Download - Preventative Orthodontics Handout
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Preven&veOrthodon&cs
andGuidanceofErup&on
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Preven&veOrthodon&cs
Topreserveandmaintainnormalrela&onshipsinthedevelopingocclusionthrough
preven&onoforaldisease,restora&vecare,andspacemaintenance
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GuidanceofErup&on
Proceduresthatinfluenceerup&vepa
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ClinicalProceduresinSpace
SupervisionandGuidanceofErup&onPreven&veandRestora&veDen&stry:To
preservearchintegrityandoverallarch
perimeter
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SpaceMaintenance
Stabiliza&onofmolarandanteriortoothposi&onstopreservearchdimensionsand
preventsymptoma&clossofarchlengthsecondarytoprematurelossofprimaryteeth
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Disking
Reduc&onofmesio-distalprimarytoothstructuretoenhanceadjacentpermanent
toothalignmentthrough&melyuseofleewayspace
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Selec&veExtrac&onofPrimaryTeeth
Extensionofdiskingconceptsinthe&melyremovalofprimaryteethtoenhance
permanenttootherup&onandalignmentposi&oning
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Recogni&onandCorrec&onofDental
Anomalies Iden&fica&onandelimina&onofanomaliesandtheireffectsonthedevelopingocclusion
toincludesupernumeraryteeth,missingteeth,toothsize/shapeanomalies,ankylosis,
pathologiclesions,etc.
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Intercep&veOrthodon&cs
Recogni&onofdevelopingmalocclusionfactorsandimplementa&onoftreatment
procedurestoeliminateorminimizetheireffectsonthefinalocclusion
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PrimarySpacingasPredictorfor
CrowdingintheMixedDen&&on
36mmofspacingintheprimaryden&&on Notransi&onal
crowding
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Nospacingintheprimaryden&&on
50%willdevelopincisorcrowding
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Crowdedprimaryden&&on
100%willdevelopcrowdedincisors
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MolarTerminalPlaneRela&onships
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MolarTerminalPlaneRela&onships
Mesialstepusually=classI
molarrela&onship
Flushterminalplane majority
=classI
Distalstep=classIImolarrela&onship
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CanineRela&onship(anevenbe
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IdealPrimaryDen&&onOcclusion
FlushterminalplaneormesialstepmolarwithclassIcanines
Generalizedspacingincludingprimatespaces Overjet2mm Overbite2mm,or30%
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DentalAnteriorCrossBite
Maxillaryincisorslinguallyposi&onedinrela&ontomandibularincisorsincentric
occlusion. Maybeduetooverretainedprimarycentralincisorsormaybeduetooverretainedprimarylateralincisorsthis
wouldindicateanarchsizeproblem Afunc&onalorskeletaldiscrepancymayalsoleadtoananteriorcrossbite
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SpaceMaintenance
Aerprematurelossofsecondprimarymolar
Regardlessof&mingofloss,spacemaintenanceisalwaysindicated.
Withoutthesecondprimarymolarsthemaxillaryfirstmolarwillmoveforwardbodilyandrotatearoundthepalatalroot,
lowermolarswill&plinguallyandmesially
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PrematureLossofAnteriorPrimaryTeeth
Spacelossisunlikely,solongastheprimarycaninesareeruptedinto
occlusion
Replacementifprimaryincisorsiselec&veonlyandisonlyrecommended
forcosme&csnotspacemaintenance
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LeewaySpace
Thedifferencebetweenthemesiodistalwidthsoftheprimarycanine,firstandsecond
primarymolarsandthepermanentcanine,
firstandsecondpremolars
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MandibularIncisorCrowding
Diskingoftheprimarycanine12mmcanallowforsomeincisoralignment.
Diskthemesialtoprovideasluicewayforalignmenttakingadvantageoftheleewayspace.
Mustgosubgingivaltofreethecontacts Indicatedwith34mmofcrowding
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MandibularIncisorCrowding
4mmorgreaterofcrowding Oenthefirststepinserialextrac&on Mustplacelowerlingualholdingarchtopreventcollapseoftheincisorsandarch
lengthloss
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CongenitallyMissingPermanentTeeth
Incidenceofmissingpermanentteethisabout4%withnogenderdifferences
Affectstwoormoreteethinabouthalfofcases
Mostfrequentarelowersecondbicuspids,
upperlateralincisors,anduppersecond
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SupernumeraryTeeth
3.6%ofchildren 10&mesmorefrequentlyinmaxillathanmandible;boystwiceasoenasgirls
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Mesiodens
80%single,20%twoormore. Morethan90%arelinguallyorpalatallymalposi&oned
Approximately3of4remainuneruptedandneedsurgicalremoval
Canberesponsiblefordelayederup&onofpermanentteeth,over-reten&onofprimary
teeth,displacedteeth,diastemas,abnormalrootresorp&on,follicularorden&gerouscysts,andresultantmalocclusion
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Impac&onofPermanentmaxillary
Canines Incidencebetween2%
to4%ofpopula&on
1/3locatedlabiallyorcentrallyinarch
2/3locatedpalatally Earlydetec&onis
importanttoprevent
rootresorp&onoftheadjacentpermanent
teeth(incidenceof50%)
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RecommendedTreatment
Extrac&onofprimarycanine Resultsshow78%ofpermanentcaninesreverttoanormalerup&onpa
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EctopicPermanentCanines
Purpose:Tocomparetheeffectsofextrac&onofprimarymaxillarycanines
andfirstmolars(doubleextrac&onapproach)vsprimarymaxillarycanines
extrac&on(singleextrac&onapproach)incasesofectopicpermanentmaxillarycanines
Conclusions:Thedoubleextrac&onapproachprovedtobeamoreeffec&ve
procedurevsthesingleextrac&onapproachinimprovingpermanent
maxillarycanines'intraosseousposi&on.
DoublevsSinglePrimaryTeethExtrac&onApproachasPreven&onofPermanentMaxillaryCaninesEctopicErup&on,Giulio
AB,SerenaIP,Ma