Interceptive XLA Of Primary Flashcards
What are the reasons for doing interceptive extractions on primary teeth?
Guide/ permit eruptions of permanent successors Encourages space closure in hypodontia Reduce localised gingival recession Preserve symmetry and molar relationship Impacted 6's
What are interceptive extractions?
Extractions undertaken to minimise or eliminate the severity of the developing malocclusion or elk ate a potentially harmful occlusion befor damage occurs
When would we consider interceptive extra hind to guide eruption of ectopic teeth?
Unerupted upper central Palatally positioned upper lateral Lingually positioned lower Ectopic canine Submergence
What is the diff dx for an unerupted central?
Trauma: Periapical granulmoa or ankylosed, dilacerstion,
Supernumerary
Dentigerous cyst
Developmentally absent
Where do 2/2 erupt relative to 1/1?
Palatally and they will remain Palatal if too crowded
What interceptive actions are there for palatally erupting 2/2?
If very Palatal then xla c/c and b’s if present as the 2/2 being to erupt and before reaching occlusal level
How do you manage lingually positioned incisor?
If the predecessor is still there xla primary’s
What is the affect of crowding on canine?
This severely and adversely affects the outcome of extractions of C’s therefore need to maintain the space
Power and short 1993
What are submerged teeth?
When the baby teeth fail to meet or maintain the occlusal relationship with adjacent and opposing teeth
What are the causes ?
Primary teeth are not continuously resorbed but they go through phases of resorption and repair if there is a temporary period where resorption predominates then this can lead to Submergence
What is the prevelence of submerge teeth?
9%
Where are submerged teeth more commonly seen?
Mandible
According to who, what happens to the submerged tooth if the permanet is present?
Kurol and thilander 1984
It is usually shed
T/F submerged teeth usually occur when the permanent is absent?
T
But can occasionally occur in situations where the permanent tooth is present and thus it stops the permanent tooth from erupting
What are the treatment options for submerged teeth?
Extarct tooth if
No permanent
Severe eg approaching gingival level
Adjacent tooth tips over the tooth
Or could consider build up with onlay
Which teeth are most commonly absent?
8 upper 2 Lower 5 Upper 5 1
When would you extract baby teeth to promote space closure in hypodontia?
When upper 2 and 5 missing
When there is missing upper laterals what could you do?
Extarct b and c early and encourage good contac between 1 and 3
If missing lower 5 what could you do?
Consult orthodontist
Consider early xla of e if crowding present
What teeth could you consider extractions of there if redession?
Consider extracting C’s if crowding is quite bad and there is localised recession on one of the lower incisors and the soft tissue will move incisors to neutral zone
In a crowded case , what can happen when the permanent lower incisor is erupting?
This can resorb the root of the c and this can be lost prematurely and therefor need to balance with the other c to preserve the centre line
What us balancing?
Extraction of the a tooth on the opposite side of the arch to minimise and correct centre line discrepancy
Which tooth would you balance with ?
A tooth of dubious quality if there is one
If all teeth are sound then xla c since it is nearest the midline and most likely tone affective
Every time you detract a tooth you need to balance. T/F
F
Only need to do one balancing extraction
What is the purpose of compensation ?
This is the extraction of the same tooth in the opposite side of the arch and this preserve buccal segment relationships and prevents over eruption of the opposing teeth
When does over eruption apply when compensating?
Only applies for the permanent teeth
What are the factors affecting the outcome following deciduous extractions?
- The tooth to be extracted: further from the midline the less effect on CL but more on molar relationships
2 crowding: if there is no crowding then no space will be lost and therefor do not need to compensate or balance - Timing: closer to the eruption of the permanent tooth the less the effect of loosing tooth early
What percentage of 6s are ectopic? Ref
3-4% Kennedy 1987
In which arch are ectopic teeth more commonly seen in?
Maxilla
What is the association with ectopic 6’s and family?
There is a familial link on 20% of cases
Which group of patients are impacted 6’s more common in?
CLP
What happens with impacted 6’s?
66% Are self correcting
What should you do in cases with impacted 6’s?
Leave e is asymmptomatic otherwise extract e
