Early treatment. Interceptive orthodontics

Transcription

1 Early treatment Interceptive orthodontics

2 Early treatment Some malocclusion can be prevented or intercepted. Diphasic treatment is sometimes considered more logical and sensible. During the phase one, craniofacial sceletal growth is controlled and the morphology improves so that later tooth positioning (phase two) will be relatively easier.

3 Etiologic factors of the development of orthodontic anomalies Internal factors Heredity Embrional injuries (e.g. viral disease, hypoxia, prenatal trauma, birth injuries) Endocrine disorders External factors Systemic diseases Nutrition Nasopharyngeal diseases and disturbed respiratory function Deleterious oral habits Premature loss of primary teeth

4 Prevention General preventive activity (to avoid/influence on the deleterious internal and external factors) Space maintainers Early orthodontic treatment prevention caries parodontopathie severe orthodontic anomalies

5 Early treatment (advantages) Treatment is easier in some cases. Early orthopedic control of sceletal morphology in some cases is easier than a later correction of the craniofacial sceleton. Alternative methods are available for treating patients at a young age. When patient is young, etiologic factors might be removed. The orthodontist can utilize growth better in the young, and there is more grows available.

6 Early treatment (disadvantages) Diphasic treatment may lengthen the treatment time. When treatment time is lengthened, patient cooperation may be wrong (mixed dentition, permanent dentition) Improper early treatment can be harmful. Nor will it help to start the treatment early, if you don t have exact diagnosis and proper treatment plan.

7 Anomalies needing early treatment Numerical anomalies of teeth Missing teeth Accessory teeth Diastema medianum (midline space) Gross discrepancy problems (size of teeth and dental arches) Dental crossbite Angle II/1 Angle III Open bite Deep bite Cleft lip and palate

8 Numerical anomalies of teeth Missing teeth Accessory teeth Diastema medianum (midline space) Gross discrepancy problems Dental crossbite Angle II/1 Angle III Open bite Deep bite Cleft lip and palate

9 Numerical anomalies of teeth Missing teeth Accessory teeth Diastema medianum Gross discrepancy problems Dental crossbite Angle II/1 Angle III Open bite Deep bite Cleft lip and palate

10 Numerical anomalies of teeth Missing teeth Accessory teeth Diastema medianum Gross discrepancy problems Dental crossbite Angle II/1 Angle III Open bite Deep bite Cleft lip and palate

11 Numerical anomalies of teeth Missing teeth Accessory teeth Diastema medianum Gross discrepancy problems Dental crossbite Angle II/1 Angle III Open bite Deep bite Cleft lip and palate

12 Numerical anomalies of teeth Missing teeth Accessory teeth Diastema medianum Gross discrepancy problems Dental crossbite Angle II/1 Angle III Open bite Deep bite Cleft lip and palate

13 Numerical anomalies of teeth Missing teeth Accessory teeth (supernumerary, supplementary) Diastema medianum Gross discrepancy problems Dental crossbite Angle II/1 Angle III Open bite Deep bite Cleft lip and palate

14 Numerical anomalies of teeth Missing teeth Accessory teeth Diastema medianum (midline space) Gross discrepancy problems Dental crossbite Angle II/1 Angle III Open bite Deep bite Cleft lip and palate

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16 Numerical anomalies of teeth Missing teeth Accessory teeth Diastema medianum (midline space) Gross discrepancy problems (size of teeth and dental arches) Dental crossbite Angle II/1 Angle III Open bite Deep bite Cleft lip and palate

17 Spacing of teeth Spacing between maxillary central incisors (distema medianum) causes: supernumerary teeth in the midline congenitally missing lateral incisors enlarged or malposed labial frenum imperfect fusion at the midline spacing as part of normal grows (the central incisors erupt with a space between them) th.:removing supernumerary teeth excision of labial frenum space closing

18 Numerical anomalies of teeth Missing teeth Accessory teeth Diastema medianum (midline space) Gross discrepancy problems (size of teeth and dental arches) Dental crossbite Angle II/1 Angle III Open bite Deep bite Cleft lip and palate

19 Gross discrepancy problems Gross discrepancy problems are those in which there is a great and significant difference between the sizes of all the permanent teeth and the space available for them within the alveolar arch perimeter. diagnoses: orthopantomogram model cast indices (Pont-index) th.: serial extraction (Hotz)

20 Numerical anomalies of teeth Missing teeth Accessory teeth Diastema medianum (midline space) Gross discrepancy problems (size of teeth and dental arches Dental crossbite (anterior) Angle II/1 Angle III Open bite Deep bite Cleft lip and palate

21 Dental crossbite One tooth alone tipped. Its antagonist in the opposite arch is out of position. th.:acrylic inclined plane lingual archwires with recurved auxiliary springs (labial archwires with bite raising) Dentoalveolar contraction and crossbite. Bilateral or unilateral contraction of the maxillary arch. th.:quad helix or lingual archwire expansion.

