True benefits of early orthodontic treatment
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True benefits of early orthodontic treatment

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True benefits of early orthodontic treatment True benefits of early orthodontic treatment Presentation Transcript

  • True benefits of early orthodontic treatment Children’s Dental World Dr. Milos Lekic
  • Why treat early
    • Malocclusions may be diagnosed early
    • Up until 10 years ago there hasn’t been evidence to point clinicians towards early or late treatment
    • Our desire to help patients with concerns and self-esteem considerations
    • Commercial influence as manufacturing has been ahead of science
    • ‘ Practice Efficiency’
  • Early treatments with proven benefits
    • Posterior and anterior crossbites
    • Crossbites associated with mandibular shifts may lead to a true skeletal discrepancy as the mandible develops asymmetrically in the direction in which it is shifting
    • Possible treatments:
      • Removable expansion – slow expansion
      • Fixed expansion – slow/fast expansion (Quad-Helix, W-arch)
      • Fixed expansion – rapid expansion (RPE)
  • Early treatments with proven benefits
    • Ankylosed teeth
      • Orthodontic treatment is usually warranted as the contralateral successor tooth is erupting
      • The successor permanent tooth may need guided eruption
      • Ankylosed teeth may be used for anchorage purposes
      • It was shown that prolonged retention of ankylosed teeth may lead to a decreased development of the associated alveolar bone
  • Early treatments with proven benefits
    • Excessive protrusions and diastemas
      • These may lead to injury or avulsions
      • They are often reasons why kids get teased
      • Thus, they affect the child’s self-esteem
      • As the condition persists, the mandibular lip may become entrapped behind the maxillary incisors, further perpetuating the problem
  •  
    • A 2x4 appliance may be used to correct the protrusion or to close the diastema space
    • Maxillary fixed appliance may be combined with a headgear
    • However, the three randomized randomized control trial studies showed that there may be no true benefit with an early two-phase treatment involving headgears or functional appliances
  • Early treatments with proven benefits
    • Severe anterior or lateral open bites
      • These conditions need to be addressed early
      • If there is a habit associated with the condition, the habit itself must be dealt with
      • The most common cause is a prolonged thumb sucking habit
      • If the habit is treated before the permanent anterior dentition erupts, the open bite may resolve spontaneously
      • If open bites are of true skeletal nature, they will require comprehensive treatment later on
  • Early treatments with proven benefits
    • Ectopic molars
      • These are best treated when they are discovered
      • They are most commonly found as the maxillary first molars erupt
      • If left untreated, ectopic molar eruption may lead to early primary molar loss as well as arch length loss
  •  
  • Early treatments with proven benefits
    • Severe arch length discrepancies
      • >10mm space required
      • Shallow to normal overbite
      • Fuller lips/profile
      • Class I malocclusion
    • Serial extraction, if successful, would still necessitate comprehensive orthodontic treatment
  • Early treatments with proven benefits
    • Pseudo Class III patients
      • Class III patients which have a discrepancy between centric relation and maximum intercuspation may have a pseudo Class III
      • This condition should be treated before it develops into a true Class III malocclusion
  • Early treatments with proven benefits
    • True Class III malocclusions due to a maxillary retrusion
      • This condition is best treated early between the ages of 8-10
      • This is a time when the maxilla is undergoing active growth which can be modified to the patient’s advantage
  •  
  • Early treatments with proven benefits
    • Space maintenance
      • There were two major studies performed with the aim of assessing treatment of crowding in the mixed dentition
      • Both studies evaluated the mandibular dentition as it generally dictates the strategy for future maxillary arch treatment
  • Early treatments with proven benefits
    • Space maintenance
      • In the mixed dentition, crowding was expected in 85% of patients
      • However, when the leeway space was accounted for and preserved with a lower lingual holding arch, 68% of patients exhibited no crowding in the permanent dentition and 87% exhibited crowding of less than 2mm in the permanent dentition
    • Thus, a large proportion of young patients may be well managed simply by preserving the mandibular arch space
    • There is a philosophy of treatment which dictates that early maxillary expansion treatment will remove the constraining influences on the mandibular arch and allow it to develop laterally
    • However, studies have shown that with such treatment, the mandibular intercanine width changes by less than 1mm
  • Early treatments with proven benefits
    • Space maintenance
      • Treatment time for lingual arch space maintenance can be in the late mixed dentition
      • One major exception is the early loss of a primary canine in which case the opposite canine should be removed and a lingual holding arch inserted
      • The treatment with only a simple lingual holding arch has been found to be stable in 76% of cases 9 years into retention
  • Early treatments with proven benefits
    • Space regaining
      • If moderate space regaining is needed in the mandibular arch, up to 1mm, it may be accomplished with a lip bumper
      • It was shown that if more than 1mm of arch length needs to be gained, the final outcome will be unstable
      • In addition, lateral expansion as a way of gaining space will be unstable as it was shown that mandibular intercanine width tends to relapse to its pre-treatment values
  •  
  • References
    • White L. Early Orthodontic Intervention. American Journal of Orthodontics and Dentofacial Orthopedics 1998;113(1):24-28.
    • www.asoorg.au
    • www.alpersdental.co.nz
    • www.umnedudent.al
    • www.azur-orthodontics.com
    • www.cypressbraces.com
    • www.kiferdentalspecialist.com
    • Gianelly AA. Treatment of Crowding in the Mixed Dentition. American Journal of Orthodontics and Dentofacial Orthopedics 2002;121(6):569-571.
    • Gianelly AA. Crowding, Timing of Treatment. Angle Orthodontist 1994;64:415-8.
    • Brennan M, Gianelly AA. The use of the Lingual Arch in the Mixed Dentition to Resolve Crowding. American Journal of Orthodontics and Dentofacial Orthopedics 2000;117:81-5.
  • Thank you.