Interceptive orthodontics

Early treatment

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.

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

Prevention◆ General preventive activity (to avoid/influence on the

deleterious internal and external factors) ◆ Space maintainers◆ Early orthodontic treatment

prevention

caries severe orthodontic anomaliesparodontopathie

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.

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.

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

◆ 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

◆ 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

◆ 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

◆ 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

◆ 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

◆ 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

◆ 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

◆ 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

Spacing of teeth

◆ Spacing between maxillary central incisors (distema medianum)• causes: supernumerary teeth in the midline

congenitally missing lateral incisorsenlarged or malposed labial frenumimperfect fusion at the midlinespacing as part of normal grows(the central incisors erupt with a space between them)

• th.:removing supernumerary teeth excision of labial frenum

space closing

◆ 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

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)

◆ 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

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.

◆ 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

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

mesiallyappliances: functional appliances (e.g.Fränkel, Bimler), labial archwire,

mandibulo-maxillary traction

◆ 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

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

◆ 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

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)

◆ 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

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

Early orthodontic treatments◆ Stop deleterious oral habits (without or with

appliances)◆ Simple orthodontic appliances◆ Myotherapy◆ Serial extraction (Hotz)◆ Treatment of cleft lip and palate

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

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

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)

Space maintainer

◆ removable◆ fixed

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

Max. 3 weeks !

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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Trainer

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

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

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, 1880. New York

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

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.

Serial extraction (Hotz, Kjellgren, Heath, Nance)

◆ 53, 63, 73, 83

◆ 54, 64, 74, 84

◆ 14, 24, 34, 44

◆ without appliances

or with appliances

Early treatment of cleft lip and palate

Thank you for your attention!