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COMPLEX NON SKELETAL PROBLEMS in PREADOLESCENT CHILDREN - Dental Ebook & Lecture Notes PDF Download (Studynama - Com - India's Biggest Website For BDS Study Material Downloads)
COMPLEX NON SKELETAL PROBLEMS in PREADOLESCENT CHILDREN - Dental Ebook & Lecture Notes PDF Download (Studynama - Com - India's Biggest Website For BDS Study Material Downloads)
PROBLEMS IN PREADOLESCENT
CHILDREN: PREVENTIVE &
INTERCEPTIVE TREATMENT
CONTENTS
M
O
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Eruption Problems ............................................................................................................................................................ 2
A
Transposition ................................................................................................................................................................. 2
M
Primary Failure of Eruption ........................................................................................................................................... 2
A
N
Impact of Radiation Therapy & Bisphosphonates ......................................................................................................... 3
Y
Traumatic Displacement of Teeth (Management)............................................................................................................ 3
D
Intrusion ........................................................................................................................................................................ 3
U
T
Extrusion ........................................................................................................................................................................ 3
S
Space Related Problems.................................................................................................................................................... 4
Expansion for Crowding in the Late Mixed Dentition: Molar Distalization ............................................................... 8
Early (Serial) Extraction............................................................................................................................................ 10
ERUPTION PROBLEMS
TRANSPOSITION
Definitions; it is positional interchange of two adjacent teeth.
o Caused genetically
Prevalence OR Most Common Transposed Teeth;
o Early Mixed Dentition; b/w permanent mandibular lateral incisor & mandibular permanent canine.
o Later Mixed Dentition; permanent maxillary canine & Premolar (Most Common) Maxillary canine &
Maxillary lateral.
Treatment of Transposition b/w Permanent Mandibular Lateral Incisors & Mandibular Permanent Canine;
o Caused due to distal eruption of mandibular lateral incisors resulting resorption of primary mandibular M
canine & primary 1st molar. O
.C
o Treatment require repositioning the lateral incisor mesially by;
Bonding the tooth or gaining surgical access to tooth and applying traction to tip the tooth back
A
to its natural position followed by bodily movement of erupted tooth. getting anchorage by
lingual arch.
o Early intervention advantage is that simple tipping movement will treat the problem. M
A
o The treatment should begin before the active eruption of canine to prevent the resorption of root of
mandibular lateral incisor.
N
Y
Treatment of permanent maxillary canine & Premolar OR Maxillary canine & Maxillary lateral transposition;
o It is mostly caused by canine, so treatment will be to bodily repositioning of canine; by translating the
canine from lingual or facial side of other tooth. D
o However, the best approach is that; U
T
If the tooth is partially transposed – then move that tooth to total transposition. While,
S
If the tooth is fully transposed – leave it there.
o In both of these condition, reshape the transposed tooth to improve its appearance.
o We are not moving that transposed to tooth to their original position because difficulty in correcting
transposition is more difficult than reshaping the tooth in that abnormal transposed position.
EXTRUSION
If extruded teeth are not repositioned at the time of injury, they pose a difficulty in their reduction.
orthodontic intrusion of extruded teeth is avoided because of;
o bony defects on intrusion
o loss of pulp vitality (especially lateral incisors)
o decreased bony support
o abnormal crown – root ratio
so the best treatment option for extruded teeth is reshaping the elongated tooth by crown reduction.
If the traumatically injured anterior teeth cannot be restored is to retain the root of the compromised tooth until
vertical growth is completed followed by placement of implant to prevent ridge resorption & need for bone grafting.
If the tooth is compromised can still be moved orthodontically, it can be repositioned and root buried is
performed.
o Root Burial; it involves de – corination (removal of clinical crown) roots are left in place and the overlying
soft tissues are closed.
o That root can be removed or implant is placed through it. Figure 12 – 7
Most common non skeletal cause of maxillary dental protrusion & spacing is finger – sucking habit.
Most common SKELETAL cause of this problem is Class 2 malocclusion.
If there is no any deep bite & space available, this problem can be treated by removable appliances as mentioned
in chapter 11.
If, bodily movement, correction of rotations is required – Fixed appliance therapy is indicated.
o In these cases, a closing loop arch wire is used with bands on posterior teeth & brackets on anterior teeth.
Retracting & space – closing force is applied via closing loops or elastomeric power chains.
o In this condition, rectangular arch wire should be used to control the tipping of teeth, because
uncontrolled tipping will cause uprighting of anterior teeth resulting rabbited teeth.
o M
Bodily incisor retraction will place large amount of opposing force on posterior teeth, that’s why
reinforced anchorage is obtained in this O
.C
condition via headgear.
Headgear should be chosen after consideration of
vertical facial & dental characteristics. A
THIS CLOSING LOOP (ARROW) ARCH WIRE WAS USED TO RETRACT M
PROTRUSIVE MAXILLARY INCISORS AND CLOSE SPACE. EACH LOOP WAS
ACTIVATED APPROXIMATELY 1 MM PER MONTH, AND THE POSTERIOR
A
ANCHORAGE WAS REINFORCED WITH HEADGEAR. N
It there is deep bite along with overjet (dental
Y
protrusion); D
U
o In this case, above mentioned method of
T
treatment will bring upper & lower teeth into vertical contact & maxillary teeth cannot be retracted
S
enough to close space b/w them.
So in this condition, bite plate is given to allow eruption of posterior teeth to reduce deep bite and
after that, retracting maxillary anterior teeth.
