NO SMILE LEFT BEHIND :

Transcription

1 NO SMILE LEFT BEHIND : EMPOWERING FAMILIES AND THEIR PROVIDERS WITH A ROADMAP FOR SUCCESS HEATHER HENDRICKS, DDS, MSO CRANIOFACIAL, CLEFT, AND SURGICAL ORTHODONTIST ATTENDING; PLASTIC SURGERY AND ORTHODONTIC CLINIC, CHILDREN S MERCY HOSPITALKCMO ADJUNCT ASSISTANT PROFESSOR- UMKC

2 CONTRIBUTIONS OF CLEIDOCRANIAL DYSPLASIA (CCD) SPECTRUM DISORDER ON THE TEETH AND FACE Slow exfoliation of primary teeth 2nd molars may erupt very early (with primary teeth) High or cleft palate Multiple extra teeth (supernumerary) Delayed, but spontaneous eruption of 1st and 2nd molars Impacted, unerupting permanent teeth

3 CONTRIBUTIONS OF CLEIDOCRANIAL DYSPLASIA (CCD) SPECTRUM DISORDER ON THE TEETH AND FACE Altered dentition and enamel hypoplasia Spacing in lower incisor area Obstructive Sleep Apnea (OSA) Anterior open bite CIII tendency (underbite) *Spectrum= range of how much CCD affects you *

4 MULTIPLE APPROACHES, ONE GOAL Different protocols, developed in different locations Toronto-Melbourne Belfast-Hamburg Jerusalem * Bronx Variations= Timing, Passive v. Active, Staging

5 MY CURRENT PROTOCOL Evidence-based adaptation of Jerusalem approach Centered on dental age, root development, and maturity level Active eruption with fixed appliances Stage treatment into 3 Phases

6 ALL I WANT ARE MY TWO FRONT TEETH! Incisors and 1st Molars Non-CCD= Age 6-9 CCD = Age 9-12 Phase 1: Eruption and alignment of upper and lower front teeth Canines and Premolars Non CCD = Age 9-12 CCD = Age Skeletal Growth Completes Non-CCD = Age CCD = Age Phase 2: Eruption and alignment of upper and lower posterior teeth Phase 3: Jaw co-ordination

7 PRE-PHASE 1: AGE 7-9 Growth Modification Maxillary expansion Reverse pull head gear Reduce CIII growth tendency

8 Early Childhood (0-5 years old)

9 SETTING THE STAGE FOR SUCCESS ESTABLISHING A DIAGNOSIS AND FINDING THE TEAM THAT FITS YOUR NEEDS

10 ANTICIPATED PRIMARY TOOTH ERUPTION TIMELINE PRIMARY (BABY) TEETH

11 SETTING THE FOUNDATION FOR THE FUTURE Normalize pediatric dental visits Healthy teeth=health kids Pediatric dentist guides family towards Orthodontist, when ready

12 Points to Remember Establish Medical and Dental Home First dental check-up when first tooth erupts, usually 6 mo. Maintain dental and overall health Familiarize child with tooth brush, flossing, dental setting, etc.

13 Mixed Dentition CHILDHOOD: 6(9)-12 YEARS OLD) THE WORK BEGINS

14 OVERALL TREATMENT GOALS Remove over-retained primary teeth Remove supernumerary teeth Erupt useable, permanent teeth Align permanent teeth Coordinate jaw relationships Functional and healthy craniofacial compelx

15 START YOUR ENGINES! Every child should obtain a panorex radiograph by age 7 Evaluate tooth position Facilitate anticipated tooth eruption pattern and timing Base treatment on dental age and root development Root at least halfway formed

16 6-9 YEARS OLD CHILDREN WITHIN THE CCD SPECTRUM OFTEN MAINTAIN MANY BABY TEETH > Lower front teeth may partially erupt, along with 1st molars < *Approximate 3-4 year delay in root development within the Spectrum*

17 9-12 YEARS OLD Lower teeth erupt before the upper teeth Molars and lower incisors partially erupt spontaneously Find Orthodontist to start the process, at least, by age 9-10

18 THE DENTAL DREAM TEAM Orthodontist obtains 3D radiograph (CT or CBCT) Orthodontist and Oral Surgeon identify permanent keeper teeth and supernumerary extras Surgeon extracts supernumerary teeth and bonds gold chain or button to permanent teeth Focus on anterior teeth, may extract extra teeth in region of canines/premolars Surgeon closes gum tissue Orthodontist delivers fixed traction appliances and begins to tease the teeth down/up to the occlusal plane

19 EXAMPLES OF FRAMEWORKS.. Plethora of options Fixed v removable Anticipate at least 8-12 months* to get teeth fully erupted Top and bottom teeth can be started at different times Hygiene is KEY Ferreira, F.M. (2016). ZHANG CY et al 2014 Bechtold TE, et al.

20 I SEE THE TOOTH, NOW WHAT? After teeth erupt close to desired level Place brackets and wires Align front teeth and retain until ready for the next step

21 TEENAGED YEARS: PHASE 2. Dental Tag-Team Evaluate to bring in the canines and premolars Utilize new fixed appliances or stiff wire for anchorage Expose and bond permanent teeth and extract any remaining supernumerary/primary teeth

22 Adulthood (Skeletal Maturity)

23 ORTHOGNATHIC SURGERY TREATMENT GOALS Coordinate all 3 dimensions of maxillomandibular relationships Produce a balanced profile Increase vertical height of the face Ensure stable, functional occlusion Provide boney support for soft tissue

24 PROSTHEDONTIC REHABILITATION Possibility of needing implants, crowns, bridges, and/or dentures Ankylosed teeth Missing teeth Completed at the end of skeletal growth

25 AT THE END OF THE DAY CCD Spectrum Disorder is NOT a condemnation of toothlessness It s a long road, but worth the results Information= Empowerment Find a good team that makes you feel comfortable Plan on starting active treatment around age 10 Remain positive and motivated!!!

26 Michael Lypka, DMD, MD Plastic/Oral Surgery Zarmina Ehsan, MD Sleep Medicine Heather Hendricks, DDS, MSO Orthodontics DENTOFACIAL CLINIC: PLASTIC/ORAL SURGERY, ORTHODONTICS, AND SLEEP MEDICINE MULTIDISCIPLINARY TEAM: ADDRESS NEEDS OF PATIENTS WITH FACIAL DIFFERENCES AND SLEEP PROBLEMS

27 HAPPY AND HEALTHY SMILES CAN BE FOUND AT CMH! 2401 GILHAM ROAD, KCMO