
molar relationship
anterior cross bite
in IOE, what are we looking for vertically ?
over bite
anterior over bite
lack of over bite
in IOE, what re we looking for transversely?
- posterior cross bite
- centre lines
in IOE, that else can we look out for>?
teeth present
crowding
spacing
perio health
tooth quality
when is interceptive orthodontics undertaken?
what problems come under failure/ delayed eruption ?
- impacted first permanent molars
- unerupted central incisors
- infra occluded deciduous teeth
- unerrupted upper canine
when do we see first permanent molars coming through?
5-6 yrs
what is the incidence of impacted first permanent molars ?
4.3%
M>F
what is the aetiology of impacted first permanent molars ?
multifactorial :
1. Increased m-d width of 6
2. Increased eruption angle of 6
3. Crowding posterior maxilla
4. Genetic eg. cleft lip and palate
what are the potential problems with impacted first permanent molars ?
- Caries of second deciduous molar tooth and first
permanent molar tooth - Root resorption of second deciduous molar tooth
- Space loss if the second deciduous molar tooth is
lost early
what is the management of impacted first permanent molars?
- Reversible
* 90% will self correct by 7yrs 100% self
correct by 8yrs - Irreversible - need interceptive tx
- Whether the E is viable
* Disimpact by placing separator/brass wire = place on Distal of E an medial aspect of 6
* Distalise 6 with URA
* If non viable xla E and distalise 6 once erupted
when do upper permanent central incisors erupt?
7-8 yrs
what is the incidence of an unerupted upper central incisor?
0.13%
M:F 2.7:1
What is the aetiology of unerupted upper central incisors?
1.Developmental - supernumeraries
2.Genetic - Holoprosencephaly
3.Environmental – previous trauma causing dilaceration
what is the management for unerupted upper centra incisors ?
*Remove cause of impaction/create space
*?Give time for eruption in younger patients – if
having intervention(removing supernumeraries) usually attach gold chain on unerupted tooth
* May need active intervention in older patients
what is the incidence of infraoccluded deciduous teeth ?
1-9%
what is the aetiology of infraoccluded deciduous teeth?
1.Genetic
2.Disturbed local metabolism
3.Gaps in the periodontal membrane
4.Local mechanical trauma
5.Local infection
in infra occluded deciduous teeth, intervention is required to prevent what ? (8)
- Tipping of adjacent teeth
- Periodontal problems
- Alveolar ridge defects due to growth restriction
- Space loss
- Displacement of developing successor teeth
- Overeruption of teeth in the opposing arch
- Caries
- Gingival hyperplasia
what can infroccluded deciduous teeth be described as
mild
mod
severe
define mild infraocclued?
occluded surface 1mm below the expected occlusal plane for the tooth
define mod infraoccluded?
occlusal surface is approx level with the contact point of one or both adjacent tooth surfaces
define severe infraoccluded ?
occlusal surfaces are level with or below the inter proximal gingival tissue of or both adjacent tooth surfaces
what will management of infraoccluded teeth be dependant on?
- Severity
- Presence of permanent
- Prognosis of primary
- Malocclusion
At 9 yrs what should we palpate for?
canines
incidence of impacted upper canine?
2% impacted (61%palatal,in line of arch 34%,
buccal 5%)
0.08% developmentally absen
describe the initial management of unerupted upper canines ?
Initial management
Clinical examination at 9yrs
Palpate for canine bulge buccally
If not palpable by 10yrs investigate further
describe the aetiologies of an unerupted upper canine ?
1.Long path of eruption
2.Delayed exfoliation of the deciduous canine
3.Small/developmentally absent 2s
4.Polygenic inheritance
5.Presence of supernumeraries;
6.Crowding
describe the clinical signs of an unerupted upper canine?
1.Visual inspection of the canine bulge
2.Palpation
3.Prolonged retention of C
4.Loss of vitality U2/1
what types of radiographs can we take to investigate an unerupted upper canine ?
