EARLY-AGE ORTHODONTIC TREATMENT

Aliakbar Bahreman, DDS, MS Clinical Professor Orthodontic and Pediatric Dentistry Programs Eastman Institute for Oral Health University of Rochester Rochester, New York

Quintessence Publishing Co, Inc

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Bahreman_FM.indd iii 3/19/13 11:42 AM Contents

Foreword by J. Daniel Subtelny vii Preface and Acknowledgments viii–ix Introduction x

Part I Clinical and Biologic Principles of Early-Age Orthodontic Treatment 1 1 Rationale for Early-Age Orthodontic Treatment 3 2 Development of the Dentition and Dental Occlusion 15 3 Examination, Early Detection, and Treatment Planning 41

Part II Early-Age Orthodontic Treatment of Nonskeletal Problems 71 4 Space Management in the Transitional Dentition 73 5 Management of Incisor Crowding 105 6 Management of Deleterious Oral Habits 131 7 Orthodontic Management of Hypodontia 157 8 Orthodontic Management of Supernumerary Teeth 189 9 Diagnosis and Management of Abnormal Frenum Attachments 205 10 Early Detection and Treatment of Eruption Problems 225

Bahreman_FM.indd v 3/19/13 11:42 AM Part III Early-Age Orthodontic Treatment of Dentoskeletal Problems 291 11 Management of Sagittal Problems (Class II and Class III Malocclusions) 293 12 Management of Transverse Problems (Posterior Crossbites) 355 13 Management of Vertical Problems (Open Bites and Deep Bites) 377

Index 417

Bahreman_FM.indd vi 3/19/13 11:42 AM Foreword

This book is a compendium of signifi cant and pertinent in- both undergo varying infl uences as well as grow in varying formation related to early-age orthodontic treatment, a sub- directions. Early-age orthodontics necessitates recognition ject that seems to have evolved into one of considerable of this process and aims to alter and redirect it whenev- controversy, with as many orthodontists expressing a nega- er feasible and possible. Dr Bahreman has undertaken a tive reaction as a positive reaction to its benefi ts. Dr Bahre- monumental effort in directing efforts along this path. An man is a believer in early-age orthodontic treatment, and he extensive exploration of the literature is an added bonus, as expresses some cogent arguments founded in years of ex- the mechanical approaches are based on this literature. In perience in practice and teaching to back up his beliefs. In fact, the extensive review of the literature and its applica- developing his treatise, Dr Bahreman outlines the develop- tion to diagnosis and varying forms of therapy are worth a ment of the occlusion and/or malocclusion from the embry- veritable fortune. onic stages, when the foundation of the jaws and thereby You may or may not agree with the basic premises, but the position of the dentition is fi rst established. you will have access to important information that will wid- Early-age orthodontics is not about the time it takes to en your scope of vision and thereby widen your treatment orthodontically treat a problem; it is a story of growth, of horizons. To my mind, an ounce of prevention, if possible, is variation in anatomy, and of muscle function and infl uenc- worth a pound of cure. The reality of prevention can exist at es, a realization that it is the jaws that contain the teeth the earliest stages of development. and that where the jaws go, the teeth will have to go, and

J. Daniel Subtelny, DDS, MS, DDSc(Hon) Professor Emeritus Interim Chair and Director of Orthodontic Program Eastman Institute for Oral Health University of Rochester Rochester, New York

