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As an early orthodontic treatment
Dr. Yaser Omar Baroud
B.D.S.
AL-Mustansiria University _ Iraq
supervised by:
Dr. Jamal Naim
PhD, Orthodontics
Dean of faculty of dentistry
University of Palestine
Definitions and Terms
Phase I treatment:
Treatment initiated during the primary or
mixed dentition with the purpose to
prevent, intercept or correct an
orthodontic problem, also known as,
early treatment.
I.
Definitions and Terms
Phase II treatment:
Treatment initiated during the permanent
dentition with a comprehensive
approach to correcting the orthodontic
problems, also known as, comprehensive
treatment.
I.
Definitions and Terms
Early Treatment = Phase I treatment
I.
Definitions and Terms
Preventive early treatment:
Patient education and maintenance of a
favorable orthodontic condition.
e.g. patient education of stopping digit
sucking habits, space maintenance
appliances.
I.
Definitions and Terms
Interceptive early treatment:
Improvement of an orthodontic
problem/condition.
e.g. Primary tooth guidance extractions,
reduction of excessive overjet, growth
modification appliances, space
redistribution, space creation, deep bite
reduction, habit appliances.
I.
Definitions and Terms
Corrective early treatment:
Complete or nearly complete correction of
an orthodontic problem.
e.g. Expansion appliances, growth
modification appliances, alignment of
anterior teeth.
II. Goals of Early Treatment
Overall goal of early treatment:
To improve or correct orthodontic
problems that would result in:
– Irreversible damage to the dentition and
supporting structures.
– Progression into a more severe orthodontic
problem that would be more difficult to
treatment in Phase II.
NON SKELETAL ORTHODONTIC ISSUES
• Crowding
– Classification
– Management
• Anterior Crossbites
– Etiology
– Managemant
• Eruption Disturbances
– Ectopic eruption of maxillary first
permanent molars
– Mesiodens
SKELETAL ORTHODONTIC ISSUES
• Transverse problems
• Vertical Problems
Crowding
Classification of Mixed Dentition
Crowding
1. Incisor Liability = mild amount of
transitional crowding of the permanent
incisors in a mixed dentition (~2-3mm).
2. Moderate Transitional Crowding: ~
4mm of anterior crowding
3. Severe Transitional Crowding: ~ >4mm
of anterior crowding
Crowding Management
1. Incisor Liability
required
no intervention
2. Moderate Transitional Crowding:
depends on the situation
3. Severe Transitional Crowding:
intervention required
Leeway Space
Moyers:
– 2.5mm per side in Mn
– 2.0mm per side in Mx
• Proffit:
– 1.7mm per side in Mn
– 0.9mm per side in Mx
• Used for:
– Crowding
– Molar drift
Crowding Management by moderate
crowding
Maintaining of arch
perimeter
• No treatment and
monitoring
• Space Maintainers
• Extract primary canines
± LLHA
Increase of arch
perimeter
• Arch width expansion
• Incisor proclination
• Distalizers – lip
bumpers, headgear etc.
Crowding Management by moderate
crowding
Maintaining of arch
perimeter
• No treatment and
monitoring
• Space Maintainers
• Extract primary canines
± LLHA
Increase of arch
perimeter
• Arch width expansion
• Incisor proclination
• Distalizers – lip
bumpers, headgear etc.
Crowding Management by moderate
crowding
Maintaining of arch
perimeter
• No treatment and
monitoring
• Space Maintainers
• Extract primary canines
± LLHA
Increase of arch
perimeter
• Arch width expansion
• Incisor proclination
(Utility or AP)
• Distalizers – lip
bumpers, headgear etc.
Crowding Management by moderate
crowding
Maintaining of arch
perimeter
• No treatment and
monitoring
• Space Maintainers
• Extract primary canines
± LLHA
Increase of arch
perimeter
• Arch width expansion
• Incisor proclination
(Utility or AP)
• Distalizers – lip
bumpers, headgear etc.