When maxillary lateral incisors are missing, one of the following Sequeale occurs;
o Erupting permanent canine resorb the primary lateral incisor & substitute for missing lateral incisor
followed by retention of primary canine. M
O
But most primary canines are lost by adolescence even if they have no any successor permanent canine below them.
o Retention of primary lateral incisor & normal eruption of permanent canine.
.C
Treatment Option of Missing Permanent Lateral Incisors; Have the permanent canine erupt in the space of missing
o
A
if the prosthetic Tx. is planned; allow the canine to erupt in lateral incisor space for development of
M
alveolar bone in that area followed by distalization of canine so that space can be opened for implant
o
placement.
A
If prosthetic treatment is not planned; allow the canine to erupt in lateral incisor space & prepare it in the
N
shape of lateral incisors followed by extraction of retained primary canine, so that premolar & other
Y
posterior teeth can be drifted mesially.
D
This type of space closure is best option in those patient who has protruded incisors & molars in class II relationship.
Because in that situation we can use reciprocal space closure mechanism b/w anterior & posterior teeth for
U
closing the spaces.
2nd T is avoided in patients with;
mentioned space closure technique
S
o Class 1 molar relationship
o Class 3 molar relationship
Will create anterior cross bite on retraction of incisors.
Unilateral orthodontic space closure is avoided in anterior areas;
o Either place implant for aesthetic purpose OR
o Remove contralateral permanent lateral incisors before eruption of permanent canines to maximize
drifting pattern for space closure.
This same procedure also applies for mandibular missing permanent lateral incisors.
AUTO TRANSPLANTATION
Sometimes there are patients with congenitally missing tooth or teeth in one area but crowding in another. – in
that situation auto transplantation can be achieved.
o Auto transplantation; it is transplantation of teeth from one position to another in same mouth.
Teeth should be transplanted that has approx. 2/3rd – 3/4th root formed.
Most Common Teeth to be Transplanted;
o Premolars are moved into location of maxillary central incisors
o 3rd molars are moved into location of 1st molar.
After this surgical tooth transplantation, approx. 3 months for healing is required followed by light orthodontic
force to achieve final tooth position & restorative treatment to recontouring of the transplanted tooth.
Success rate of this treatment is high & predictable.
S
If both primary canines are lost and central incisors are tipped lingually; this will decrease arch circumference &
increase the crowding.
o Place lingual arch to expand the arch & align the teeth.
HEADGEAR
OTHER APPLIANCES USED FOR DISTALIZING THE MOLARS & INCREASE THE ARCH CIRCUMFERENCE.
A
M
A
N
Y
D
U
T
S
02) Pendulum appliance can be used that also gains anchorage from the palate but uses helical springs to supply the
Studynama’s BDS Community is one of India’s Largest Community of Dental Students. About
19,232 Indian Dental Course students are members of this community and share FREE study
material, cases, projects, exam papers etc. to enable each other to do well in their semester exams.
03) Fixed appliance using palatal & dental anchorage and NiTi coil springs to slide the molars along heavy lingual wires.
M
O
If the patient is above 12 years of age, the primary method of molar distalization will be temporary anchorage devices.
.C
After molar distalization, the retention will be given by lingual arch.
A
EARLY (SERIAL) EXTRACTION M
A
It is timed extraction of primary, and ultimately, permanent teeth to relieve sever crowding.
N
Y
Serial extraction makes lateral comprehensive treatment easier & quicker.
D
Serial extraction is reserved for severe crowding.
o space discrepancy greater than 10 mm per arch.
U
Serial extraction should be done in those child who does not have skeletal contribution to malocclusion.
T
STEPS of Serial Extraction S
Extraction of four Primary canines
o Extraction of primary incisors if necessary, followed by extraction of primary canines to allow eruption of
& alignment of permanent incisors.
o Undertaken at the age of approximately 8 years in a child of average dental development, at the time of
eruption of the maxillary lateral incisors. This should allow spontaneous alignment of the incisors at the
cost of canine space.
Extraction of 1st Primary Molars
o This extraction is done so as to influence the permanent 1st premolar to erupt before canine so that
permanent 1st premolars can be extracted.
o Undertaken at the age of approximately 9 years when the roots of the first premolars are half – 2/3rd
formed. The aim is to encourage the first premolars to erupt before the canines, which is often not the
case in the lower arch.
Because in maxilla, premolars erupt naturally before canine, while in mandible, premolar erupt
after the canine.
Extraction of the first premolars
o Undertaken near the time of eruption of the canines, after confirming that they are buccally palpable and
mesially angulated, if there is sufficient crowding to warrant premolar extractions and if all other teeth
are present and sound.
However, enucleation should also be done carefully, because premature enucleation will
leave bone defect at the site of 1st premolar which will persists.
After the loss of 1st premolar, extraction space is closed by mesial drift of 2nd premolar & permanent 1st molar and
by distal drift of canines.
During alignment of incisors, there is some lingual tipping of lower incisors & also increase in overbite after serial
extraction.
M
o This can be prevented by alternative approach to serial extraction which begins with extraction of primary 1st molar instead of primary canine
so that there is less lingual tipping of incisors & less tendency to develop deep bite.
O
Major goal of serial extraction is to prevent future crowding. However, some crowding persists which is corrected
.C
by fixed appliance in later comprehensive treatment.
U
T
S
Studynama’s BDS Community is one of India’s Largest Community of Dental Students. About
19,232 Indian Dental Course students are members of this community and share FREE study
material, cases, projects, exam papers etc. to enable each other to do well in their semester exams.