vii

Bahreman_FM.indd vii 3/19/13 11:42 AM Preface

After obtaining a master’s degree in orthodontics in 1967, I To understand the morphogenesis of nonskeletal and skel- began my career at a newly founded dental school in Tehran. etal occlusal problems, to detect problems early, and to inter- My responsibilities included teaching and administrative du- vene properly, we must look at all areas of occlusal develop- ties at the university and maintenance of a very busy private ment, including prenatal, neonatal, and postnatal changes of practice. In addition, I established both the orthodontic and the dentoskeletal system, and explore all genetic and envi- pediatric dentistry departments at the university. ronmental factors that can affect occlusion at different stages Many patients were being referred to the orthodontic de- of development. In other words, we must have a profound partment, and there were no qualifi ed faculty members to understanding of the fundamental basis and morphogenesis help me provide care. To rectify the situation, I designed an of each problem and then apply this knowledge to clinical advanced level, comprehensive curriculum in orthodontics practice. Thus, the goals of this book are: for undergraduate students, including classroom instruction, laboratory research, and clinical demonstrations. Once the • To provide a comprehensive overview of all areas of dental students completed the course, they could work in the clinic, development, from tooth formation to permanent occlu- thus temporarily solving the issue of the heavy patient load sion, to refresh the reader’s memory of the fundamentals in the orthodontic clinic. With additional staff now available, I necessary for diagnosis and treatment planning. could select patients, mostly children in the primary or mixed • To emphasize all the important points of the developmen- dentition, for some interceptive treatment. tal stages that must be recognized during examination of Despite my diffi culties in performing all of the aforemen- the patient to facilitate differential diagnosis. Each tooth can tioned duties, this situation had a fortunate outcome. It helped become anomalous in a number of ways and to different me to understand and discover the advantages of early-age degrees. Occlusion and maxillomandibular relationships orthodontic treatment, which was not common in those can vary in the sagittal, transverse, and vertical directions. years. During my more than 40 years of practice and teaching, • To discuss the application of basic knowledge to practice by especially in early orthodontic treatment, I have accumulated presenting several cases with different problems and differ- a considerable amount of educational data for teaching pur- ent treatment options. poses. I would like to share this experience and information • To demonstrate the benefi ts of early-age orthodontic treat- with readers. ment, achieved by intervention in developing malocclusion The public’s growing awareness of and desire for dental and guidance of eruption. services, especially at an early age, have encouraged our pro- fession to treat children earlier. Despite the recommendation Materials are presented in three parts: In Part I, “Clinical and by the American Association of Orthodontists that orthodon- Biologic Principles of Early-Age Orthodontic Treatment,” three tic screening begin by the time a child is 7 years old, many chapters introduce and explain the concept of early-age treat- orthodontists still do not treat children prior to the complete ment, describe its necessity and advantages, and discuss the eruption of the permanent teeth. I believe that this inconsis- controversies surrounding this topic; discuss the basic foun- tency is due to the educational background of orthodontists dation of occlusal development, empowering the practitioner as well as a lack of familiarity with recent technical advance- to detect anomalies and intervene as necessary; and illustrate ments and the various treatment options that are available for the procedures, tools, and techniques available for diagnosis, young patients. emphasizing differential diagnosis and treatment planning for The therapeutic devices available for this endeavor are not early-age treatment. complex, but deciding which ones to use and when to employ Part II, “Early-Age Orthodontic Treatment of Nonskeletal them are important steps. As we make these decisions, we Problems,” consists of seven chapters describing the non- should also remember not to treat the symptom but rather to skeletal problems that might develop during the primary and treat the cause. My goal is to present the basic information mixed dentitions. The chapters explain the ontogeny, diagno- necessary to understand the problems, to differentiate among sis, and early detection of, and intervention for, these prob- various conditions, and to review different treatment options. lems. Topics include space management, crowding, abnormal Case reports are examined to facilitate clinical application of oral habits, abnormal frenum attachment, hypodontia, super- the theory in a rational way. numerary teeth, and abnormal eruption problems.

viii

Bahreman_FM.indd viii 3/19/13 11:42 AM Part III, “Early-Age Orthodontic Treatment of Dentoskeletal This book will provide the reader with a fi rm foundation of Problems,” consists of three chapters on early intervention the basic science and case examples with various treatment for the dentoskeletal problems that might arise during the pri- options. It is my hope that the information provided will pro- mary and mixed dentitions in the three dimensions: sagittal mote a better understanding of abnormalities and their causes problems (anterior crossbite and Class II and Class III maloc- and enable readers to recognize the clues for early detection clusions); transverse problems (posterior crossbites); and ver- and intervention. tical problems (open bites and deep bites).

