Review Lecture 1. Review- Lecture 2

Transcription

1 Ortho Part III: Management of the Developing Occlusion- Problems We Commonly Face & How to Solve Them Paul K. Chu, DDS St. Barnabas Hospital 02 DEC 2010 Review- Lecture 1 Convert % to milligrams F ion (SnF)? So a 0.4% SnF 2 gel (GelKam) has how much mg fluoride per ml? Step 1- convert to F ion. *** % SnF 2 x 0.25 = %F ion*** 0.4% x 0.25 = 0.1 % F- ion Step 2- Convert % F- ion to ppm ***%F ion x 10 4 = ppm F*** 0.1% x 10 4 = 1000 ppm F ion Review Lecture 1 Step 3 Convert ppm F ion to mg/ml *** ppm = mg/l *** 1000 ppm F ion = 1000 mg/l We want denominator to be ml, so with stoichiometry 1000 mg X 1 L = 1 mg/ml L 1000mL Review- Lecture 2 Tanaka- Johnson Analysis Maxillary: add??? to Mn incisal measurement= Mx buccal segment requirements Mandibular: add??? to Mn incisal= Mn buccal segment requirements *Remember Moyers! Review- Lecture 2 Mx: SUM Mn incisal measurement then DIVIDE BY 2 then add 11.5mm to get MAXILLARY buccal segment requirements Mn: SUM Mn incisal measurement then DIVIDE BY 2 add 10.5 mm to get MANDIBULAR buccal segment requirements 1

2 Review- FMIA IMPA FMIA = (62) Angle between Frankfurt Horizontal and long axis of lower incisor. IMPA = (93) Angle between long axis of lower incisor and Mandibular Plane. Management of Developing Occlusion Review--- FMA = (22 +/ - 3) Angíe between Frankfurt Horizontal and Mandibular Plane 1. Parents have questions 2. Will ask you about the opinions of different Orthodontists they ve visited 3. Orthodontic emergencies 4. They don t want to leave your practice 5. On your Board Exams (written & oral)!!!! Ngan, Yen, et. Al (1998) Pediatric dentistry has increasingly shifted from a conservative restorative approach toward a concept of total pediatric dental care. Thus, all aspects of oral health care including diagnosis, prevention, oral medicine, restoration, and correction of are increasingly the responsibility of the pediatric dentist. What is this called?? The space difference between the C-D-E & suceedaneous is called? Children who had a premature loss of one or more canines or molars more commonly received orthodontic treatment 3 times more likely to receive orthodontic therapy versus group with no loss Miyamoto (1976) 2

3 Factors influencing development of Abnormal oral musculature Oral habits Existing Stage of occlusal development Factors influencing develoment of Abnormal oral musculature + = Factors influencing develoment of Oral habits (Thumb/Tongue/Bruxism) = Thumb Sucking- non Nutritive sucking Considered normal up to 2 yrs of age- but most children DON T develop habit Class II skeletal occurs with digit sucking 21.5% during ages 3-4; 41.9% age 12!! ( Popovich, Thompson [1973]) Appliance MAIN indication: when child wants to discontinue task Thumb Sucking- non Nutritive sucking negative reinforcement? Anxiety caused by nagging and punishment often creates GREATER tension and intensifies ifi habit Appliances DON T STOP- they just remind. Bluegrass Thumb Appliance Factors influencing development of 3

4 Tongue Habits Profit says this is incorrectly called tongue thrust i.e. TT, deviate swallow, visceral swallow, or infantile swallow There is a high prevalence of anterior tongue position in children Problems habit causes: open bite; incisor protrusion; lisping Tongue Habits Everyone Swallow NOW Where is your tongue? What is happening to your mandible? Tongue Habits Lips relaxed; tongue against lingual of max incis; elevator muscles raise mandible to allow contact of molars In infants- strong lip activity it to seize nipple; tongue tip against lower lip below nipple; elevator muscles relaxed to keep jaw open This develops over time to our normal adult swallow pattern Tongue Habits Best methods of treatment Demonstrate correct swallowing (tongue on incisive papilla when swallowing) Pt stands in front of mirror w/ cup of water and sips and swallows whiles smiling Mint leaf- pt holds mint leaf on incisive papilla with tip of tounge..saliva forms while leaf is melting and pt needs to swallow saliva Bruxism AAPD Guidelines 2010: Habitual, nonfunctional, and forceful contact between occlusal surfaces, can occur while awake or asleep Redding, Rubright, & Zimmerman report 15% of all children showed some degree of bruxism Etiology is multifactorial and has been reported to include central factors (eg, emotional stress, parasomnias, traumatic brain injury, neurologic disabilities) and morphologic factors (eg,, muscle recruitment). (Ramjford) occlusal interference + nervous tension-> eval occlusion 1 st ->may need occlusal adjustment! Bite Plate fabrication to allow eruption of molars Bruxism Bruxism management ranges from patient/parent education, occlusal splints, and psychological techniques to medications. (AAPD Guidelines) Bite Plate Allows worn molars to supra erupt Can fabricate plate to allow for incisors to erupt as well! 4

