PREVENTIVE
development.
ORTHODONTICS
So these are the topics that we will be
discussing first is the maintainance….
Ok, before we start lets have first an ice
breaker, so in here meron tayong very
short saying which is connected to our
lesson. So first blank consists of 10
letters, and the second blank consists 4
letters. So may nakakaalam ba neto?
Slide 6:
Preventive orthodontic MEANS:
- A dynamic, ever -constant vigilance, a
routine, a discipline, for both the
dentist and the patient.
Slide 7:
I. Maintenance of Normal Occlusion
1. Need for Patient-Dentist Rapport
o it is essential that a proper
rapport be established between
the dentist and the child and his
parents at the first visit.
Throughout the appointment,
tanungin din natin yung patient natin,
how they are feeling or if there are
specific areas they want to have
addressed. If possible, begin asking
these questions before you recline
your patient in the chair. Para mas
maging comfortable sila.
Slide 8:
2. Significance of Study Casts
o So during the first visit with the
use of illustrations or models
you can explain to the parents
that normal occlusion does not
just happen, madaming factors
ang nakaka affect and also the
complexity of dental
o It is important also that the
patient knows how much easier
it is to prevent or intercept
incipient problems rather than
correct them at a later date.
Sabi nga nila nasa huli ang
pagsisisi
Slide 9:
2. Necessity for Diagnostic Records
o This does not mean that
services need to be rendered
however Child should be seen as
early as two and a half years of
age- kasi at this age posterior
teeth have erupted already
which means caries may occur
already
o Next one is at the age of 5,
bitewing radiograph should be
taken twice a year
o Periapical radiograph
examinations should be made
once a year if development of
malocclusion is suspected.
Slide 10:
II. Orthodontic alternatives in Occlusal
Maintenance- so we have 3:
Slide 11: (basahin muna lahat)
1. Preventive- to prevent anything
abnormal from occurring
2. Interceptive- to intercept an abnormal
situation that is developing.
3. Corrective- to correct an abnormality
that has already developed
Slide 12:
So these are example of preventive measures, pag
preventive di pa nag ooccur ang problem.
Slide 13:
So these are the examples of developing problems
that must be prevented from continuing.
Slide 14:
So under habit problems this is one of the example,
thumb sucking. (Basahin yung sa pic)
malocclusion. So first illustration ano kaya?
Pwede magsagot kahit sino
Slide 22:
So these are examples of excessive overbite and
overjet.
Slide 23: Example of crossbite

Slide 24: Next is the radiographic examination

A complete and accurate radiographic examination

should be made soon after the first visit. This may
be either a panoramic radiograph together with
bite wing views, or a complete long-cone
technique, periapical series together with bite-wing
views.

The most likely radiographic indicators of future

orthodontic problems are:

