XLAs in Orthodontics Flashcards
List 3 reasons why you may have to extract primary incisors
- If they are retained and affect the eruption pathway of the permanent incisors
- If the teeth have experienced trauma and have a poor prognosis
- If the teeth are highly carious
What is the most common reason to extract a primary canine in the maxillary arch?
To aid the eruption of permanent canines
What can be done to aid the positioning of an ectopic permanent tooth yet to erupt?
Elective extraction of corresponding primary teeth
What are some detrimental effects that can occur from the loss of primary teeth? (4)
- Crowding
- Ectopic/Impacted eruption
- Unfavourable molar relationships
- Centre-line shifts
What are balancing extractions?
Why are they carried out?
- A balancing extraction is a tooth from the opposite side of the same arch
- Designed to minimise centreline shift
What are compensating extractions?
Why are they carried out?
- Compensation means extraction of a tooth from the opposing quadrant to the enforced extraction.
- Designed to minimise occlusal interferance by allowing teeth to maintain occlusal relationships as they drift
Is a balancing or compensation loss necessary for an early loss of primary incisors?
Not necessary to balance or compensate for loss of a primary incisor
Is a balancing or compensation loss necessary for an early loss of 1st primary molars or canines?
Balancing extraction may be needed in a crowded arch
Compensation is not needed
Is a balancing or compensation XLA necessary for an early loss of primary 2nd molar?
Balancing isnt necessary as will not affect the midline
Compensation may be necessary esepcially in a crowded dentition
What can be used to maintain arch length and width as well as preservation of leeway space?
Space maintainers
What are the functions of space maintainers (4)
- Maintain arch length, and width- preservation of leeway space
- Prevent over-eruption of opposing teeth
- Improve aesthetics (anterior segment)
- Aid in the management of oral habits (prevention of digit sucking)
Describe an ideal space maintainer
- Simple
- Durable, strong and stable
- Passive and not causing orthodontic changes to other teeth
- Cleansable and not increasing the risk for caries development
What type of space maintainers are these?
Unilateral Space Maintainer
What are the specific names of these unilateral space maintainers?
A) Band and Loop
B) Band and Loop
C) Distal Shoe
What is the type and name of this space maintainer?
Type: Fixed Bilateral
Name: Lingual Arch
What is the type and name of this space maintainer?
Type: Fixed Bilateral
Name: Nance Palatal Arch
What is the type and name of this space maintainer?
Type: Removable Bilateral
Name: Upper removable appliance
What may be an indication of a lower lingual arch space maintainer?
Loss of several posterior teeth and lower first permanent molars (6s) have erupted
If a patient has poor OH and need a space maintainer for the upper arch what should be used?
Upper removable appliance
When determining the consequences of premature primary tooth loss what are the 3 key factors to consider?
- Degree of crowding
- Type of tooth loss
- Age of the child
When making a decision to extract a tooth for orthodontic treatment what should be considered? (4)
- Degree and site of crowding
- Type of malocclusion
- Presence and position of teeth
- Dental health of teeth
A paeds patient has a grossly carious lower 6 which you will XLA.
You decide the opposing 6 should also be extracted. How would you justify this to the patient/parent to gain their consent?
Explain that whilst the opposing 6 is healthy, there are benefits to it being removed
* If it is not removed, it will over erupt and lead to occlusal disturbances. It will prevent the forward moment of the lower 7 which you want to take place of the 6. This can lead to a localised space
* If the opposing tooth is not extracted then you will loose the class 1 molar relationship. This will disturb the inter arch relationship
* Explain that maxillary spaces are closed more rapidly. The 7 will drift and close the space
* Explain that the 8 is radiographically present. In most patients, 8s are non-functional and are removed due to the arch being too short to accommodate them. However, with the 6 being removed and the 7 drifting forward, the 8 can therefore make up for the lack of teeth in a few years time
* Removing the 6 may also provide relief of buccal crowding