5 Factors influencing develoment of Factors influencing development of Existing Malocclusion Existing Malocclusion- crowding in the primary dentition has an influence on permanent crowding Distal Mesial Distal Mesial PERCENTAGES: Relation of primary 2 nd molar relation to permanent molar occlusion* 56% Class I; 44% Class II (1mm) 76% CI; 23% CII; 1% CIII ( 2mm) 68% CI; 13%CII; 19%CIII Factors influencing develoment of Stage of occlusal development IN GENERAL- more space loss is likely to occur if teeth are ACTIVELY erupting adjacent to the space left by the premature loss of a primary tooth Class II % *Bishara, et. Al- Facial & Dental Changes in Adolescents & Their Clinical Implications (2000) Factors to Consider When Thinking of Space Maintenance Factors to Consider When Thinking of Space Maintenance Time Elapsed Space Loss Dental Age of Patient Amount of Bone Covering Unerupted Tooth Sequence of Eruption of Teeth Delayed Eruption of Primary Tooth Congenital Absence of Primary Tooth 5

6 Factors to Consider When Thinking of Space Maintenance Time Elapsed Space Loss Most space closure occurs w/in the first 6 mos after extraction Insert appliance asap Factors to Consider When Thinking of Space Maintenance Dental Age of Patient According to Gron emergence of permanent teeth based on root development e e Usually when 2/3 of root is developed Loss of a primary molar <7 YO = delayed succedaneous eruption; after 7 YO= early emergence Amount of Bone Covering Unerupted Tooth Root development not accurate if bone covering developing tooth is destroyed by infection- accelerated If bone IS covering crown- then may be months before eruption will be seen- good to put a space maintainer * erupting premolars require 4-5 months to move through 1 mm of bone!* Factors to Consider When Thinking of Space Maintenance Sequence of Eruption of Teeth Know when the teeth are erupting next to lost tooth Premature loss of 1 st primary molar= distalization of canines leading to midline shift and possibly deeper overbite ***What happens when you place a B&L around a lower E extending to canine? When does the C exfoliate?** 6

7 Factors to Consider When Thinking of Space Maintenance Delayed Eruption of Permanent Teeth Many teeth are delayed in development & eruption Some are partially impacted or altered path Tx: extract primary place space maintainer- allowing tooth to erupt Factors to Consider When Thinking of Space Maintenance Congenital Absence of Permanent Teeth Do we hold space? Do we close space? 7

8 SCENARIOS For the 1 st & 2 nd primary molar & primary canine area Loss of 2 nd Primary molar before eruption of permanent molar For the primary & permanent incisor area Loss of the 1 st permanent molar PRIOR to eruption of 2 nd permanent molar Loss of the 1 st permanent molar AFTER eruption of 2 nd permanent molar For the 1 st & 2 nd primary molar & primary canine area Band & Loop (or crown & loop) Loss of 1 st Prim molars= anterior effects; 2 nd st permanent molar effects 1 st nd = Space Maintenance for 1 st & 2 nd Primary Molar Band & Loop OR Crown & Loop B&L good for loss of E or D Use when primary laterals l in place Place an anterior projection on loop over abutment tooth- so loop doesn t slip into gingiva Space Maintenance for Primary Canine Loss Use spurs on LLHA if 1 st primary molars are missing to prevent distalization ti of canines Loss of 2 nd Primary molar before eruption of permanent molar Mesioangluation of 6 is a common problem Distal Shoe Removable acrylic appliance (i.e. pressure appliance) 8