1. Resorption pattern of the deciduous

dentition
 Abnormal resorption pattern of
deciduous dentition is associated
most frequently with Space
deficiency problems
 The Canines and 2nd molars are
prone to aberrant resorption
III. Indications of Future Orthodontic pattern
Problems
As you can see, here in the radiograph shown is an
Slide 16: example of a retained deciduous canine in a 16-
year-old patient. So if periodic radiographic
IV. First is the: examination and removal of the deciduous canine
1. VISUAL EXAMINATION- we must look at the proper time have done it might have
for prevented the palatal impaction of the permanent
 Gross malocclusions successor or, at the very least, reduced the severity
 Excessive overbite and overjet of the problem.
- 0-1mm normal overbite and overjet in
deciduous dentition 2. Eruption cycle of the permanent
 Cross-bite dentition
 It is important that we know The chronology
 Basal malrelationship and other
and sequence of eruption of human primary
problems
and permanent teeth as they are important
milestones during a child’s development. Lalo
Slide 16:
na sa ibang parents pag kunyare may natanggal
Ok, so may game tayo, we have 4 illustrations so
na ngipin, or may sirang ngipin, hmm okay lang
sasabihin niyo lang kung anong type ng gross
yan di pa naman yan permanent, not knowing
 na Malaki yung magiging effect, kasi dun nag
sstart magkaroon ng malocclusion.
Slide 25:
V. Contingency of Extraction
 Tooth shedding time of the deciduous dentition
should be kept on schedule
Slide 26:
 Indications of primary tooth extraction
include:
1. Extensive caries
2. Over retained deciduous teeth
The second picture in the lower right is
indicated for extraction because as you
can see the permanent tooth or tooth
11 has fully erupted but the primary
tooth on the opposite side is firm,
which might suggest for extraction.
3. Ankylosed tooth- the picture shows
(A) Severe ankylosis of the primary
mandibular left second molar at
five years of age. (B) Occlusal
view of the ankylosed primary
mandibular left second molar. (C)
Periapical radiograph of the
ankylosed primary mandibular
left second molar.  the gap which will steal some of the space for the
4. Supernumerary tooth
One abnormal variation of the
patient’s dentition, that can effect
the occlusion, is supernumerary
teeth or extra teeth. The
etiology of supernumerary teeth
is not known but it may be due to
patient’s genetics in tooth bud
formation.
5. Mandibular canine extraction
We don’t extract deciduous teeth
because they will exfoliate normally
unless they are indicated for
extraction, for example When there
is not enough space for other teeth
or the succedaneous teeth.
Slide 27:
Another example of over retained primary canine,
so dapat ng ma extract because the permanent
canine have already erupted.
Slide 28:
VI. Role of 2nd Deciduous Molar Region
 Larger than its successor
 Abnormal resorption or prolonged
retention may have a far-reaching
effect
Slide 29: OVER RETENTION
Erupting canines maybe forced labially or
prevented from erupting due to additional arch
length.
Irregularity of incisors
Slide 30: EARLY LOSS
We have here an example wherein in this picture
primary/ deciduous teeth are circled and are
about to be lost prematurely.
Slide 31:
When primary teeth have been lost prematurely
the six permanent tooth will drifts forward into
5th, 4th, and 3rd permanent teeth which are still
unerupted.
Slide 32:
So in here u can see the 5th, 4th, and 3rd permanent
teeth have drifted forwards and stolen the space
for the third tooth or the canine becoming now
crowded. Resulting now to, next page
Slide 33:
In here you can see the lateral view of a child. In
the right picture lower permanent teeth drifted
forwards and stolen the space of other permanent
teeth, resulting to malocclusion. while for the left
picture u can see the normal occlusion which is
the absence of crowding.
Slide 34:
VII. Critical Period of Tooth Exchange
As I said a while back in preventive
orthodontics a Constant vigilance is
essential during the critical period of tooth
exchange
Slide 35:
Be on a lookout for anything that might
stand in the way of the development of a
normal occlusion like:
Abnormal resorption pattern
Slide 36: Retained deciduous root fragments
so Deciduous teeth that persist beyond their shedding
time is known as retained deciduous teeth.
Slide 37: Ankylosis
- Ankylosed deciduous teeth is mostly
due to trauma
- There is no active eruption and become
at a lower level that the other teeth or it
becomes submerged.
- So submereged tooth should be
removed allowing the permanent one to
erupt
Slide 38:
Non-resorbing bony crypt
Slide 39:
Soft tissue barrier
Slide 40:
Overhanging restoration
- If the restoration is overcontoured it
might cause the adjacent tooth to supra
erupt
- And if it is overextended, it might cause
shrinking of the adjacent tooth
Slide 41:
VIII. Space Control in Deciduous Dentition
An important part of preventive
orthodontics is the correct handling of
spaces:
Slide 42:
So first note for, untimely loss of deciduous tooth,
The early loss of a baby tooth can result in the loss
of space in the arch, which can lead to crooked or
impacted permanent teeth. Katulad kanina when
early tooth loss happened, drifting of the teeth
will occur which will lead to impacted permanent
tooth
Slide 43:
Second is to put space maintainer if indicated
only, just like in this short video, when the 2nd
molar has been removed there is the
succedaneous tooth which is the 2nd premolar
space maintainer is indicated to provide or
maintain the space.
Slide 44:
And lastly for anterior teeth or region put space
maintainer also if only indicated. Because there is
A naturally occurring spacing between the teeth
of the primary dentition. In the maxillary arch, it is
located between the lateral incisors and canines,
whereas in the mandibular arch the space is
between the canines and first molars. It also
occurs between the canine and first premolar
teeth in adult primates.
Slide 45:
IX. Space Maintenance
Slide 46:
The best space maintainers are deciduous tooth
particularly the molars.
Slide 47:
When primary molars are lost prematurely, drifting
of the permanent molars and premolars into the
edentulous area may occur, it may lead to:
 1. Loss of ARCH LENGTH
2. Crowding of permanent
dentition
3. Impaction of permanent teeth
4. Esthetic Difficulties
Slide 51:
X. Prerequisites for space maintainers
There are certain prerequisites for all space
maintainers, whenever they are fixed or
removable
Slide 52:
First, they should maintain the mesiodistal
dimension of the lost tooth
Slide 53:
If possible, they should be functional, at least to
the extent of preventing the overeruption of the
opposing tooth or teeth.
Slide 54:
They should be as simple and as strong as possible
Slide 55:
They must not endanger the remaining teeth by
imposing excessive stresses on them
Slide 56:
They must be easily cleaned and not serve as traps
for debris which might enhanced dental caries and
soft tissue pathology
Slide 57:
Lastly, their construction must be such that they do
not restrict normal growth and developmental
process or interfere with such functions as
mastication, speech or deglutition.
Slide 58:
XI. Space maintainainers in maxillary and
mandibular anterior segments
Slide 59:
in MAXILLARY ANTERIOR SEGMENT
Space maintainers are Not usually necessary,
however a fixed space maintainer may be justified
as an aid to proper speech. So theres a speech
disorder that is called LISPING. It is very common
when there is the absence of maxillary incisor.
Lisping is a speech impediment that specifically
relates to making the sounds associated with the
letters S and Z
Slide 60: next reason is for Esthetics
Slide 61: last is Psychological Purpose, kasi
pumapasok ditto yung bullying.
Slide 62:
for MANDIBULAR ANTERIOR SEGMENT
Removable appliance is not usually advisable
because usually mandibular incisors erupt
lingually due to:
1. Poor retention qualities
2. Probable removal during mealtime
3. Greater likelihood of loss
4. Interference with normal forward and
movement of incisors
Slide 63:
When deciduous teeth are loss prematurely we
maintain the space by using
XII. Space maintainainers -it is a fixed or
removable appliance designed to preserve the
space created by the premature loss of a
primary tooth or a group of teeth.
Slide 64: there 2 types of space maintainers the
fixed space aintainers and removable space
maintainers.
When we say FIXED SPACE MAINTAINERS- these
are Space maintainers which are fixed or fitted
onto the teeth and It can be:
o Functional
o Non-functional
Another type is the REMOVABLE SPACE
MAINTAINERS- A removable space maintainer,
of course, can be removed. One common removable
space maintainer is the Hawley appliance.

