Interceptive treatment Flashcards
What is interception?
Early identification and management of potential problems
Avoidance of a worse malocclusion
Early appliance treatment
Normal development of the primary dentition?
Established by 30 months
Positive overjet and overbite
Spacing normal
Primary dentition problems?
- Delayed eruption
- Missing teeth
- Supernumery teeth
- Abnormal teeth
- Crowding
- Overjet
- Class III
- Crossbite
- Caries/trauma
- Habits
When is delayed eruption of primary teeth a problem?
Contralateral side different
Abnormal sequence of eruption
What can missing primary teeth indicate?
Missing permanents - affects less than 1% of pts
Prevalence of supernumerary teeth?
30-35% of pts with primary supernumary will have a permanent one
How to treat geminated primary teeth?
Consider extracting early to allow alignment of single permanent tooth
How many mms of spacing is needed in primary dentition?
> 6mm
What can primary overjets indicate?
Overjet greater in permanent dentition - just observe primary overjet
How to manage primary class III?
Observe
What tends to persist?
Skeletal crossbites
How to manage caries/trauma to primary incisors?
Trauma to primary incisor = possible ankylosis, look out for deflection of permanent successor
What can habits e.g. thumb sucking cause?
Anterior open bite
Unilateral posterior crossbite
How do 6s often erupt?
Into half unit class II - corrects to class I in time with the leeway space
How much larger are permanent incisors compared to lower incisors?
Upper arch - 7mm greater
Lower arch - 5mm greater
Permanents more proclined, inter-canine width growth
What is the most common cause of delayed eruption?
Supernumerary teeth
How to manage erupted mesiodens?
Extract and align teeth
How to manage unerupted supernumery?
XGA supernumery
How to manage supplemental teeth?
Usually extract most displaced or poorly formed teeth
If a tooth is lost early, what should you think about?
Centre lines e.g. premature loss of C = shift of centre line to extraction side
Solve by balancing loss of primary canine
Balancing extractions
Compensating extractions
Space maintenance
When can occur in crowded cases when the LLD is lost early?
Lower centre line shift to left
Premature loss of ULE results in?
Mesial movement 1st permanent molars
Space loss greater and faster in upper arch
Do NOT balance as disrupts occlusion
How to maintain space?
Fixed and removable appliances
Problems with space maintainers?
Pts unsuitable for appliances
Must fit immediately
Often unnecessary
Options with impacted 1st permanent molars?
Disimpact UR6
Extract E
What causes a median diastema?
Normal - ugly duckling stage (= 21/12 distally inclined due to position of canine crowns, upper midline diastema)
Supernumerary tooth
Generalised spacing
Proclined upper incisors - class II div 1, digit sucking
Trauma
Pathology (cysts, tumours)
Indications for XLA of primary canines?
• Permit lateral 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
When anterior crowding: • All primary canines extracted • Upper laterals erupted, lower laterals spontaneously align • Crowding transferred to buccal segments (no space for 3s)
When to treat an anterior crossbite? Posterior crossbite of 6s?
Anterior crossbite = Early
Posterior crossbite of 6s = early (look for mandibular displacement on closure)
How to correct a posterior crossbite?
Adams cribs on 6s
0.7mm diameter stainless steel
(retention and anchorage)
Midline screw
Acrylic baseplate
(anchorage)
How to manage mixed dentition digit sucking?
Educate patient and parents and
advice cessation of habit
When to refer class III skeletal pts to ortho?
When pt 8-10 yrs old
How to manage missing teeth in the late mixed dentition?
Monitor/ refer to hospital for treatment plan
jointly with Paediatrics/ Restorative
(multi-disciplinary care)
How to manage infraoccluded teeth in the late mixed dentition?
Monitor then extract under LA
Problems in the late mixed dentition?
Missing teeth • Infraoccluded teeth • Crowding • Poor quality 6s • Ectopic canines • Habits • Increased overjet
How to manage poor quality 6s in the late mixed dentition?
If poor prognosis = refer to ortho for opinion on extraction timing
How to manage ectopic canines in the late mixed dentition?
Refer at time of diagnosis
What to do when the pt is 9 years old?
Screen for palpation of maxillary canines buccally
- radiographs
Refer to ortho if ectopic
Effects of digit sucking?
Proclined upper incisors
Anterior open bite
Unilateral posterior crossbite
Increased overjet
Habit breaking appliances?
Better spontaneous correction if stops before 8 yrs old Passive removable appliance: - 3 months full time - 3 months nights only - Hayrake (for correction of AOB)
How to manage increased overjet in the late mixed dentition?
Refer to ortho - mixed appliance in growth spurt:
11-13yrs old
Problems with adult treatment?
Lack of growth – treatment slower
• Mutilated dentition determining extraction
patterns, reduced periodontal support,
periodontal disease…
• Co-operation can be more difficult – ability to
attend/ willingness to participate
•Different expectations
