Interceptive Orthodontics

Question 1

Early mixed dentition problems

Answer 1

Delayed eruption 
Early loss
First permanent molars
Median diastema 
Increased overjet 
Crowding 
Anterior cross bite 
Posterior cross bite
Habits
Class III

Question 2

Early loss of incisor

Answer 2

Little effect

Question 3

Premature loss of C

Answer 3

Results in shift in centre line to extraction side

Question 4

Premature loss of D

Answer 4

Shift of lower centre line to side of loss

Consider BALANCING

Question 5

Premature loss of E

Answer 5

Upper - upper first molar drifts forwards and use up space needed for 5
mesial movement/rotation of first permanent molars
Space loss greater and faster in upper arch
5s may be excluded palatally

disrupts occlusion - DO NOT BALANCE

Question 6

Premature loss of primary teeth

Answer 6

Balance extractions
Compensating extractions
Space maintenance

Question 7

Balancing

Answer 7

taking tooth out in opposite side of same arch to alleviate centre line shift

Question 8

Compensating

Answer 8

Taking out tooth in opposite arch to alleviate over eruption

ONLY temporary
DO NOT COMPENSATE IN PRIMARY

Question 9

Space maintainers

Two types

Problems

Answer 9

Fixed
Removable

Often unsuitable for appliances
Must fit immediately
Often unnecessary

Question 10

First permanent molars

Answer 10

Guidelines for extraction
Certain time
Impacted - common in upper arch e.g against E
Options are disimpact or extract E

Question 11

Median diastema

Causes

Answer 11

‘Ugly duckling’ - distally inclined due to canine crown position

Supernumerary

Generalised Spacing

Proclined upper incisors - thumb sucking

Trauma

Cysts

Question 12

Increased overjet in MD

Answer 12

No advantage to treating earlier

Question 13

Crowding in MD

Answer 13

Extract primary teeth?

Transverse expansion in lower arch relapses

Question 14

Anterior cross bite in MD

Answer 14

All primary canines extracted
Upper laterals erupt
Lower laterals align
Crowding may transfer to buccal segments therefore no room for 3s

Use 2x4 FA
OR

URA - frees up occlusion for mastication

Question 15

Posterior cross bite in MD

Answer 15

Consider treating early - mandibular displacement on closure? - indicates lateral displacement of occlusion

Use URA, palatal screw, adam’s cribs

Question 16

Habits in MD

Answer 16

Educate patient and parents and advise cessation of digit sucking or bottle sucking

Question 17

Class III in MD

Answer 17

Facemask suitable for some SKIII patients aged 8-10 years

Question 18

Indications for C extraction

Answer 18

Permit laterals to align
Allow incisor to be moved over the bite
Potentially improving position of palatally displaced permanent canines

Question 19

Missing teeth in late mixed dentition

Answer 19

Use OPTs to observe eruption

Consider bridges/implants in future

Question 20

Infra occluded teeth in LMD

Answer 20

Most exfoliate before becoming an issue

Question 21

Crowding in LMD

Answer 21

Wait until permanent dentition has erupted

Question 22

Poor quality 6s in LMD

Answer 22

AGI

Not generally good patients for extensive ortho treatment

Question 23

Ectopic canine in LMD

Answer 23

Urgent referral
Palpate in all 9-10 year olds
Maybe worth removing C is not resorbing

Question 24

Habits in LMD

Answer 24

Effects of digit sucking 
Proclined upper incisors
Anterior open bite
Unilateral posterior cross bite
Increased overjet 

Habit breaking appliances are useful

Question 25

Increased overjet in LMD

Answer 25

Better to wait until 4s are through - anchor for crib

Question 26

Problems with adult treatment

Answer 26

Lack of growth - slower but also predictable Mutilated dentition determine extraction patterns (some teeth need extraction not the ones you need), reduced periodontal support, perio disease Permanent retention required Different expectations Co-operation more difficult