Slide 65: First we have the functional fixed space
maintainer which is the BAND WITH PONTIC
-In this type it uses pontic, just like in the picture
Slide 69:
Next space maintainer is the mandibular lingual
holding arch
-This type can be active or passive because as I’ve said a
while back it is capable of exerting pressure and
perform tooth movement.

there’s an - it is a space maintainer for preserving mandibular arch

length

appliance that
replaces the lost Slide 70: For the indications, it is indicated in….

And contraindicated in…….

tooth Slide 71: this is the nance appliance

there’s an o It is a passive type of appliance, and it is a

maxillary appliance that does not contact

appliance that the anterior teeth but approximates the

anterior palate

replaces the lost Slide 72: it is indicated for…..

tooth
And contraindicated…..

However it can cause allerygy because of the

this appliance replaces the lost tooth
acrylic resin and also speech interference
Slide 66:
Slide 73: next is the transpalatal arch appliance
Next is the non-functional fixed maintainers, first
is the band and loop.
This is passive and developed by robert
goshgarian.
- It is a passive type of retainer,
when we say passive the
In this appliance a wire extends across the palate
appliance exerts no active
and connected to the permanent maxillary molars
pressure, it remains passive in
which is soldered to a molar band.
the mouth example are space
maintainers or retainers. Slide 74: for the indications..
- Band and loop is used to
maintain space of a single tooth Contraindications..
just like in these pictures
Slide 75: next lets proceed to removable space
Slide 67: maintainers, first is the acrylic resin partial
Band and loop is indicated when uni….. denture….. basahin na lahat.
Slide 68:
It is contraindicated when there is …
Slide 76: last is the Hawley appliance, so same siya
ng use indication and contraindications sa acrylic
resin partial denture. Same lang.
removable
Advantages:
 Less stress on the remaining
teeth- Being tissue borne, they
impose less stress on the
remaining teeth
 Functional- they can be
functional in the truest sense,
by virtue of their tissue
stimulation in the edentulous
area. Which often they
accelerate the eruption of teeth
beneath them.
 Esthetic- usually they are
considerably more esthetic than
the fixed type
spacemaintainers.
 Easier to fabricate, less
chairtime- they are easier to
fabricate requiring less
chairtime.
 Easier to keep clean- and lastly
they are generally easier to
keep clean.
Disadvantages:
 Dependent on the patient’s cooperation- on
the liability side first is the greater
deoendence on the px’s cooperation. Kung
susuutin niya ba or tatanggalin tanggalin
niya.
 Loss- there is also a bigger chance of loss
and breakage of course pag tinanggal nung
patient tapos nakalimutan niya kung san
niya nilagay mawawala na.
 Breakage
 Patient’s inability to adjust w/ the
appliance- lalo na sa bata tapos di sanay
talagang tatanggalin nila, minsan
magwawala pa.
FIXED SPACE MAINTAINERS- A fixed space
maintainer is fixed (i.e., held) to a tooth or
to more than one tooth. Fixation usually is
done by cementing the space
maintenance appliance in place.
First we have the:
1. Band and Loop space maintainer
 it is used most frequently to maintain the
space of either: PRIMARY FIRST MOLAR or
SECOND MOLAR after permanent first molar
has erupted.
 used to maintain space of a single tooth
 The appliance includes a band on the
abutment tooth and a wire loop that
traverses the edentulous space. The wire
touches the tooth on the other side of the
space to hold both teeth in place and should
be wide enough to allow eruption of the
permanent tooth.