Preventive and Interceptive Orthodontics in Pediactric Dentistry

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  • Need photos for serial extraction.
  • Preventive and Interceptive Orthodontics in Pediactric Dentistry

    1. 1. PEDIATRIC DENTISTRY SEMINAR ON PREVENTIVE AND INTERCEPTIVE ORTHODONTICS Submitted by Dr Tridib Goswami (2010-11)
    2. 2. PREVENTIVE AND INTERCEPTIVE ORTHODONTICS
    3. 3. Index: • Preventive Orthodontics – – – – Parent Education Caries control Care of Deciduous Dentition Maintenance of quadrant wise tooth shedding time table – Check up of oral habits and habit breaking appliance if necessary – Extraction of Supernumerary teeth – Space maintenance
    4. 4. Index: • Interceptive Orthodontics – – – – – – – Serial Extraction Space regaining Crowding Correction of developing cross-bite Midline Diastema Muscle exercise Interception of skeletal mal-relation • Orthodontic Trainer • Conclusion • Reference
    5. 5. Introduction • Preventive orthodontics is that part of orthodontic practice which is concerned with the patient and parent education, supervision of growth and development of dentition and the cranio-facial structure which is largely the responsibility of a general dentist. • Many of the procedures are common in preventive and interceptive orthodontics but the timings are different.
    6. 6. Introduction • Preventive is undertaken before the malocclusion occurs where as Interceptive is done once the malocclusion has already manifested. • Example : – Extraction of supernumerary teeth is done before they cause malocclusion is preventive whereas in interceptive extraction is done after the damage is done.
    7. 7. Preventive Orthodontics
    8. 8. Definition: • Preventive orthodontics – Graber (1966) has defined preventive orthodontics as the actions taken to preserve the integrity of what appears to be normal occlusion at a specific time.
    9. 9. Parent Education: • Preventive dentistry should ideally begin much before the birth of the child. • The expecting mother should be told about nutrition and ideal environment for the fetus's development. • Soon after birth educate the parent about nursing and care of the child, advise the use of physiological nipple instead of the conventional nipple in case of bottle feeding which may lead to orthodontic problems.
    10. 10. Parent Education • Parent should be educated on nursing bottle syndrome. • Should be taught about maintenance of good oral hygiene and correct brushing habits.
    11. 11. Physiologic nipples,pacifiers , conventional nipples &Nursing bottle caries
    12. 12. Caries Control: • Caries involving proximal surface of deciduous teeth if not restored may lead to the loss of arch length due to mesial drifting and create discrepancies between the arch length and tooth material when the bigger permanent teeth erupt. • Caries should be detected using clinical and radiographic examination.
    13. 13. Care Of Deciduous Dentition • It includes timely check up’s of deciduous dentition and restoration of carious tooth. • As deciduous dentition act’s as an excellent space maintainers care must be taken to prevent premature loss of the teeth. • This can be accomplished by procedures like pit and fissure sealant and fluoride application.
    14. 14. Maintenance Of Quadrant Wise Tooth Shedding Time Table • There should not be more than 3 months difference between shedding deciduous tooth and eruption of permanent teeth. • Factors leading to delay in eruption: – Presence of over retained deciduous tooth roots. – Presence of unresorbed root fragments. – Supernumerary tooth. – Cyst or tumor. – Fibrosis of gingiva – Ankylosed primary teeth.
    15. 15. Check up of oral habits and habit breaking appliance if necessary: • Habits such as finger and thumb sucking , nail biting tongue thrusting and lip biting should be identified and stopped in time so as to prevent mal-occlusion. • Habit breaking appliances can be used to stop these habits, they are of two kinds: – Fixed habit breaker • Example – Blue Grass Appliance – Removable habit breaker • Example – Palatal Crib – Both the appliances act as a reminder and make the habit an unhappy experience.
    16. 16. Adverse Habits Thumb Sucking Effect of thumb sucking Effect of nail biting Effect of lip biting
    17. 17. Habit Breaking Appliance Fixed Removable
    18. 18. Extraction Of Supernumerary teeth: • Presence of supernumerary teeth may interfere with the eruption of nearby normal teeth and cause mal-occlusion, so must be extracted before it causes any such problem. • Presence of an unerupted mesiodense should be identified and extracted before it causes mal-occlusion in this case approximation of the central incisors.