Tehran, whose dedication as an educator and preparation Acknowledgments of superb histologic slides is remarkable and who allowed me to use his slides in my publication; Mr Aryan Salimi for First and foremost, I would like to gratefully acknowledge scanning some of the slides and radiographs in this book; the valuable opportunity that was afforded me as a student and Ms Elizabeth Kettle, Program Chair of the Dental Sec- in Dr Daniel Subtelny’s orthodontic program. Between 1964 tion of the Medical Library Association, head of Eastman’s and 1967, I completed both my orthodontic specialty and library, for her sincere help in editing this publication. master degree programs with Dr Subtelny as my mentor. As Finally, I wish to acknowledge the constant support of chairman and program director, researcher, and mentor, Dr my family: Malahat, Nasreen, Saeid, Alireza, Tannaz, and Subtelny has dedicated over 57 years of his life to teaching, Peymann Motevalei. Especially high gratitude goes to my personally infl uencing the lives of over 350 students from wife, Malahat, for her tolerance, support, and encourage- around the world, myself included. In 1999, after over 32 ments. I also want to thank my son Alireza for his technical years of teaching, practicing, and administrating in Tehran, I help and guidance in computer skills and my granddaughter was fortunate enough to return to the Eastman Institute for Tannaz Motevalei for drawing some of the illustrations. Oral Health to work alongside Dr Subtelny as a faculty mem- This publication is the product of 17 years spent orga- ber in the Orthodontic and Pediatric Dentistry Programs. nizing materials derived from my 45 years of practice and In addition to Dr Subtelny, there are several individuals to teaching as well as reviewing hundreds of articles and whom I would like to express my deep gratitude for their books. I herewith dedicate this book to the teachers, practi- help and encouragement in preparation of this book: the tioners, residents, and students who are dedicated to treat- late Dr Estepan Alexanian, head of the Department of His- ing malocclusion earlier in children, before it becomes more tology at the Shahid Beheshti University Dental School in complicated and costly.

ix

Bahreman_FM.indd ix 3/19/13 11:42 AM Introduction

Occlusal development is a long process starting around the has erupted, at approximately 12 years. The controversy sur- sixth week of intrauterine life and concluding around the age rounding early versus late treatment is often confusing to of 20 years. This long developmental process is a sequence the dental community; therefore, clinicians must decide on of events that occur in an orderly and timely fashion under a case-by-case basis when to provide orthodontic treatment. the control of genetic and environmental factors. Dental oc- Indeed, there are occasions when delaying treatment until a clusion is an integral part of craniofacial structure and coordi- later age may be advisable. nation of skeletal growth changes. Occlusal development is The long-term benefi ts of early treatment are also con- essential for establishing a normal and harmonious arrange- troversial. The majority of debates seem to revolve around ment of the occlusal system. early or late treatment of Class II malocclusions. There is less As we learn about craniofacial growth changes, the poten- controversy regarding many other services that can be per- tial infl uences of function on the developing dentition, and formed for the benefi t of young patients during the primary the relationships of basal jawbones and head structure, we or mixed dentition, such as treatment of anterior and poste- acquire a better understanding of when and how to inter- rior crossbite, habit control, elimination of crowding, space vene in the treatment guidance for each patient. It is more management, and management of eruption problems. effective to intervene during the primary or mixed dentition Practitioners who are in favor of early treatment of Class II period to reduce or, in some instances, avoid the need for problems contend that early intervention is the best choice multibanded mechanotherapy at a later age. for growth modifi cation when the problem is skeletal and Untreated malocclusions can result in a variety of prob- especially when it results from mandibular retrusion. On the lems, including susceptibility to dental caries, periodontal other hand, opponents believe that there is no difference in disease, bone loss, temporomandibular disorders, and un- the fi nal result and that a single-phase treatment approach is desirable craniofacial growth changes. Moreover, the child’s preferable because of the advantages that accompany the appearance may be harmed, which can be a social handicap. reduced treatment time. The benefi ts of improving a child’s appearance at an early Unfortunately, some practitioners, without a profound age should not be undervalued. The goals of many clinicians evaluation of the indications for early treatment, conclude who provide early treatment are not only to reduce the time that late treatment is always preferable. However, broad and complexity of comprehensive fi xed appliance therapy conclusions drawn from narrowly focused research can be but also to eliminate or reduce the damage to the dentition misleading. One cannot conclude that no birds can fl y by and supporting structures that can result from tooth irregu- considering the fl ight characteristics of the ostrich. larity at a later age. In short, early intervention of skeletal and To evaluate and demonstrate the benefi ts of early treat- dental malocclusions during the primary and mixed dentition ment, I aim to discuss and clarify available treatments and stages can enable the greatest possible control over growth services and discuss cases with different problems and dif- changes and occlusal development, improving the function, ferent treatment options. An understanding of all aspects of esthetics, and psychologic well-being of children. early treatment requires a thorough knowledge of the basics For many decades, orthodontists have debated about the of embryology, physiology, and growth and development. best age for children to start orthodontic treatment. While we This includes development of the dentition, tooth formation, agree on the results of high-quality orthodontic treatment, eruption, exfoliation, and all transitional changes. Therefore, we often differ in our opinions as to how and when to treat my other goal is to integrate the basic science and the clini- the patient. Some practitioners contend that starting treat- cal, in order to refresh the reader’s memory on important ment in the primary dentition is the most effective means of points about the bases of nonskeletal and skeletal problems orthodontic care. Others prefer to begin the treatment in the that can arise during the transitional stages of occlusion. mixed dentition. There is also controversy about whether the Each patient who enters our practice represents a new early, middle, or late mixed dentition is preferable. chapter and a new lesson that we can learn from. A thorough Despite the fact that the American Association of Ortho- knowledge of the basis for early-age orthodontic treatment, dontists recommends that orthodontic screening be started an understanding of the proper treatment techniques, and by the age of 7 years, many orthodontists do not treat chil- a willingness to consider their appropriateness for each in- dren prior to the eruption of permanent teeth, and some dividual patient will allow us to intervene in ways that will postpone the treatment until the full permanent dentition provide the maximum benefi t for a young and growing child.