Crowding Management by moderate
crowding
Maintaining of arch
perimeter
• No treatment and
monitoring
• Space Maintainers
• Extract primary canines
± LLHA
Increase of arch
perimeter
• Arch width expansion
• Incisor proclination
(Utility or AP)
• Distalizers – lip
bumpers, headgear etc.
Severe Transitional Crowding
Signs:
• Lack of interdental spaces in primary
dentition.
• >4mm of crowding of permanent
incisors.
• Early loss of primary canine by ectopic
eruption of lateral incisor.
• Ectopic eruption of upper first
permanent molars.
Severe Transitional Crowding
Management
Serial Extraction: A planned sequence of
tooth removal during the transition
from primary to permanent dentition to
promote eruption of teeth through
attached gingiva (keratinized tissue) and
reduce the severity of crowding.
Eruption sequence of the permanent
dentition: Maxilla:
61245378
Mandible:
6 1 2 (3 4) 5 7 8
Serial Extraction
Case selection:
1. No skeletal disproportions; balanced AP,
V, T dimensions
2. Class I molar relationship
3. Non-retrusive lip profile
4. Normal overbite
5. Coincident midlines
6. Severe crowding warranting extractions.
By the age of 7-8, If the upper and
lower incisors erupt in a crowded
situation, and one can hope that
growth in the arch on in the alveolar
process can compensate for this
crowding,…..
By the age of 7-8, If the upper and
lower incisors erupt in a crowded
situation, and one can hope that
growth in the arch on in the alveolar
process can compensate for this
crowding,
He is wrong!!!!
In some cases the amount of crowding
not exceeding 2 mm can be solved
spontaneously by the incisal liability or
the force generation coming from the
active protruding tongue but not all.
Many authors discovered that:
(( Inter canine distance sustain the
same or increase very minimal after
the eruption of permanent incisors))
procedure:
Extraction of Cs as soon as the permanent incisors
complete their eruption, such extraction will allow
spontaneous relief of crowding.
Procedure…
Extraction of Ds, and
this is done after an
accepted alignment
of the incisors.
The aim of these
extractions is to
accelerate the
eruption of the
permanent first
premolar.
Extraction of permanent first premolar as soon as
they emerge from the oral mucosa, thus allowing
the space for the canines and 2nd premolars to
occupy the space mesial to 6s and distal to 2s.
Serial extraction
Serial Extraction
Phase II full braces for alignment, bite
and root parallelism.
Complications:
I.
II.
III.
IV.
V.
A complication can occur if the primary first
molar is extracted early and the first premolar
still does not erupt before the canine. This can
lead to impaction of the premolar that requires
later surgical removal .
Loss of some arch perimeter.
Concave profile.
Increase in overbite.
Not enough to solve the problem ( alone).
Before committing a crime…..
 A complete diagnostic aids should be taken before
starting the S.E. procedure and the patient should
have at least beside clinical examination an OPG that
can demonstrate the existence of the complete
dentition at the beginning of the treatment.
Before committing a crime……………..
 All the local factors that
worsen the crowding should
be avoided during the
treatment such as presence of
S.N.T, as early loss of primary
Es or bad conservative work
for the rest of the remaining
teeth.
Advantages:
 Immediate relief of crowding or
malocclusion.
 Less time consuming and low cost
especially if at the end, the teeth arranged
with good alignment.
 Simple procedure
 Less duration of wearing orthodontic
appliances.
Disadvantages:
 Subject the child to multiple extraction
visits, which may leave a bad impression
toward the dentist.
 Painful.
To be considered……..
 SE should be done at both arches at the same
time.
 SE is very good applied in the upper arch rather in
the lower arch because of favorable sequence of
eruption.
 The opinion of starting SE with a patient is not a
simple one for all (( orthodontist, parents and
patient )).
To be considered……..
 In a lot of cases the final
outcome of teeth alignment
are accepted by the parent,
patient and even the dentist.
However, an upper and
lower fixed appliances are
needed to give the final
touches….
 The appliances are worn for
6-8 months only rather than
2-2.5 years.
‫دجلة وقت الغروب‪...‬بغداد‬
‫‪Thank‬‬
‫‪you….‬‬