    19. 19. Supernumerary teeth:
    20. 20. Space Maintenance • Space maintenance is done by providing an appliance which only checks space loss and is not concerned with development of dentition. • Premature loss of deciduous teeth can cause drifting of teeth which may lead to loss of space, to prevent this space maintainers are provided.
    21. 21. Ideal requirements: • Maintains mesio-distal dimension of space. • Should not interfere with vertical eruption of adjacent tooth. • Should provide mesio-distal space opening when required. • Maintain individual functional movement of teeth
    22. 22. Classification of Space Maintainers
    23. 23. Removable Space Maintainers Classification:• Unilateral maxillary posterior • Unilateral mandibular posterior • Bilateral maxillary posterior • Bilateral mandibular posterior • Bilateral maxillary anterior and posterior • Bilateral mandibular anterior and posterior • Primary/permanent anterior • Complete primary teeth loss.
    24. 24. Removable Space Maintainers Advantages • Easy to clean permits maintenance of proper oral hygiene. • When appliance not worn allows blood circulation to soft tissue. • Room can be made for the erupting permanent teeth without changing the appliance.
    25. 25. Removable Space Maintainers Disadvantage: • Can be lost or broken by the patient. • Uncooperative patients may not wear the appliance. • May cause irritation to the underlying soft tissue.
    26. 26. Removable Space Maintainers Acrylic Partial Denture • Used in patients who have undergone multiple extraction. • Can be modified to allow eruption of teeth. • Inclusion of artificial teeth in denture restores masticatory function.
    27. 27. Before and after placement of acrylic partial denture
    28. 28. Removable Space Maintainers Full or Complete Denture • In some cases like in Rampant caries all primary teeth may require extraction in which case this complete denture is given. • These dentures not only restore masticatory function along with esthetics, but also guide the I permanent molar into position. • During the eruption of the permanent incisors a portion of the denture is cut away and adjusted accordingly.
    29. 29. Removable Space Maintainers Removable Distal Shoe Space Maintainer: • This is an immediate acrylic partial denture which is put into position immediately after extraction so as to guide the I permanent molar when the II deciduous molar is lost prematurely. • The acrylic extends into the alveolus after removal of the primary tooth which is removed after eruption of the permanent tooth.
    30. 30. Fixed Space Maintainers Advantages: • Bands and loops used require no or minimal tooth preparation. • Jaw growth is not hampered. • Can be used in uncooperative patients. • Masticatory function restored if pontics are used.
    31. 31. Fixed Space Maintainers Disadvantage: • Elaborate instrumentation with expert skill required. • Supra eruption can take place if pontics not used. • There can be decalcification of tooth material under the bands.
    32. 32. Fixed Space Maintainers Band and Loop Space Maintainer: • It is a unilateral fixed appliance used for posterior segments. • Most commonly used space maintainer. • Tooth distal to the extraction site is banded and a loop of thick stainless steel wire is soldered to it with it’s mesial end touching the tooth mesial to the extraction site.
    33. 33. Fixed Space Maintainers Band and Loop Appliance: Construction: • The larger tooth, the II deciduous Molar is used. • A loop of thick stainless steel wire is soldered to the band which spans the edentulous area and contacts the abutment tooth below the contact area. • The loop is contoured to rest on the tissues on both sides with an opening in the loop sufficient to allow eruption of the cusp of the underlying permanent tooth.
    34. 34. Fixed Space Maintainers Band and Loop Space Maintainers: Advantages: • Low cost factor. • Takes little chair time. • Can be adjusted easily to accommodate changing dentition Disadvantages: • Does not prevent continued supra-eruption of opposing tooth. • Caries check is difficult. • Oral Hygiene maintenance is difficult.
    35. 35. Showing band and loop appliance on one side and crown and loop on the other.
    36. 36. Fixed Space Maintainers Crown And Loop Appliance: • In this appliance crown is used along with a loop in the same manner as in band and loop appliance. • Crown is preferred in case of the abutment tooth is highly carious. • In case the abutment tooth has had vital pulp therapy. Construction: • It is the same as that of the band and loop difference being instead of a band a crown is used.
    37. 37. Fixed Space Maintainers Crown And Loop Appliance: Advantage: • The crown increases the life of the underlying weakened tooth. • They also prevent the supra-eruption of the opposing tooth. Disadvantage: • It is difficult to remove the crown to make adjustments in the loop.