22 Numerical anomalies of teeth Missing teeth Accessory teeth Diastema medianum (midline space) Gross discrepancy problems (size of teeth and dental arches Dental crossbite Angle II/1 Angle III Open bite Deep bite Cleft lip and palate

23 Angle Class II/1 distoocclusion The dental aspect of class II. largely are adaptations to the sceletal and muscular pattern. Molars: distal displacement of mandibular and/or mesial displacement of maxillary molars. Incisors: the upper incisors tipped labially th.: moving the upper teeth backward and the lower mesially appliances: functional appliances (e.g.fränkel, Bimler), labial archwire, mandibulo-maxillary traction

24 Numerical anomalies of teeth Missing teeth Accessory teeth Diastema medianum (midline space) Gross discrepancy problems Dental crossbite Angle II/1 Angle III Open bite Deep bite Cleft lip and palate

25 Angle class III. mesioocclusion True or pseudo Class III. (skeletal, dental) Molars: mesial displacement of mandibulary molars Incisors: anterior crossbite (mesial displacement of mandibulary front) th.: to alter the growth of the early Class III. condition appliances: inclined plane chin cup? labial archwires

26 Numerical anomalies of teeth Missing teeth Accessory teeth Diastema medianum (midline space) Gross discrepancy problems Dental crossbite Angle II/1 Angle III Open bite Deep bite Cleft lip and palate

27 Open bite Open bite is the failure of the teeth meeting antagonist in the opposite arch. Causes: disturbances in the eruption of the teeth and alveolar growth habits (finger sucking) vertical sceletal displasia th.: controlling the habit (oral screen) labial archwire (in mixed or in permanent dentition)

28 Numerical anomalies of teeth Missing teeth Accessory teeth Diastema medianum (midline space) Gross discrepancy problems (size of teeth and dental arches Dental crossbite Angle II/1 Angle III Open bite Deep bite Cleft lip and palate

29 Deep bite Wide range of incisal overlap (overbite) Deep bite as a clinical problem is not defined in terms of millimeters, but in the light of future aesthetical and functional changes. In good occlusions, the amount of overbite is determined largely by dental factors, that is crown length and tooth position. th.: in the mixed dentition: flat maxillary bite plane (the incisors depressed and the improve the Spee curve) monoblock or functional orthopedic appliances utility archwire

30 Early orthodontic treatments Stop deleterious oral habits (without or with appliances) Simple orthodontic appliances Myotherapy Serial extraction (Hotz) Treatment of cleft lip and palate

31 Simple orthodontic appliances Appliances for closing the space Space maintainers Inclined plane Chin cap Oral sheald/screen Appliances for stop the deleterious oral habits Simple plate with bite plane

32 Simple orthodontic appliances Appliances for closing the space Space maintainers Inclined plane Chin cap Oral sheald/screen Appliances for stop the deleterious oral habits Simple plate with bite plane

33 Early loss of primary teeth early = one year prior to the eruption of permanent successor causes: caries injury th.: space maintainer (passive) space regainer (active)

34 Space maintainer fixed removable

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36 Simple orthodontic appliances Appliances for closing the space Space maintainers Inclined plane Chin cap Oral sheald/screen Max. 3 weeks! Appliances for stop the deleterious oral habits Simple plate with bite plane

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38 Simple orthodontic appliances Appliances for closing the space Space maintainers? Inclined plane Chin cap Oral sheald/screen Appliances for stop the deleterious oral habits Simple plate with bite plane

39 Trainer

40 Simple orthodontic appliances Appliances for closing the space Space maintainers Inclined plane Chin cap Oral sheald/screen Appliances for stop the deleterious oral habits Simple plate with bite plane

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42 Simple orthodontic appliances Appliances for closing the space Space maintainers Inclined plane Chin cap Oral sheald/screen Appliances for stop deleterious oral habits Simple plate with bite plane

43 Simple orthodontic appliances Appliances for closing the space Space maintainers Inclined plane Chin cap Oral sheald/screen Appliances for stop the deleterious oral habits Simple plate with bite plane (for jumping the bite) Kingsley, New York

44 Simple orthodontic appliances Appliances for closing the space Space maintainers Inclined plane Chin cap Oral sheald/screen Appliances for stop the deleterious oral habits Simple plate with bite plane

45 Myotherapy In the primary dentition: to prevent the anomaly In the mixed and permanent dentition: to complete the treatment with appliances Exercises to strengthen: m. masseter m. orbicularis oris, etc.

46 Serial extraction (Hotz, Kjellgren, Heath, Nance) 53, 63, 73, 83 54, 64, 74, 84 14, 24, 34, 44 without appliances or with appliances

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51 Early treatment of cleft lip and palate

52 Thank you for your attention!