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Orthodontics > Interceptive Orthodontics > Flashcards

Interceptive Orthodontics Flashcards

1
Q

Interceptive treatment

A
  • Any treatment procedure which eliminates or reduce severity of developing malocclusion
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2
Q

Interceptive treatment success percentage

A
  • Fully corrected 15%
  • improved 49 %
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3
Q

Main aim for Interceptive treatment

A
  • Maintain midline
  • Prevent development of full unit class 2 molar
  • Minimise crowding
  • Prevent trauma
  • Psychological factor
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4
Q

Management of developing dentition

A
  • Calcification dates
  • Eruption dates
  • Transition from primary to permanent dentition
  • development of dental arches
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5
Q

Transition from primary to permanent dentition

A
  • Lower incisors develop and may erupt lingual to primary incisors
  • Often lower incisor crowding that will improve with inter- canine growth
  • Upper permanent incisors develop palatally to primary incisors .
  • if there is upper crowding the upper 2s may be palatally excluded
  • Physiological spacing of upper labial segment resolves as upper 3 erupts
  • Leeway space
  • Flush terminal planes of secondary primary molars E.
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6
Q

Leeway space
Leeway space of maxilla and mandible

A
  • Different in size between C,D,E and permanent 3,4 and 5
  • Maxilla 1.5mm each side
  • Mandible 2-2.5 on each side
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7
Q

Development of dental arches

A
  • Inter- Canine width: Measured across cups of canine.
    -Increased 1-2 mm during primary dentition, further 3mm in permanent dentition and growth ceases - development age of 9
  • Inter-Molar width: Measured across lingual cusps of lower Es or 5s
  • Increases 2-3mm b/w ages of 3-18 but little change after 14yrs
  • Arch circumference : Determined by measuring around buccal cusps/ Incisal edges of teeth.
  • little change in maxilla from primary dentition, Lower reduces by ~4mm due to Leeway space.
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8
Q

Issue may occur in mixed dentition

A
  • Early loss of primary teeth e.g trauma, caries, permature exfoliation.
  • Impacted first permanent molars (6s)
  • Submerged primary molar
  • Dilaceration
  • Supernumerary teeth
  • Unerupted maxillary incisor
  • Crossbite (anterior/ posterior)
  • Digit habits
  • Early loss of 6s (caries, hypoplasia)
  • Ectopic canines
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9
Q

Early loss of primary teeth e.g Trauma, caries, premature exfoliation

A
  • Crowded case - may result in neighbouring teeth drifting into space.
  • This will depend on degree of crowding, patient age and location
  • Less likely to occur in spaced arches
  • Effect is greater in maxilla
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10
Q

1- Early loss of deciduous teeth- Effect

A
  • Primary incisors (a,b)- little effect- shed early
  • Primary canine (C)- Unilateral early loss in crowded mouth - shift central line
  • Primary First molar(D): Unilateral early loss - Central line shift + affect molar relationship+ crowding
  • Primary second Molar(E): Unilateral early loss - Forward drift of 6 - Space loss for 5.
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11
Q

Interceptive solutions of early loss

A
  • Balancing extraction - Extraction of same tooth on other side
  • Space maintenance - early loss of E to prevent drift of 6 and loss space for the 5
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12
Q

Space maintainers

A
  • Best space maintainer is tooth itself.
  • GDP - Restoration / stainless steel crown
  • URA
  • Band and loop space maintainer
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13
Q

Which arch has more space after shedding primary teeth ? Why?

A
  • lower arch because bigger teeth than upper
  • Lower 6’s move forward and aim to Class I molar relationship.
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14
Q

What happened if lose Es early?

A
  • 5s will erupt palatally
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15
Q

How can GDP prevent loss of Es ?

A
  • By Hall technique
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16
Q

Dis advantage of space maintainer

A
  • Cost
  • Compliance
  • High risk of caries pt
  • Can loose 6’s if caries risk is high
  • Dilaceration (kinky root) (can cause by trauma and development )
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17
Q

2- Other reasons for interceptive extraction of primary teeth

A
  • To guide/ allow the eruption of permanent successors. E.g. Late mixed dentition - lower 1-1 palatally erupt because of Lower As.
  • To encourage space closure in hypodontia.E.g. Consider interceptive extraction of UCBs to encourage 3-1/1-3 contact.
  • To reduce gingival recessions.
    E.g. Interceptive extractions of lower Cs if significant crowding is present and pronounced gingival recession of lower incisor.Soft tissue move incisors into neutral zone. Crowding relieved in incisor region but transferred to canine region.
  • Impacted 6’s do not resolve spontaneously.
    *Impaction of 6s against distal aspect of the E.
    *More common in maxilla.
    *2/3 of cases self correct.
    *Spontaneous correction is less likely after age of 8.
  • Interception - Disimpaction using seperstion (Elastomeric/brasswire) .
  • Extraction of resorbed E+/- distalisation of upper 6 with URA / sectional fixed appliance
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18
Q

