Treatment

Definition:

Is the treatment provided to a patient during

the mixed dentition and occasionally late
primary dentition (6-12 years). “Preventive
and interceptive orthodontics” were terms
used in the past to describe orthodontic
treatment in children.

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 Benefits of early treatment:
1)Influence jaw growth in positive manner.
2)Harmonize width of dental arches.
3)Improve eruption patterns.
3)Lower risk of trauma.
4)Correct bad oral habits.
5)Improve esthetics.
6)Shorten and simplify treatment.
7)Reduce impaction.
8)Improve speech problems.
9)Preserve or gain space.
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Clinical problems include

 Dento-alveolar  Skeletal problems:

problems(non-skeletal)
-Skeletal (cl.II & III).
-Space problems. -Skeletal posterior
-Eruption problems. crossbite.
-Occlusal RS. -Skeletal openbite.

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 Treatment

Dento-alveolar problems:
Space problems’ treatment include:
A) Space maintenance.
B) Space loss treatment.
C) Spacing treatment.

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A- Space maintenance

 Space maintenance for missing primary teeth with

adequate space.
- Indicated in:
1- Adequate space.
2- All unerupted teeth present.
3- More than six-month delay before successor
erupt.

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 Appliances include:

1) Band and loop space maintainers

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 2) Distal shoe space maintainer:

- Indicated when E is lost before

the eruption of 6.
- The shoe will guide the
eruption of the first molar
preventing it from occupying
the space of the second molar.

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3) Lingual arch space maintainer

Indicated when multiple posterior teeth are missing.

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 4) Partial denture

Indicated for bilateral posterior space maintenance with loss of 1ry

incisors (esthetics).

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 B) Space loss treatment

Crowding could be due to:

- Space deficiency.
or - Space loss.

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 Management of space deficiency

Minimal Mild
(<2mm) (2-3mm)
No treatment Interproximal reduction of
B&C

Moderate Severe
V.Severe
(3-5mm) (5-9mm)
(7-10mm)
ِِArch expansion Expansion/
Serial extraction
Extraction

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 Arch expansion for
moderate crowding

Removable expansion Fixed W-arch expansion

appliance with screw appliance

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Serial extraction

Def:
“Is an interceptive measure in the form of
a planned sequence of tooth removal to
reduce crowding. It is done during the
transition from 1ry to permanent
dentition.”

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 • Criteria for serial extraction:
1)No skeletal Discrepancy.
2)Class I molar RS.
3)Normal overbite.
4)Space deficiency of 10mm or more.
5)No congenitally missing teeth.

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CLASS I MIXED DENTITION
SEVERE CROWDING
SERIAL EXTRACTION

ORTHOGNATHIC
STRAIGHT/SLIGHTLY CONVEX
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 SERIAL EXTRACTION

PRETREATMENT ANTERIOR CROSSBITE

MIDDLE MIXED DENTITION AVERAGE OVERBITE
CLASS I POSTERIOR CROSS-BITE
AVERAGE OVERJET+ (RIGHT MOLARS)
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 SERIAL EXTRACTION

POSTERIOR MOLAR CROSSBITE SEVERE CROWDING

(RIGHT SIDE) -MAXILLARY ARCH
MIDLINES COINCIDE MOLAR ROTATION
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 SERIAL EXTRACTION

SEVERE CROWDING EXCESSIVE CURVE OF SPEE

MANDIBULAR ARCH (DEEP OVERBITE)

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 SERIAL EXTRACTION

INTRA-ORAL (PERI-APICAL)
RADIOGRAPHS

CEPHALOMETRIC
RADIOGRAPH
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 SERIAL EXTRACTION

PROGRESS
PRIMARY CANINES EXTRACTED
AWAITING ERUPTION OF FIRST PREMOLARS
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 SERIAL EXTRACTION

FIRST PREMOLARS ERUPTING

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 SERIAL EXTRACTION

PROGRESS
INTRA-ORAL RADIOGRAPHS
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 SERIAL EXTRACTION

EXTRACTION OF
LOWER LINGUAL
FIRST PREMOLARS
HOLDING ARCH
AND ERUPTION OF CANINES

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 Management of space loss
(space regaining)
 Localized space loss (3mm or less):
*Maxillary include:
-Removable/fixed space regainer appliance.
-Headgear.

*Mandibular include:
-Lingual arch.
-Lip bumper
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 Maxillary space regainers

a) Removable b) Fixed space

space regainer regainer

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 c) High-pull
headgear
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 Mandibular space regainers

a) Lingual arch

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 b) Lip bumper

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 CREATE SPACE
HOLD/DISTALIZE LOWER MOLAR
ADVANCE INCISORS
TRANSVERSE EXPANSION (DENTAL)

MANDIBULAR LIP BUMPER

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 CREATE SPACE
DISTALIZE UPPER MOLAR

SPACE LOSS
PENDULUM APPLIANCE POST TREATMENT
NANCE HOLDING ARCH
UNILATERAL/BILATERAL
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 PENDULUM APPLIANCE-Unilateral

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 REMOVABLE
TRANSPALATALB
APPLIANCE-
AR- Unilateral
Sectional screw

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 Space loss >3mm:

Extraction should be evaluated against space

regaining. Consultation with orthodontist is
necessary.

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Anterior dentoalveolar crossbite

 Caused by:
- Over retention of upper 1ry incisor.
- Lack of space.
- Lingual development of permanent incisor
tooth bud.

 Must be ttt as soon as diagnosed.

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 Treatment
of cross-bite

If space inadequate;
Removable appliance Space regaining
with finger spring then crossbite
correction

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 Pre-treatment

Post-treatment

Cross-bite appliance with

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double palatal spring (arrow)
Transverse RS problems

 Causes:
- Cheek sucking habit.
- Mouth breathing habit.
 Treatment:
- Removable appliance with acrylic plate
with screw.
- Fixed appliance (W- arch).

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 Unilateral posterior
cross-bite

Removable appliance
with screw
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 5 MONTHS

2 TURNS/WEEK

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 RIGHT UNILATERAL
TRANSVERSE DIMENSION POST. CROSSBITE
FUNCTIONAL SHIFT

INITIAL CONTACT POSITION

MAXIMUM INTERCUSPATION

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 DENTAL+?SKELETAL EXPANSION
QUADHELIX EXPANDER

FIXED BANDS AND REMOVABLE WIRE

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DENTAL+?SKELETAL EXPANSION
REMOVABLE EXPANDER

FULL COVERAGE ACRYLIC EXPANSION KEY

CLASPS
MIDLINE EXPANSION SCREW
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 FIXED ACRYLIC
EXPANDER

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 Vertical RS

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 Anterior openbite

Is the failure of Caused by finger

anterior teeth to sucking habit
overlap

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 Fixed habit breaking
appliance

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