    38. 38. Fixed Space Maintainers Lingual Arch Space Maintainers: • Most effective space maintainer for the lingual arch. • Consists of bands on the I permanent molars or II deciduous molars which is joined by a stainless steel wire contacting the lingual surface the 4 mandibular incisors. • This device prevents mesial drifting of the molars and also the lingual collapse of the anterior teeth.
    39. 39. Fixed Space Maintainers Lingual Arch Space Maintainers: Construction: • The wire should be made to contact the cingula of mandibular incisors slightly above the gingival papilla. • Posteriorly the wire extended should maintain 3-4 mm contact with the lingual surface of the band to provide for long solder joint.
    40. 40. Fixed Space Maintainers Lingual Arch Space Maintainers: Advantage: • Allows eruption of permanent teeth without interference. • Ease of cleaning for proper Oral Hygiene. Disadvantage: • May cause unwanted movement. • Does not prevent supra-eruption of opposing teeth.
    41. 41. Lingual Arch Space Maintainer
    42. 42. Fixed Space Maintainers Palatal Arch Appliance/ Nance Palatal Appliance: • It is similar in design as that of the lingual arch difference being the wire does not contact the anterior teeth. • It incorporates an acrylic button in the anterior region that contacts the palatal tissue. • It prevents the mesial drifting of the maxillary molars.
    43. 43. Fixed Space Maintainers Nance Arch Appliance: Construction: • The wire should extend from the deepest and most anterior point in the middle of hard palate. • ‘U’ bend is given in the wire for retention of the acrylic 1-2 mm away from the soft tissue. • The acrylic button provides excellent resistance against forward movement. • Posteriorly the wire is soldered to the molar bands.
    44. 44. Fixed Space Maintainers Palatal Arch Appliance/ Nance Palatal Appliance: • Advantage: • Maintains space bilaterally. • Does not contact the maxillary incisors so better oral hygiene can be maintained. • Disadvantage: • May cause tissue hyperplasia and infection due to poor oral hygiene. • Does not prevent supra-eruption of opposing teeth.
    45. 45. Nance Space Holding Appliance
    46. 46. Fixed Space Maintainers Transpalatal arch: • Stabilizes the maxillary I permanent molars • Consists of thick stainless steel wire that spans the palate connecting the bands on I molar on either side. • Best indicated when one side of the arch is intact and the other has several missing primary teeth.
    47. 47. Fixed Space Maintainers Transpalatal arch appliance: Construction: • The arch is soldered to molar bands present on the I permanent maxillary molars of both sides. • The arch is straight, without any button and does not touch the palate.
    48. 48. Fixed Space Maintainers Transpalatal arch appliance: Advantage: • Prevents rotation of the tooth. • No soft tissue irritation on the palate. Disadvantage: • May cause both the molars to tip together. • Can be used only in the case of unilateral tooth loss, one side must be intact.
    49. 49. Transpalatal arch
    50. 50. Fixed Space Maintainers Distal shoe space maintainer: • This appliance guides the I permanent molar into position when the II deciduous molar is prematurely removed.
    51. 51. Fixed Space Maintainers Distal Shoe Space Maintainer: Construction: • In the lower arch, the contact area of the distal extension should have a slight lingual position while in maxillary should be slightly facial over the crest of the alveolar ridge. • Adequate width must be provided or the tooth may slip. • The length of the distal extension should be the same as the mesio-distal dimension of the II deciduous molar. • The gingival extension should be constructed to extend 1 mm below the marginal ridge.
    52. 52. Fixed Space Maintainers Distal Shoe Space Maintainer: Advantage: • Guides the I permanent molar into it’s position before it’s occlusal eruption. Disadvantage: • Over extension causes injury to permanent tooth bud. • Prevents complete epithelialization of the extraction site.
    53. 53. Interceptive Orthodontics
    54. 54. Definition: • Interceptive orthodontics – The American Association of orthodontists (1969) defined interceptive orthodontics as the phase of science and art of orthodontics employed to recognize and eliminate the potential irregularities and malpositioning in the developing dentofacial complex.
    55. 55. Serial Extraction: • It is correctly timed and planned removal of deciduous and permanent teeth in mixed dentition stage.
