8/6/2019 Preventative Orthodontics Handout

1/33

Preven&veOrthodon&cs

andGuidanceofErup&on

8/6/2019 Preventative Orthodontics Handout

2/33

Preven&veOrthodon&cs

Topreserveandmaintainnormalrela&onshipsinthedevelopingocclusionthrough

preven&onoforaldisease,restora&vecare,andspacemaintenance

8/6/2019 Preventative Orthodontics Handout

3/33

GuidanceofErup&on

Proceduresthatinfluenceerup&vepa

8/6/2019 Preventative Orthodontics Handout

4/33

ClinicalProceduresinSpace

SupervisionandGuidanceofErup&onPreven&veandRestora&veDen&stry:To

preservearchintegrityandoverallarch

perimeter

8/6/2019 Preventative Orthodontics Handout

5/33

SpaceMaintenance

Stabiliza&onofmolarandanteriortoothposi&onstopreservearchdimensionsand

preventsymptoma&clossofarchlengthsecondarytoprematurelossofprimaryteeth

8/6/2019 Preventative Orthodontics Handout

6/33

Disking

Reduc&onofmesio-distalprimarytoothstructuretoenhanceadjacentpermanent

toothalignmentthrough&melyuseofleewayspace

8/6/2019 Preventative Orthodontics Handout

7/33

Selec&veExtrac&onofPrimaryTeeth

Extensionofdiskingconceptsinthe&melyremovalofprimaryteethtoenhance

permanenttootherup&onandalignmentposi&oning

8/6/2019 Preventative Orthodontics Handout

8/33

8/6/2019 Preventative Orthodontics Handout

9/33

Recogni&onandCorrec&onofDental

Anomalies Iden&fica&onandelimina&onofanomaliesandtheireffectsonthedevelopingocclusion

toincludesupernumeraryteeth,missingteeth,toothsize/shapeanomalies,ankylosis,

pathologiclesions,etc.

8/6/2019 Preventative Orthodontics Handout

10/33

Intercep&veOrthodon&cs

Recogni&onofdevelopingmalocclusionfactorsandimplementa&onoftreatment

procedurestoeliminateorminimizetheireffectsonthefinalocclusion

8/6/2019 Preventative Orthodontics Handout

11/33

PrimarySpacingasPredictorfor

CrowdingintheMixedDen&&on

36mmofspacingintheprimaryden&&on Notransi&onal

crowding

8/6/2019 Preventative Orthodontics Handout

12/33

8/6/2019 Preventative Orthodontics Handout

13/33

Nospacingintheprimaryden&&on

50%willdevelopincisorcrowding

8/6/2019 Preventative Orthodontics Handout

14/33

Crowdedprimaryden&&on

100%willdevelopcrowdedincisors

8/6/2019 Preventative Orthodontics Handout

15/33

MolarTerminalPlaneRela&onships

8/6/2019 Preventative Orthodontics Handout

16/33

MolarTerminalPlaneRela&onships

Mesialstepusually=classI

molarrela&onship

Flushterminalplane majority

=classI

Distalstep=classIImolarrela&onship

8/6/2019 Preventative Orthodontics Handout

17/33

CanineRela&onship(anevenbe

8/6/2019 Preventative Orthodontics Handout

18/33

IdealPrimaryDen&&onOcclusion

FlushterminalplaneormesialstepmolarwithclassIcanines

Generalizedspacingincludingprimatespaces Overjet2mm Overbite2mm,or30%

8/6/2019 Preventative Orthodontics Handout

19/33

8/6/2019 Preventative Orthodontics Handout

20/33

DentalAnteriorCrossBite

Maxillaryincisorslinguallyposi&onedinrela&ontomandibularincisorsincentric

occlusion. Maybeduetooverretainedprimarycentralincisorsormaybeduetooverretainedprimarylateralincisorsthis

wouldindicateanarchsizeproblem Afunc&onalorskeletaldiscrepancymayalsoleadtoananteriorcrossbite

8/6/2019 Preventative Orthodontics Handout

21/33

8/6/2019 Preventative Orthodontics Handout

22/33

SpaceMaintenance

Aerprematurelossofsecondprimarymolar

Regardlessof&mingofloss,spacemaintenanceisalwaysindicated.

Withoutthesecondprimarymolarsthemaxillaryfirstmolarwillmoveforwardbodilyandrotatearoundthepalatalroot,

lowermolarswill&plinguallyandmesially

8/6/2019 Preventative Orthodontics Handout

23/33

8/6/2019 Preventative Orthodontics Handout

24/33

PrematureLossofAnteriorPrimaryTeeth

Spacelossisunlikely,solongastheprimarycaninesareeruptedinto

occlusion

Replacementifprimaryincisorsiselec&veonlyandisonlyrecommended

forcosme&csnotspacemaintenance

8/6/2019 Preventative Orthodontics Handout

25/33

LeewaySpace

Thedifferencebetweenthemesiodistalwidthsoftheprimarycanine,firstandsecond

primarymolarsandthepermanentcanine,

firstandsecondpremolars

8/6/2019 Preventative Orthodontics Handout

26/33

MandibularIncisorCrowding

Diskingoftheprimarycanine12mmcanallowforsomeincisoralignment.

Diskthemesialtoprovideasluicewayforalignmenttakingadvantageoftheleewayspace.

Mustgosubgingivaltofreethecontacts Indicatedwith34mmofcrowding

8/6/2019 Preventative Orthodontics Handout

27/33

MandibularIncisorCrowding

4mmorgreaterofcrowding Oenthefirststepinserialextrac&on Mustplacelowerlingualholdingarchtopreventcollapseoftheincisorsandarch

lengthloss

8/6/2019 Preventative Orthodontics Handout

28/33

CongenitallyMissingPermanentTeeth

Incidenceofmissingpermanentteethisabout4%withnogenderdifferences

Affectstwoormoreteethinabouthalfofcases

Mostfrequentarelowersecondbicuspids,

upperlateralincisors,anduppersecond

8/6/2019 Preventative Orthodontics Handout

29/33

SupernumeraryTeeth

3.6%ofchildren 10&mesmorefrequentlyinmaxillathanmandible;boystwiceasoenasgirls

8/6/2019 Preventative Orthodontics Handout

30/33

Mesiodens

80%single,20%twoormore. Morethan90%arelinguallyorpalatallymalposi&oned

Approximately3of4remainuneruptedandneedsurgicalremoval

Canberesponsiblefordelayederup&onofpermanentteeth,over-reten&onofprimary

teeth,displacedteeth,diastemas,abnormalrootresorp&on,follicularorden&gerouscysts,andresultantmalocclusion

8/6/2019 Preventative Orthodontics Handout

31/33

Impac&onofPermanentmaxillary

Canines Incidencebetween2%

to4%ofpopula&on

1/3locatedlabiallyorcentrallyinarch

2/3locatedpalatally Earlydetec&onis

importanttoprevent

rootresorp&onoftheadjacentpermanent

teeth(incidenceof50%)

8/6/2019 Preventative Orthodontics Handout

32/33

RecommendedTreatment

Extrac&onofprimarycanine Resultsshow78%ofpermanentcaninesreverttoanormalerup&onpa

8/6/2019 Preventative Orthodontics Handout

33/33

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