Interceptive orthodontics Flashcards by Clelia Serra

What is the orthodontic timetable?

Primary dentition
Early-mixed dentition
Late-mixed dentition
Permanent dentition

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When is the best time for orthodontic treatment?

early permanent dentition

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What is the primary dentition, when established?

Established by 30 months
Positive overjet and overbite
Spacing normal

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When is delayed eruption important?

When contralateral side different

abnormal sequence eruption

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What are the primary dentition problems?

Delayed eruption 
Missing teeth
Supernumary teeth 
Abnormal teeth
Crowding
Overjet
Class III
Crossbite 
Caries/trauma
Habits

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Does missing primary mean will get missing permanent?

can indicate this, but not always

Affects less than 1% of population

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When are supernumerary teeth a worry?

What is the percentage that will have primary then permanent supernumerary

If causing displacement of other teeth

30-35% of patients will then get permanent

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When do abnormal teeth need treatment

When displacing the permanent tooth

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What is a fusion tooth?

2 teeth fused together - have 2 roots

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What is a germinated tooth?

One tooth, one root, looks large

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Why would you want to extract abnormal teeth?

To allow alignment of single permanent tooth

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How much spacing is needed in the primary dentition for there to be enough space in the permanent dentition?

> 6mm spacing

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If have an overjet in the primary dentition what does that mean for permanent?

Will probably be greater in the permanent dentition

Don’t do treatment at primary stage

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Are crossbites in primary usually in permanent too?

Skeletal crossbites - tend to persist

Dental crossbites - variable

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When may you want to treat crossbite?

If causing displacement between ICP and RCP

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What is the problem with trauma to the primary tooth?

Possible ankylosis
Look out for deflection of permanent successor
Get dilaceration

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What can habits cause in the primary dentition?

Anterior open bite
Unilateral crossbite
No intervention at this stage - not a problem till permanent teeth through

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What is leeway space? What does this allow?

The mesio-distal width of the C,D,E are wider than the 3,4,5 underneath
Common to have 1st molars in 1/2 unit class II, the leeway space allows the molars to drift mesially into class I

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What is the leeway space in the lower and upper arch?

Lower = 2.5mm
Upper = 1.5mm

What is the size discrepancy between primary and permanent incisors?

Upper 7mm greater when permanent
Lower 5mm greater
Permanent also more proclined to give more space
Lower, mandible grows to create space

If have delayed eruption what do you need to check?

No trauma
Dilacerated incisor
Most common cause midline = supernumerary teeth that needs to be removed

How would you treat an erupted mesiodens?

Extract and align

How would you treat an unerupted supernumerary mesiodens preventing incisors from erupting?

Need to remove via surgery XGA

What is a supplemental tooth? How do you treat it?

Looks exactly the same as the tooth next to it

Extract as most are poorly formed or displaced

If have premature loss of a C and D what can this cause

Shift in centreline to the side that had C or D removed

What happens if have premature loss of E?

Mesial movement of 6's, uses up the space needed for the 5's Space loss greater and faster in the upper arch In the upper arch, mesial movement/rotation of 6's results in the 5's being excluded palatally

What needs to be dont if extract a C and D to prevent loss of centreline

balance the extraction

Why don't you balance the loss of E's?

Disrupts occlusion | Can be unpredictable effect and doesn't change the centre line

Would you compensate in the primary dentition?

No, if 6's then would compensate

What are the problems with space maintainers?

Patient's are often unsuitable for appliances Must fit immediately Often unnecessary

What are the causes of a midline diastema in the early-mixed dentition stage?

Normal - ugly ducklin stage 21/12 distally inclines because of the position of the canine crowns Supernumerary tooth Generalised spacing Proclined upper incisors: Class II div I from digit sucking Trauma Pathology

What would you do if have an increased overjet in the early mixed dentition?

No advantage to treatment in the mixed dentition | Decide whether to treat now or wait - may want to treat early if lips are really incompetent

How could crowding be treated in the early mixed dentition? (not actually done)

Transverse expansion in lower arch relapses | Extract primary teeth -B's or C's but this just moves the crowding to premolar area

What are the indications for extraction of primary canines?

``` Permit local incisors to align Allow incisor to be moved over the bite Potentially to improve the position of palatally displaced permanent canines Severe upper and lower crowding Upper laterals palatal/impacted ```

How would you treat posterior crossbite in the early mixed dentition?

Consider treating early if have mandibular displacement on closure Correct with URA

How would you correct the posterior crossbite

URA: Midline screw Adam's cribs on 6's 0.7mm diameter SS (retention and anchorage) Acrylic baseplate (anchorage)

In the early mixed dentition what should be done about habit?

Educate patient and parents cessation of the habit

What can be done if patient has class III in early mixed dentition?

URA Suitable for some class III aged 8-10 years old Refer to an orthodontic specialist Screw to expand the upper arch, wear for 14 hours a day

What are the problems faced in the late mixed dentition

``` Missing teeth Infraoccluded teeth Crowding Poor quality 6's Ectopic canines Habits ```

What needs to be done if have infraoccluded teeth?

Monitor then extract under LA

What can be done if have ectopic canines in the late mixed dentition?

Refer at time of diagnosis Screen every year old patient for palpation of maxillary canines buccally and radiographs Refer to orthodontist if evidence of ectopic position

What is the effect of habits in the late mixed dentition?

Proclined upper incisors Anterior open bite Unilateral posterior cross-bite Increased overjet

When can you get better spontaneous correction of occlusion with digit sucking?

when stop before 8 years old

What removable appliance can be used for patients that digit suck?

Hayrake passive removable appliance - for correction of anterior openbite wear 3 months full-time and 3 months night time only It works by getting in the way every time patient tries to suck thumb

If have an overjet in late mixed dentition what can be done to treat?

Funcitonal appliances best during adolescent growth spurt 11-13 years need something to put crib on - 4's

What are the problems with adult treatment?

Lack of growth Multilated dentition determining extraction patterns, reduced perio support for retention, perio disease Co-operation can be difficult - ability to attend Different expectations Can't have any active disease, no bleeding on probing, more uncomfortable