    56. 56. Serial Extraction: Indication: – Class 1 anterior crowding. – Lingual eruption of lateral incisors. – Midline shift potential due to unilateral canine loss. – Ankylosis of tooth. Contraindication: – – – – Mild to moderate crowding. Deep or open bite Midline Diastema. Cleft lip and palate cases.
    57. 57. Serial Extraction Advantage: – Better oral hygiene is possible. – It eliminates or reduces the duration of multibanded fixed treatment. – More stable results obtained. Disadvantage: – Treatment time is prolonged. – Extraction of buccal teeth can result in deepening of bite – Requires patient to visit the dentist often.
    58. 58. Space Regaining • The treatment which is done so as to regain the space which is lost due to space closure following early loss of deciduous teeth. • Appliance used for regaining the space are called space regainers.
    59. 59. Fixed Space Regainers Open Coil Space Regainer: • This is a reciprocal active space regainer which is used once the I premolar has erupted so as to create space for the II premolar. Radiograph Showing Pre and Post Space Regaining
    60. 60. Space Regaining Open Coil Space Regainer Construction: • Molar band is fitted on the I permanent molar to which molar tubes are soldered or spot welded horizontally both bucally and lingually. • A stainless steel wire which is slightly smaller than the tube size is selected and bent into a ‘U’ shape, the base of which should contain a reverse bend to contact the distal surface of the I premolar. • A spaced coil is selected which will slide on the wire. • The band is cemented with the spring coil compressed.
    61. 61. Fixed Space Regainers Greber’s Space Maintainer: • This appliance can easily be fabricated in the mouth in a single short appointment. Construction: • A ‘U’ shaped assembly which may be welded or soldered , is fitted in the tube, the appliance placed and the wire section extended to contact the tooth mesial to the edentulous area. • Push coil springs are used which is measured and cut adding 1-2 mm extra to allow spring activation. • The springs are compressed enough to allow the assembly to fit into the edentulous area.
    62. 62. Greber’s Space Regainer
    63. 63. Fixed Space Regainers Hotz Lingual Arch: • This is a device used for moving the molar diatally. • It is best suited for a situation where the I molar had drifted mesially but the premolar or cuspid has not. • Anchorage for movement is achieved as the arch contacts all the teeth.
    64. 64. Fixed Space Regainers Lip Bumper: • The appliance is most easily used for the space regaining procedure in which bilateral Movement is desired. • It is used to relief the lip pressure which can be used to distallize the molars. Construction: • It consists of a heavy labial arch wire over which a heavy acrylic flange is prepared in the anterior region such that it does not contact the lower anterior.
    65. 65. Lip Bumper Pre treatment and post treatment photographs showing distal movement of molars and alignment of the incisors
    66. 66. Fixed Space Regainers Anterior Space Regainer: • This is a device used for anterior space regaining direct bonding is done to attach the labial tubes to the lateral incisors. • The pressure is generated by an activated open coil spring.
    67. 67. Removable Space Regainer Free End Space Regainer: • It utilizes a labial arch wire for stability and retention, with a back-action loop spring . • The base of the appliance is made of acrylic resin. • Movement of the permanent molar is achieved by activating the free end wire loop.
    68. 68. Free End Space Regainer
    69. 69. Removable Space Regainer Split Saddle Space regainer: • In this the functional part of the appliance consists of a block that is split buccolingually and joined by a wire in the form of a buccal and lingual loop. • Appliance is activated by periodic spreading of the loops.
    70. 70. Removable Space Regainer • Jack Screw: • In this appliance the space is regained by expansion of the screw in the edentulous space expanding the plates anterioposteriorly.
    71. 71. Jack Screw Appliance
    72. 72. Crowding • It is a condition where the tooth are not in there normal position in the arch they are abnormally placed. • It occurs when there is inadequate arch circumference to accommodate the teeth in proper alignment.
    73. 73. Crowding Maxillary and Mandibular Arch of the same patient showing crowding
    74. 74. Crowding Options for management of crowding: • Observe – In some cases the crowding is self correcting so, no treatment is required. • Disc Primary Teeth – Sometimes the primary teeth prevents the incisors to align itself, in such cases the primary teeth is proximally stripped using a bur or a proximal stripper. • Extraction Of Teeth – In some cases extraction of teeth is required so as to create space. Proximal Stripper
    75. 75. Correction Of Developing Crossbite: Crossbite : • Anterior cross bite is an abnormal labiolingual relationship between one or more of the anterior teeth while posterior crossbite it is an abnormal bucco-lingual relationship of a tooth or teeth in the maxilla or mandible, or both, in centric relationship.