3- Submerged / infra occluded primary molars

A
  • Exfoliation of primary teeth occurs due to process of resorption and repair. Resorption using winning out

-In 8-14% of children there is temporary predominance of repair - leading to temporary ankylosis

  • Due to growth of surrounding bone and teeth the affected molar appears to sink down or become submerged.
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19
Q

Submerged / infra-Occluded primary molars Solution? Interceptive

A
  • Removal of submerged molar may be considered if:
    -Occlusal surface of molar is lies at or below contact point of adjacent teeth
  • Root formation of successor tooth is almost complete
  • Successor tooth is absent - depending on condition of primary tooth
20
Q

4- Dilaceration

A
  • Distortion or bend in the crown or root of tooth - often in failure of eruption.
  • Cause- Developmental- more often affect a single central incisor - crown often turned upwards and labially

Cause- Trauma - Intrusion of primary incisor causes displacement of underlying tooth germ- causes displacement of crown / root and possible disruption to the developing enamel / dentine leading to hypoplasia.

Management: Depending on severity - either surgical removal or exposure attempt orthodontic alignment.

21
Q

5- Supernumerary Teeth

A
  • A tooth additional to the normal series
  • Occur 1% of primary and 1% of permanent dentition
22
Q

Types of Supernumerary teeth

A
  • Supplemental - Resemble a tooth - usually last series 2,5,8
  • Conical - Peg shaped, often erupts between upper central incisors.
  • Tuberculate- barrel shaped, classically associated with failure of eruption
  • Odontome- Complex or compound
23
Q

Supernumerary teeth - effect & management

A
  • Failure of eruption
  • Displacement of adjacent tooth
  • Crowding
  • No effect
24
Q

Supernumerary teeth- Failure of eruption

A
  • Surgical removal of supernumerary +/- bond the untrusted tooth . ENSURE there is sufficient space for unerupted tooth. Observe +/- apply orthodontic traction (URA or FA)
25
Q

Supernumerary teeth - Displacement of adjacent tooth

A
  • Removal of supernumerary tooth
    Align displaced tooth orthodontically
26
Q

Supernumerary tooth- Crowding

A
  • Usually due to supplemental type - Remove and align other teeth orthodontically
27
Q

Supernumerary- No effect

A
  • Incidental finding and if position would not interfere with orthodontic tooth movement it can be left and monitored
28
Q

6- Unerupted maxillary incisor define , Cause and Incidence ?

A
  • Eruption of contra lateral tooth > 6/12
  • Lower erupted >1 year but no sign of uppers
  • Deviation from normal sequence of eruption

Causes-
Hereditary: supernumerary tooth, cleft lip/ palate, gingival firbromatosis (gingival really tough)

Environmental: Trauma (retained primary tooth/ dilacerated permanent incisor), Early loss, Space loss, Cyst.

Incidence:
- 0.13% in 5-12 yr old
- 2.6% in referred population

29
Q

7- Crossbite - Anterior cause

A
  • Presentation - Upper incisors occluding in cross bite with lower incisors (Class 3 relationship with negative OJ)
  • Often associated with forward mandibular displacement
30
Q

Anterior crossbite - Indication for interceptive treatment

A
  • Labial enamel wear to upper incisor
  • Labial gingival recession +/- mobility of lower incisor
  • Possible TMD
31
Q

What is Interceptive correction to procline incisor/s in anterior crossbite ?

A
  • Removable appliance : Adam’s Cribs 4s/6s or double crib 6/E . Southend clasps, C clasps
    Active- Z spring or screw palatal to incisor (s) in crossbite
    Baseplate: Posterior bite planes to open anterior occlusion to permit proclination of upper incisor.
  • Upper 2x4 Fixed appliance : Bond upper 6-21/12-6 - using push coil to Procline upper incisors.
32
Q

Interceptive correction of posterior crossbite

A

Upper removable appliance:

Retention: Adam’s crib 4s/6s or double crib 6/E.

Active: Screw- Midline or sectioned baseplate to expand specific teeth

Baseplate : posterior bite planes to open occlusion to prevent interdigitation which could prevent upper expansion.

33
Q

8- Digit Habits

A
  • Considered normal in babies and young children due to natural nutritive sucking instinct.
  • This tend to reduce after 6 months as babies are weaned
  • Digit sucking may continue providing comfort for the child.
34
Q

Prevalence of Digit/ dummy sucking.

