Interceptive Orthodontics Flashcards
Early mixed dentition problems
Delayed eruption Early loss First permanent molars Median diastema Increased overjet Crowding Anterior cross bite Posterior cross bite Habits Class III
Early loss of incisor
Little effect
Premature loss of C
Results in shift in centre line to extraction side
Premature loss of D
Shift of lower centre line to side of loss
Consider BALANCING
Premature loss of E
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
Premature loss of primary teeth
Balance extractions
Compensating extractions
Space maintenance
Balancing
taking tooth out in opposite side of same arch to alleviate centre line shift
Compensating
Taking out tooth in opposite arch to alleviate over eruption
ONLY temporary
DO NOT COMPENSATE IN PRIMARY
Space maintainers
Two types
Problems
Fixed
Removable
Often unsuitable for appliances
Must fit immediately
Often unnecessary
First permanent molars
Guidelines for extraction
Certain time
Impacted - common in upper arch e.g against E
Options are disimpact or extract E
Median diastema
Causes
‘Ugly duckling’ - distally inclined due to canine crown position
Supernumerary
Generalised Spacing
Proclined upper incisors - thumb sucking
Trauma
Cysts
Increased overjet in MD
No advantage to treating earlier
Crowding in MD
Extract primary teeth?
Transverse expansion in lower arch relapses
Anterior cross bite in MD
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
Posterior cross bite in MD
Consider treating early - mandibular displacement on closure? - indicates lateral displacement of occlusion
Use URA, palatal screw, adam’s cribs
Habits in MD
Educate patient and parents and advise cessation of digit sucking or bottle sucking
Class III in MD
Facemask suitable for some SKIII patients aged 8-10 years
Indications for C extraction
Permit laterals to align
Allow incisor to be moved over the bite
Potentially improving position of palatally displaced permanent canines
Missing teeth in late mixed dentition
Use OPTs to observe eruption
Consider bridges/implants in future
Infra occluded teeth in LMD
Most exfoliate before becoming an issue
Crowding in LMD
Wait until permanent dentition has erupted
Poor quality 6s in LMD
AGI
Not generally good patients for extensive ortho treatment
Ectopic canine in LMD
Urgent referral
Palpate in all 9-10 year olds
Maybe worth removing C is not resorbing
Habits in LMD
Effects of digit sucking Proclined upper incisors Anterior open bite Unilateral posterior cross bite Increased overjet
Habit breaking appliances are useful
Increased overjet in LMD
Better to wait until 4s are through - anchor for crib
Problems with adult treatment
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
