Interceptive treatment

Question 1

What is interception?

Answer 1

Early identification and management of potential problems
Avoidance of a worse malocclusion
Early appliance treatment

Question 2

Normal development of the primary dentition?

Answer 2

Established by 30 months
Positive overjet and overbite
Spacing normal

Question 3

Primary dentition problems?

Answer 3

• Delayed eruption
• Missing teeth
• Supernumery teeth
• Abnormal teeth
• Crowding
• Overjet
• Class III
• Crossbite
• Caries/trauma
• Habits

Question 4

When is delayed eruption of primary teeth a problem?

Answer 4

Contralateral side different

Abnormal sequence of eruption

Question 5

What can missing primary teeth indicate?

Answer 5

Missing permanents - affects less than 1% of pts

Question 6

Prevalence of supernumerary teeth?

Answer 6

30-35% of pts with primary supernumary will have a permanent one

Question 7

How to treat geminated primary teeth?

Answer 7

Consider extracting early to allow alignment of single permanent tooth

Question 8

How many mms of spacing is needed in primary dentition?

Answer 8

> 6mm

Question 9

What can primary overjets indicate?

Answer 9

Overjet greater in permanent dentition - just observe primary overjet

Question 10

How to manage primary class III?

Answer 10

Observe

Question 11

What tends to persist?

Answer 11

Skeletal crossbites

Question 12

How to manage caries/trauma to primary incisors?

Answer 12

Trauma to primary incisor = possible ankylosis, look out for deflection of permanent successor

Question 13

What can habits e.g. thumb sucking cause?

Answer 13

Anterior open bite

Unilateral posterior crossbite

Question 14

How do 6s often erupt?

Answer 14

Into half unit class II - corrects to class I in time with the leeway space

Question 15

How much larger are permanent incisors compared to lower incisors?

Answer 15

Upper arch - 7mm greater
Lower arch - 5mm greater
Permanents more proclined, inter-canine width growth

Question 16

What is the most common cause of delayed eruption?

Answer 16

Supernumerary teeth

Question 17

How to manage erupted mesiodens?

Answer 17

Extract and align teeth

Question 18

How to manage unerupted supernumery?

Answer 18

XGA supernumery

Question 19

How to manage supplemental teeth?

Answer 19

Usually extract most displaced or poorly formed teeth

Question 20

If a tooth is lost early, what should you think about?

Answer 20

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

Question 21

When can occur in crowded cases when the LLD is lost early?

Answer 21

Lower centre line shift to left

Question 22

Premature loss of ULE results in?

Answer 22

Mesial movement 1st permanent molars
Space loss greater and faster in upper arch
Do NOT balance as disrupts occlusion

Question 23

How to maintain space?

Answer 23

Fixed and removable appliances

Question 24

Problems with space maintainers?

Answer 24

Pts unsuitable for appliances
Must fit immediately
Often unnecessary

Question 25

Options with impacted 1st permanent molars?

Answer 25

Disimpact UR6 | Extract E

Question 26

What causes a median diastema?

Answer 26

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)

Question 27

Indications for XLA of primary canines?

Answer 27

• 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) ```

Question 28

When to treat an anterior crossbite? Posterior crossbite of 6s?

Answer 28

Anterior crossbite = Early | Posterior crossbite of 6s = early (look for mandibular displacement on closure)

Question 29

How to correct a posterior crossbite?

Answer 29

Adams cribs on 6s 0.7mm diameter stainless steel (retention and anchorage) Midline screw Acrylic baseplate (anchorage)

Question 30

How to manage mixed dentition digit sucking?

Answer 30

Educate patient and parents and | advice cessation of habit

Question 31

When to refer class III skeletal pts to ortho?

Answer 31

When pt 8-10 yrs old

Question 32

How to manage missing teeth in the late mixed dentition?

Answer 32

Monitor/ refer to hospital for treatment plan jointly with Paediatrics/ Restorative (multi-disciplinary care)

Question 33

How to manage infraoccluded teeth in the late mixed dentition?

Answer 33

Monitor then extract under LA

Question 34

Problems in the late mixed dentition?

Answer 34

``` Missing teeth • Infraoccluded teeth • Crowding • Poor quality 6s • Ectopic canines • Habits • Increased overjet ```

Question 35

How to manage poor quality 6s in the late mixed dentition?

Answer 35

If poor prognosis = refer to ortho for opinion on extraction timing

Question 36

How to manage ectopic canines in the late mixed dentition?

Answer 36

Refer at time of diagnosis

Question 37

What to do when the pt is 9 years old?

Answer 37

Screen for palpation of maxillary canines buccally - radiographs Refer to ortho if ectopic

Question 38

Effects of digit sucking?

Answer 38

Proclined upper incisors Anterior open bite Unilateral posterior crossbite Increased overjet

Question 39

Habit breaking appliances?

Answer 39

``` 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) ```

Question 40

How to manage increased overjet in the late mixed dentition?

Answer 40

Refer to ortho - mixed appliance in growth spurt: | 11-13yrs old

Question 41

Problems with adult treatment?

Answer 41

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