Early treatment in orthodontics /certified fixed orthodontic courses by Indian dental academy

15
INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com EARLY TREATMENT IN ORTHODONTICS

Transcript of Early treatment in orthodontics /certified fixed orthodontic courses by Indian dental academy

INDIAN DENTAL ACADEMYLeader in continuing dental educationwww.indiandentalacademy.com

www.indiandentalacademy.com

EARLY TREATMENT IN ORTHODONTICS

INTRODUCTION:

There is an on going discussion among orthodontists as to the optimal time to initiate

orthodontic treatment under various clinical situations. Since the objectives of

orthodontic care must include the minimal amount of treatment that achieves the

maximum benefit for the patient, the timing of the commencement of treatment becomes

of paramount importance. Patient should expect and receive only that amount of

treatment that minimizes both the biologic and financial cost to them and yet obtain the

optimal outcome.

www.indiandentalacademy.com

2 -phase treatment became plausible with the emergence of the functional matrix

hypothesis by Moss in 1960s. This theoretical basis provided a rationale to shift

from the restrictive genomic paradigm of Brodie, who considered that the pattern

of craniofacial growth was established by 3 months in the infant and was

immutable, to the functional matrix paradigm of the 1970s, which provided a

rational basis to promote functional appliances to correct the skeletal pattern

during growth.

www.indiandentalacademy.com

The challenge facing orthodontists in the 21st century is the need to integrate the

scientific evidence into practice. It needs to be evaluated from 2 perspectives:

• EFFECTIVENESS: how well it works?

• EFFICIENCY: how much it benefits patient in terms of cost and risk.

www.indiandentalacademy.com

EARLY TREATMENT OF CLASS II

Growth modification is advocated as an early intervention in the treatment of

growing Class II patients. These include the various functional appliances

like Twin Blocks, Activators, Functional regulators etc.

It would appear that functional appliances will be more successful during a

period of rapid growth. Bjork found as patients grew older the effectiveness

of functional appliances reduced. Broadbent stated that skeletal maturity

influenced the treatment outcome.

www.indiandentalacademy.com

juvenile adolescent

adult

PHV

GRO

WTH

/ U

NIT

TIM

E

AGE 2 10 / 12 14 / 18

Pancherz & Hagg on using Herbst appliance, found that there was an increrased

condular growth response when the functional appliance treatment was carried out

close to the period of most rapid growth in stature,ie; Peak Height Velocity.

Therefore the major consensus seems to be that treatment should be carried out

during the Peak height Velocity stage.

www.indiandentalacademy.com

An RCT conducted by Tulloch etal(1998) evaluated the benefit of early

Class II treatment and concluded that for children with moderate to

severe class II problems, early treatment followed by later

comprehensive treatment on an average does not produce major

differences in jaw relationship or dental occlusion compared with those

treated with one later stage treatment.

Tulloch and Proffit(2004) published the outcomes of their 2 phase RCT and

concluded that:

• 2phase treatment started before adolescence in mixed dentition might not be an

more clinically effective than a single phase treatment started during adolescence.

• Early class II treatment is effective but not efficient

• The difference in skeletal and dental morphology achieved in early treatment

disappeared almost completely after comprehensive treatment with fixed appliances.

www.indiandentalacademy.com

Kevin O’Brien et al (2003) assessed the effectiveness of early

treatment with twin block (RCT), and concluded that:

• Early treatment with twin block appliance is effective in reducing

overjet and severity of malocclusion.

•Small change in skeletal relation might not be clinically

significant

The Evidence from a Meta Analysis by J Y.Chen et al (2004)

1. Most important changes from treatment were dentoalveolar

2. Skeletal change was not clinically significant

3. Similar response to ANB changes in both headgear and functional

groups !!

4. Functional appliances do not modify or enhance growth

www.indiandentalacademy.com

Some authors argue that an early phase of treatment will help in building up

of patients Self Esteem. But the impact of early treatment on psychosocial

development does not appear to warrant early intervention on the average.

The University of North Carolina in their prospective trials failed to

demonstrate the improvement in self concept with early treatment.

www.indiandentalacademy.com

EARLY TREATMENT OF CLASS III

Rationale:

1. To prevent progressive irreversible soft tissue or bony changes

2. To improve skeletal discrepancies

3. To improve occlusal function

4. To simplify phase II comprehensive treatment

5. To provide more pleasing facial esthetics.

Indications:

Turpin developed a list of positive and negative factors such as-

• Good facial esthetics

• Mild skeletal disharmony

• No familial prognathism

• A-P functional shift

• Convergent facial type

• Symmetric condylar growth

• Poor cooperationwww.indiandentalacademy.com

TIMING FOR CLASS III TREATMENT:

Timing of chin cup treatment for class III malocclusion appears to be irrelevant

for growth modification and stability. This treatment intervention at best

provides temporary results for mandibular protrusion [Sugawara(1997) and

Sakamoto(1987)]

The timing of protraction face mask for class III skeletal maxillary deficiency is

advised during early mixed dentition treatment [Bacetti etal (1998) and Baik

(1987) ]

www.indiandentalacademy.com

No added benefit of RPE in the absence of cross

bites in relieving crowding.

Inadequate data to justify routine usage in class II

malocclusions with a view to self correct the mandible !!( Foot

and shoe principle by Mc Namara)

Early Intervention in the Transverse Dimension

(Gianelly [2004])

www.indiandentalacademy.com

Absolute Indications of Early Treatment Include:

[Ghafari etal (1998)]

• Functional posterior cross bites

• Anterior crossbites

• Openbites

• Early loss of teeth compromising the integrity of arch

• Proclined anteriors that are susceptible to trauma

• Functional disturbances

• Transverse discrepancies

www.indiandentalacademy.com

CONCLUSION

Early treatment has its own advantages and indications in specific

conditions as discussed. Case selection is very important. GENETICS

plays an important role in the response of the patient to treatment. Thus

we can only alter the environmental factors and allow the natural growth

to express itself !

It may be advisable to change the terminology

“EARLY TREATMENT”

TO

“EARLY TIMELY TREATMENT”www.indiandentalacademy.com

www.indiandentalacademy.com

www.indiandentalacademy.com

Leader in continuing dental education