1.Horizontal parallax – 2 periapicals (20o tube shift)
2.Vertical parallax - Anterior occlusal (70–75°) and
OPT/ PA
3.CBCT
what is the management of an unerrupted upper canine ?
1.No active treatment and monitor
radiographically
Possible sequelae if left:
a)Root resorption
b)Cyst formation
2.Interceptive treatment – xla (see pic)
3.Surgical exposure and orthodontic alignment
4.Surgical repositioning
5.Extraction
incidence of cross bites?
Anterior x-bite incidence 2.2-11.9%
Posterior x-bite incidence in 1o
dentition 1-16%
aetiology of cross bites?
1.Local causes
2.Skeletal
3.Soft tissues
4.Pathology/trauma
management of cross bite ?
removable appliances
quadhelix
2 by 4 appliance
why is tx of a cross bite carried out early?
1.Eliminate displacements
2.Prevent perpetuation into permanent
dentition
3.Prevent periodontal breakdown/wear
why can deciduous teeth have poor prognosis ?
- caries
- trauma
however their problems can occur in permeant dentition causing :
- centreline shift
- localisation of pre existing crowding
what is the management of poor prog decidous teeth ?
age
existing space requirements
tooth type
what happens if we extract incisors ( AB)?
Minimal effect on midline
No interceptive treatment
what happens if we need to extract canine (C)?
balance the xls of contralateral tooth to preserve midline
what happens if we need to extract first deciduous molar(D)?
Spaced arch - no interceptive treatment
Crowded arch - balance Xla to preserve
midline
what happens if we need to extract second devious molar (E)?
no interceptive tx
what is aetiology of poor prog of first permanent molar?
caries
MIH
what are the problems with loss of first permanent molar s?
- Spacing
- Occlusal interferences
- Anchorage concerns
- Alveolar defects
- Tipping of teeth
what is the best course of tx for poor prog of first permanent molar?
- extraction
- however if we are extracting mandibuakr first molar we may need to do compensatory extraction to opposing maxillary molar
what is the best spontaneous occlusal result
- extracting at age 8-10 provides best spontaneous space closure
- extract after eruption of lateral incisors but before eruption of second permanent molar and or premolar
- class 1
- all permanent teeth present
- minimal incisor/ moderate buccal segment crowding
incidence of early loss of maxillary central incisor?
3% of children
M>F
what is the immediate intervention ?
reimplantation - to act as a space maintainer
what is the management of maxillary central incisor?
- space maintainer if lost early - reduces length of subsequent tx and complexity (need M and D stops on the prosthetic tooth to prevent drifting)
- can do premolar transplant
- orthodontic space closure
what is the long term management of early loss of maxillary central incisor ?
- denture
- bridge
- implant
*options above may require ortho tx prior to restorative work
what is the aetiology of class 2 skeletal pattern ?
- skeletal
- soft tissues
- habits (digit sucking)
what is the management of severe skeletal class 2 ?
- early tx maybe appropriate
-Early class II correction - Trauma limitation
- Pyschosocial benefits
Early class II intervention - Digit sucking dissuasion
what is the aetiology of class 2 digit sucking?
Common in the mixed dentition
12% 9yr olds
2% 12yr olds
what is the extent of the malocclusion dependant on ?
- Frequency
- Intensity
- Duration - >6hrs
what is the management for class 2 digit sucking ?
- Conservative management
- Encouragement
- Positive reinforcement
- Bitter nail varnish
- Gloves worn to bed
- If habit persists
- Removable
- Fixed palatal arch with dissuader
what are the characteristic features of class 2 digit sucking ?
- Proclination of upper incisors
- Retroclination of lower incisors
- Asymmetrical AOB
- Narrowed upper arch
- Posterior crossbite
what is the aetiology of class 3 skeletal pattern ?
skeletal
genetic
what is the management of c3 skeletal?
Early class III correction
* Reduces need for OGN surgery