A

-At 15 months 63.2% of children had sucking habit
37.6% comforter/ dummy
22.8 digit

  • At 36 months . Non- Nutritive sucking had reduced to 40%.
35
Q

Dental effects of Digit habit?

A
  • Proclination of maxillary incisors
  • Retroclination of mandibular incisors
  • Reduced overbite or anterior open bite (which is often asymmetric)
  • Posterior crossbite ( Often unilateral and associated with mandibular displacement)
  • These effects are varied and dependent on: The position of the digit duration of habit.
36
Q

When to stop Habbit? How ?

A
  • Before eruption of permanent incisors - before 6years
  • Behavioural - Rewarding child for not exercising the habit
  • Mechanical - preventing or interrupting the process of thumb sucking e.g. sock on hand , boxing gloves.
  • Aversive - generating negative sensations when the habit is exercised, such as bad taste or discomfort (bad taste nail varnish)
37
Q

Aversive orthodontic options to stop habbit?

A
  • Upper removable appliance
  • Functional appliance
  • Hayrake appliance
  • Blue grass roller
38
Q

9- Early loss of 6s

A
  • 6s are never the first choice for extraction in orthodontics as they don’t provide space anteriorly where we usually need it for relief of crowding or Overjet reduction and can complicate anchorage provision .

However, for children where the 6s have poor long-term considerations of removal of affected tooth at the appropriate time to encourage spontaneous space closure with eruption of second molar 7 into the place of first molar 6

39
Q

Aetiology of 6s poor prognosis?

A
  • Caries (6s are the most caries prone tooth in the permanent dentition because of morphology and early eruption in oral cavity
  • Molar incisor hypomineralisation
40
Q

Molar incisor Hypomineralisation (MIH)

A
  • MIH is tooth condition where the enamel is softer than normal
  • This can lead to dental decay or crumbly tooth
  • It is usually noticed when adult incisors or molars erupt
  • MIH can affect 1, some or all 6s and permanent incisors.
  • There are different levels of severity
  • 1 in 8 children in UK have MIH.
  • ## Aetiology not fully known. Could be Disturbance in tooth development around the time of birth or in first few years of life. Severe childhood illness, high fever or traumatic birth period .
41
Q

MIH signs and symptoms

A
  • The affected teeth may be discoloured and may appear cream, yellow or brown
  • The teeth may be sensitive to temperature / sweet foods
  • Because enamel is softer, these teeth are more at risk of caries sometimes,
    It can be more difficult to anaesthetise the tooth with local anaesthetic.
42
Q

MIH management- Incisors

A
  • Flouride varnish- to decrease sensitivity
  • Micro-abrasion- to remove the outer layer of tooth enamel to improve the appearance.
  • Resin infiltrant This improves the appearance of teeth by altering how light reflects off the teeth.
  • Tooth whitening - to improve the colour of the tooth. This can cause temporary sensitivity. Tooth whitening is not routinely used in under 18 years old but may be provided in certain circumstances.
  • Composite veneers
43
Q

MIH Management - Molars

A
  • Tx depends on level of severity,
  • Fluoride varnish to help decrease sensitivity
  • Fissure sealant
  • GIC/ composite restoration
  • Preformed metal crown- to protect a more decayed or broken down tooth
  • Tooth removal - In molar with more than 2 surface breakdown if it’s done at right time . The 7s (unaffected by MIH) can take place of 6s. If orthodontic treatment might be required in future, a decision about best timing of the extractions can be made in conjunction with orthodontist.
44
Q

Inceptive extraction of 6s of poor prognosis - ideal case for optimal space closure

A
  • Presence of all permanent teeth (including 8)
  • Dental age ~ 9yrs old
  • Class 1 occlusion
  • Crowding present in premolar region
  • ln lower arch : -Bifurcatjon of 7 has just formed. Crypt of the 7 overlaps the root of 6
  • In upper arch: 7 is usually distally tipped and moves mesially to produce good space closure .
45
Q

Balancing / compensating extractions

A
  • Ideal Class 1 case
  • If lower 6 is to be extracted- Usually consider COMPENSATING extraction to prevent upper 6 over erupting and stopping forward movement and eruption of 7
  • If upper 6 is to be extracted - don’t usually consider a compensating extraction as space closure is less predictable in the lower arch due to density of mandibular bone and position of lower 7.
  • If anterior space will be required e.g significant anterior crowding, increased OJ, Class 3 cases where retroclination of LLS may be required or provision of URA - Extraction of 6s may be delayed
46
Q

10- Ectopic canine

A
  • Extraction of upper c in children aged 10-13 years in uncrowned mouths increase chance of normalisation of ectopic upper 3.
  • Improvement in Upper 3 position should be noted in 9/12 months following extraction of upper c

Orthodontics (45 decks)

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