    76. 76. Classification Of Crossbite: • • • • Anterior or Posterior Unilateral or Bilateral True or Functional Combination of the above
    77. 77. Crossbite Pre treatment and post treatment Photographs
    78. 78. Crossbite Correction can be done by using: • Z – spring • Tongue blade • Lower anterior inclined plane • Appliance with screw and Z – spring • Elastic bands
    79. 79. Use of Z-spring for anterior crossbite correction
    80. 80. Use of tongue blade therapy for anterior crossbite
    81. 81. Use of lower anterior inclined plane to correct anterior crossbite
    82. 82. Correction with appliance incorporating screw and Z-spring
    83. 83. Post treatment
    84. 84. Midline Diastema • It is defined as space greater than 0.5 mm between the proximal surface of adjacent teeth.
    85. 85. Midline Diastema Correction: • Removable Appliance like Active Plate or Split labial bow can be used. • Fixed Appliances like Stainless steel brackets with wire or elastic band or both can be used. • Presently for esthetic reasons lingual appliances may be used for the same.
    86. 86. Reduction of midline diastema
    87. 87. Muscle Exercises • Dental tissues are surrounded by muscles from all directions. • It is vital for these muscles to have normal function for the proper development of dentition. • So as to regain the normal strength of the required muscle certain Muscle exercises are advised.
    88. 88. Muscle Exercises Exercise of the Masseter Muscle: • Patient is asked to clench the teeth while counting up to 10 and then release. • This is repeated for some duration of time.
    89. 89. Muscle Exercises • Exercise for the lips: • Button Pull Exercise – A button of half inch Diameter is used through which a thread is passed n the placed behind the lips, the thread is pulled by the patient while he resist’s the buttons removal from the mouth using lip pressure. • Tug of war exercise – It is similar to the above mentioned difference being two buttons are used, one placed behind the lips and the other is pulled by another person.
    90. 90. Muscle Exercises • Exercise For The Tongue: – One Elastic swallow – Two Elastic swallow • These exercise are used to correct improper swallowing. – The Hold Pull Exercise • This is used to stretch the lingual frenum.
    91. 91. Interception Of Skeletal Malocclusion Interception Of Class II Malocclusion: • Occurs as a result of excessive maxillary growth or a deficient mandibular growth or a combination of both. • Such growth can be restricted with the use of Face bow with head gear. • Treatment is done by myo-facial appliances.
    92. 92. For Class II correction
    93. 93. Interception Of Skeletal Malocclusion Interception Of Class III Malocclusion: • Occurs as a result of mandibular proganthism or maxillary retoganthism or a combination of both. • Chin up with head gear helps in restriction of mandibular growth.
    94. 94. Class III Correction
    95. 95. Pre-orthodontic Trainer • It is pre-fabricated, single size and ready to use. • Requires no impression and takes minimal chair time. • Designed specifically for mixed dentition stage • Two types are available: – Starting/Phase 1, blue in colour and soft to wear. – Finishing/Phase 2, pink in colour and is harder.
    96. 96. Pre-orthodontic Trainer
    97. 97. Conclusion The first step in maintaining good dentition is to maintain good oral hygiene and control abnormal oral habits which itself will reduce the requirement of orthodontic treatment by a substantial amount. The best treatment is prevention, so if at the preventive stage itself we can evade malocclusion it is less traumatic and also cost effective to the patient. If incase we are unable to prevent the malocclusion we must intervene to avoid adverse occlusal and dental consequences. The use of such orthodontics can prevent and stop the occurrence of malocclusion leaving a beautiful arch and a confident smiling face.
    98. 98. S.No. Book Author Editions 1. Text book of Pedodontics Shobha Tandon 2nd 2. Orthodontics S.I. Bhalajhi 4th The Art And Science 3. Dentistry For Child And Adolescent Mc Donald 8th 4. Text Book Of Pedodontics Fenn 4th 5. Principles And Practice Of Arathi Rao 3rd Pedodontics 6. Internet
    99. 99. THANK YOU

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