Overview of Phase I Treatment and Growth Modification Flashcards
What are the three main outcomes after a first ortho checkup
- No treatment
- Regular monitoring
- Early treatment: Phase I treatment
What is the definition and features of Phase I treatment
Early or interceptive orthodontic treatment in the mixed dentition
- Limited orthodontic goals
- Limited duration
- Retention may be required
- Patient may require a second round of orthodontic treatment at a later age (permanent dentition) - Phase II
Why do some patients require Phase I treatment?
- Some problems can worsen if left untreated
- Some results may not be achievable once the face and jaws have stopped growing or if teeth have erupted
Hence, with Phase I
Phase II treatment may be less complicated and shorter
What are the general objectives of Phase I treatment?
- Guide skeletal growth
- Provide adequate space for/Guide eruption of permanent teeth
- Correct habits
- Eliminate presence/risk of trauma to oral tissues
- Improve function: Incision, Mastication. Speech
- Improve facial harmony and dental aesthetics
What are some considerations prior to Phase I treatment?
1.Patient compliance/motivation
2. Effectiveness (severity, problem type)
- Undesirable side effects (eg. too old)
2. Effects on phase II treatment
3. Overall treatment fees
4. Duration of treatment (Burnout)
5. Duration of Retention (Burnout)
At what age should reverse-pull headgear/facemask (for maxillary retrusion) be implemented?
8-10
Why do some clinicians use bone anchored maxillary protraction (connected to mini screws)?
To reduce dental effects
What is the success rate of pull reverse headgear/facemask?
255% revert back to negative OJ due to excess mandibular growth
Why is early intervention in SK class III beneficial?
- Greater orthopedic change in a shorter duration
- Earlier functional improvement
- Facial and dental aesthetics
- Avoid sequelae of anterior crossbite:
Gingival recession labial to lower incisors
Incisal wear - Psychosocial benefits (vs wearing in teenage years)
- Better patient compliance
At what age should Chincup (for mandibular prognathia) be implemented?
Under 7
What is the success rate of Chincup? and Why?
Not good :(
Small transitory improvement
- ++ force magnitude and duration
- prolonged duration of wear required
- mandibular growth is difficult to control
Continued use until growth completion may be effective
When should intervention for SK Class II be done?
- Before adolescent growth spurt is effective (75%) but no adv to during growth spurt
Only done if there are specific indications
What are the indications for SK Class II Phase I treatment?
- Risk of dental trauma
- OJ >8mm
- activity of the child - Deep overbite with soft tissue trauma
- palatal of upper
- buccal of lower - Psychosocial concerns
- Facial aesthetics
What are the appliances used in intervention for skeletal Class II patients
- Headgear - to hold max growth back + distalising effect on molars
- Removable biteplate
- Functional appliances
- Removable (Twin-block)
- Fixed (Herbst, MARA) -> non-complance dependent
At what age should constricted maxilla be intervened?
ASAP
Esp if:
1. Shift on closure
2. Constriction severe enough to reduce space within arch
With increasing age: mid palatal suture more interdigitated (dental>skeletal effects) - too late = tipping of teeth
What are the appliances used in intervention for maxillary expansions and what are the cons
Removable expander
Cons:
- Dislodges easily
- Complaince-dependent
Quadhelix or W-arch (younger pts)
- less force
Hyrax expander (Adolescents)
Cons: heavy force with rigid jackscrew
What are the benefits of correcting skeletal crossbites earlt?
- Eliminate functional shift
- Increase arch perimeter
- Achieve dentoalveolar symmetry
- Reduce attrition of teeth
- Simplify future treatment
- Avoid surgical expansion
- Avoid gingival recession
When should functional shifts be corrected?
ASAP
What are the different methods of intervention for functional shifts?
Aetiology dependent
1. Localised interference
a: Primary canines/teeth: careful equilibration (minor discrepancies)
b. Displaced tooth: removable or partial fixed appliance
2. Constricted maxilla: Skeletal expansion
3. Maxilla retrusion: Facemask therapy
Why is early correction of functional shifts important?
- To prevent adaptive remodeling - a true skeletal mandibular asymmetry or prognathia can develop
- Later correction of skeletal discrepancies may require surgery
- Dental asymmetry may result from dentoalveolar compensation during growth and eruption
- Teeth in traumatic occlusion may become mobile over time or develop gingival recession
What are the indications for early intervention for increased overjet?
- Increased risk for dental trauma
- psychosocial concerns
What are the appliances used to fix increased overjet
Dependent on etiology
1. Dental: fixed appliances
2. Skeletal or for anchorage (to retract incisors): Cervical-pull headgear
What are the indications for early intervention for deep overbite?
Dental/soft tissue trauma
Why should deep overbites not be resolved till pubertal spurt or early permanent dentition unless trauma is present?
Increase teeth for anchorage
What is the treatment for over-eruption of anteriors
2x4
2: Posterior units
4: Ant brackets
Difficult as there can be reciprocal eruption of anteriors