True benefits of early orthodontic treatment


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True benefits of early orthodontic treatment

  1. 1. True benefits of early orthodontic treatment Children’s Dental World Dr. Milos Lekic
  2. 2. Why treat early <ul><li>Malocclusions may be diagnosed early </li></ul><ul><li>Up until 10 years ago there hasn’t been evidence to point clinicians towards early or late treatment </li></ul><ul><li>Our desire to help patients with concerns and self-esteem considerations </li></ul><ul><li>Commercial influence as manufacturing has been ahead of science </li></ul><ul><li>‘ Practice Efficiency’ </li></ul>
  3. 3. Early treatments with proven benefits <ul><li>Posterior and anterior crossbites </li></ul><ul><li>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 </li></ul>
  4. 4. <ul><li>Possible treatments: </li></ul><ul><ul><li>Removable expansion – slow expansion </li></ul></ul><ul><ul><li>Fixed expansion – slow/fast expansion (Quad-Helix, W-arch) </li></ul></ul><ul><ul><li>Fixed expansion – rapid expansion (RPE) </li></ul></ul>
  5. 5. Early treatments with proven benefits <ul><li>Ankylosed teeth </li></ul><ul><ul><li>Orthodontic treatment is usually warranted as the contralateral successor tooth is erupting </li></ul></ul><ul><ul><li>The successor permanent tooth may need guided eruption </li></ul></ul><ul><ul><li>Ankylosed teeth may be used for anchorage purposes </li></ul></ul><ul><ul><li>It was shown that prolonged retention of ankylosed teeth may lead to a decreased development of the associated alveolar bone </li></ul></ul>
  6. 6. Early treatments with proven benefits <ul><li>Excessive protrusions and diastemas </li></ul><ul><ul><li>These may lead to injury or avulsions </li></ul></ul><ul><ul><li>They are often reasons why kids get teased </li></ul></ul><ul><ul><li>Thus, they affect the child’s self-esteem </li></ul></ul><ul><ul><li>As the condition persists, the mandibular lip may become entrapped behind the maxillary incisors, further perpetuating the problem </li></ul></ul>
  7. 8. <ul><li>A 2x4 appliance may be used to correct the protrusion or to close the diastema space </li></ul><ul><li>Maxillary fixed appliance may be combined with a headgear </li></ul><ul><li>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 </li></ul>
  8. 9. Early treatments with proven benefits <ul><li>Severe anterior or lateral open bites </li></ul><ul><ul><li>These conditions need to be addressed early </li></ul></ul><ul><ul><li>If there is a habit associated with the condition, the habit itself must be dealt with </li></ul></ul><ul><ul><li>The most common cause is a prolonged thumb sucking habit </li></ul></ul><ul><ul><li>If the habit is treated before the permanent anterior dentition erupts, the open bite may resolve spontaneously </li></ul></ul><ul><ul><li>If open bites are of true skeletal nature, they will require comprehensive treatment later on </li></ul></ul>
  9. 10. Early treatments with proven benefits <ul><li>Ectopic molars </li></ul><ul><ul><li>These are best treated when they are discovered </li></ul></ul><ul><ul><li>They are most commonly found as the maxillary first molars erupt </li></ul></ul><ul><ul><li>If left untreated, ectopic molar eruption may lead to early primary molar loss as well as arch length loss </li></ul></ul>
  10. 12. Early treatments with proven benefits <ul><li>Severe arch length discrepancies </li></ul><ul><ul><li>>10mm space required </li></ul></ul><ul><ul><li>Shallow to normal overbite </li></ul></ul><ul><ul><li>Fuller lips/profile </li></ul></ul><ul><ul><li>Class I malocclusion </li></ul></ul><ul><li>Serial extraction, if successful, would still necessitate comprehensive orthodontic treatment </li></ul>
  11. 13. Early treatments with proven benefits <ul><li>Pseudo Class III patients </li></ul><ul><ul><li>Class III patients which have a discrepancy between centric relation and maximum intercuspation may have a pseudo Class III </li></ul></ul><ul><ul><li>This condition should be treated before it develops into a true Class III malocclusion </li></ul></ul>
  12. 14. Early treatments with proven benefits <ul><li>True Class III malocclusions due to a maxillary retrusion </li></ul><ul><ul><li>This condition is best treated early between the ages of 8-10 </li></ul></ul><ul><ul><li>This is a time when the maxilla is undergoing active growth which can be modified to the patient’s advantage </li></ul></ul>
  13. 16. Early treatments with proven benefits <ul><li>Space maintenance </li></ul><ul><ul><li>There were two major studies performed with the aim of assessing treatment of crowding in the mixed dentition </li></ul></ul><ul><ul><li>Both studies evaluated the mandibular dentition as it generally dictates the strategy for future maxillary arch treatment </li></ul></ul>
  14. 17. Early treatments with proven benefits <ul><li>Space maintenance </li></ul><ul><ul><li>In the mixed dentition, crowding was expected in 85% of patients </li></ul></ul><ul><ul><li>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 </li></ul></ul>
  15. 18. <ul><li>Thus, a large proportion of young patients may be well managed simply by preserving the mandibular arch space </li></ul><ul><li>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 </li></ul><ul><li>However, studies have shown that with such treatment, the mandibular intercanine width changes by less than 1mm </li></ul>
  16. 19. Early treatments with proven benefits <ul><li>Space maintenance </li></ul><ul><ul><li>Treatment time for lingual arch space maintenance can be in the late mixed dentition </li></ul></ul><ul><ul><li>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 </li></ul></ul><ul><ul><li>The treatment with only a simple lingual holding arch has been found to be stable in 76% of cases 9 years into retention </li></ul></ul>
  17. 20. Early treatments with proven benefits <ul><li>Space regaining </li></ul><ul><ul><li>If moderate space regaining is needed in the mandibular arch, up to 1mm, it may be accomplished with a lip bumper </li></ul></ul><ul><ul><li>It was shown that if more than 1mm of arch length needs to be gained, the final outcome will be unstable </li></ul></ul><ul><ul><li>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 </li></ul></ul>
  18. 22. References <ul><li>White L. Early Orthodontic Intervention. American Journal of Orthodontics and Dentofacial Orthopedics 1998;113(1):24-28. </li></ul><ul><li> </li></ul><ul><li> </li></ul><ul><li> </li></ul><ul><li> </li></ul><ul><li> </li></ul><ul><li> </li></ul><ul><li>Gianelly AA. Treatment of Crowding in the Mixed Dentition. American Journal of Orthodontics and Dentofacial Orthopedics 2002;121(6):569-571. </li></ul><ul><li>Gianelly AA. Crowding, Timing of Treatment. Angle Orthodontist 1994;64:415-8. </li></ul><ul><li>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. </li></ul>
  19. 23. Thank you.