9 Crown with distal shoe 1) D = P/SSC; E=EXT 2) D = prepped and pick up alginate impression- 3) Send pt home with SSC & temp-bond or durelon (i.e. temporary cements) DON T CRIMP! Crown with distal shoe Crown with distal shoe Extraction of the E and preparation for cementation Cementation Confirmation by radiograph Distal Shoe - Contraindications: extremely poor OH; blood dyscrasias; immunosuppression; congenital heart defects; rhuematic defects Implant never becomes totally lined with epithelium- is associated a chronic inflammatory response 9

10 Pressure appliance Removable/fixed acrylic appliance with distal extensions covering molar pads just MESIAL to 6 s Pressure-appliance therapy following premature loss of primary molars. ASDC J Dent Child. Carroll CE, Jones JE,1982 Sep- Oct;49(5): For the primary & permanent incisor area Some think there s no loss If no spacing exists prior to loss of incisor- most certainly loss will occur after (McDonald Avery) For the primary & permanent incisor area Fixed or Removable Lab: Fit bands; Photo; Alginate impression upper & lower arches Loss of multiple teeth Maxilla: crossbite in 1 st permanent molar area + anterior drifting of maxillary molars Reduced masticatory function- nutritional effects Acrylic Partial Denture Passive Lingual Arch Nance Loss of multiple teeth Maxilla: crossbite in 1 st permanent molar area + anterior drifting of maxillary molars Reduced masticatory function- nutritional effects Multiple tooth loss LLHA Remember- need permanent incisors!! Acrylic Partial Denture Passive Lingual Arch Nance 10

11 LLHA Archwire should rest on cingulae of incisors mm above gingival margin Solder joint should be in mid-third and parallel to band Archwire should be below plane of occlusion posteriorly Check for passivity on the model and in the mouth before cementation Archwire should be in contact with lower incisor cingulae Transpalatal Arch Rarely recommended for bilateral tooth loss in maxilla Can prevent mesio-palatal rotation of palatal root of Mx 1 st permanent molar but allows mesial tipping of molars & space loss May have an indication for use when one side of the arch is intact but several primary teeth are missing contralaterally NO SOFT TISSUE IMPINGMENT!!! Nance Arch Used commonly in maxilla for bilateral tooth loss Incorporates acrylic button in contact with palate to prevent molars from tipping Not hygenic Ensure acrylic button in firm contact with palate IMO Difficult to retain due to shearing forces of occlusion Flexure in function will de-bond Difficult to adjust My Least Favorite Crowded permanent lateral incisors / preserve leeway space/loss of leeway space Passive LLHA Passive? Active? Next time: Interceptive Orthodontics 11

12 From Lecture 3 Preview- Headgear Clockwise & Counterclockwise mandibular rotation Class II Openbite= Clockwise Class III= Counterclockwise Headgear Appliances High Pull Headgear Will deepen bite- for use in clockwise rotating patients (i.e. Class II openbite) Headgear Appliances Cervical Pull Headgear Will open bite- for use in counterclockwise rotating patients (i.e. Class III deepbite) Headgear Appliances Headgear Appliances Combi- Headgear -maximizes molar retraction while controlling molar extrusion -for Class II molars w/ favorable chin position Reverse Pull Headgear/ Facemask -for Class III Occlusion 12

13 2nd yrs will be Jan 2011 Jan: Study Pinkham/McDonald Avery Feb: Pinkham/Handbook/ Guidelines Mar: Board Reviews April: Old Study aids May: Exam + Present AAPD Meeting *Research, Jobs, Life. Orthodontic Mechanics Components Straightwire VS Edgewise Edgewise: Horizontal Slot 1) Archwire: wire used as a source of force to direct teeth to move in desired directions. 2) Headgear tube: a cylindrical tube where the headgear is attached, if prescribed. 3) Ball hook: used for attachment of elastics. 4) Elastic ligature: grey or clear elastic tie used to secure the archwire to the bracket. 5) Steel ligature: small steel wire tied to the bracket to secure the archwire to the bracket. 6) Coil spring: small spring placed around arch wire to either maintain or increase the space between teeth. 7) Elastic: rubber band used to move teeth in the prescribed direction. Straightwire: Pretorqued Slots 9)Elastic hook: hook soldered to band to serve as a place to hook your elastics to the molar teeth. Appliances- Frankel Appliances- Bionator The Frankel appliances are removable designs invented by Professor Rolf Frankel. The Frankel philosophy uses the vestibules to enhance favorable growth in developing dentition and restrict undesireable muscle forces. Research has shown Bionator treatment produced a statistically significant increase in mandibular protrusion, and in total mandibular and body lengths 13