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Bahreman_FM.indd x 3/19/13 11:42 AM PART CLINICAL AND I BIOLOGIC PRINCIPLES OF EARLY-AGE ORTHODONTIC TREATMENT

Bahreman_CH01.indd 1 3/18/13 10:26 AM Rationale for Early-Age 1 Orthodontic Treatment

In the past, orthodontic treatment has been focused mainly on juvenile and adult treatment. Treatment options for patients in these age groups often are limited by complex dental and orthodontic problems and the lack of suffi cient future cranio- facial growth. During the later part of the 18th century, orthodontic treatment of Class II malocclusion was limited primarily to retrac- tion of the maxillary anterior teeth to decrease excessive overjet. In 1880, Norman Kingsley1 published a description of techniques for addressing protrusion. He was among the fi rst to use extraoral force to retract the maxillary anterior teeth after extraction of the maxillary fi rst premolars; the extraoral force was applied with headgear. Later, Case2 continued to refi ne these methods. Angle’s classifi cation3 of malocclusion, published in the 1890s, provided a simple defi nition of normal occlusion and was an important step in the development of orthodontic treatment. Angle opposed the extraction of teeth and favored the preservation of the full dentition. His position against tooth extraction led him to depend on extraoral force for the expan- sion of crowded dental arches and retraction of the anterior segment. Later he discontinued the use of extraoral force and advocated the use of intraoral elastics to treat sagittal jaw discrepancies. Because of Angle’s dominating belief that treatment with Class II elastics was just as effective as extraoral force, the use of headgear was abandoned by the 1920s. Then, in 1936, Oppenheim4 reintroduced the concept of extraoral anchorage, employing extraoral traction to treat maxillary protrusion. Accepting the position of the mandible in Class II malocclusions, Oppenheim attempted to move the maxillary dentition distally by employing a combination of occipital anchorage and an E-arch, allowing the mandible to continue its growth. This resulted in an improved relationship with the opposing jaw. In 1947, Silas Kloehn5 reintroduced extraoral force, in the form of cervical headgear, for the treatment of skeletal Class II relationships. In 1944, another student of Angle’s, Charles Tweed,6 was discouraged by the prevalence of relapse in many of his pa- tients treated without extraction, so he decided to oppose the conventional wisdom of nonextraction. In the early part of the 20th century, there was optimism about the infl uence of orthopedic force on skeletal growth. An almost universal belief was that orthodontic forces, if applied to the growing face, could alter the morphologic outcome. In the United States, headgear was the principal appliance used for facial orthopedic treatment, whereas in Europe the functional appliance was predominantly used. In 1941, Alan Brodie,7 one of Angle’s students, concluded that the growing face could not be signifi cantly altered from its genetically predetermined form and that the only option for the orthodontist in cases of skeletal malocclusion would be dental camoufl age, or the movement of teeth within their jaws. This idea led to tooth extraction.

3

Bahreman_CH01.indd 3 3/18/13 10:26 AM 3 Examination, Early Detection, and Treatment Planning

Panoramic radiographs Longitudinal Panoramic The panoramic radiograph is a common diagnostic tool in Radiograph Monitoring today’s dental practice. It is a kind of radiograph that pro- vides a full picture of the dentition and the complete maxilla and mandible. Over many years of teaching and practice, in both pediat- Panoramic radiographs do not show the fi ne detail ric dentistry and orthodontic departments, the author be- captured on intraoral radiographs and are not as specifi c came interested in conducting a retrospective evaluation as other intraoral radiographs, but in a single radiograph it of patients who were referred for some type of orthodontic provides a useful general view of all dentition, the maxilla problem and who had previous panoramic radiographs avail- and mandible, the sinuses, and both TMJs. This type able. This retrospective evaluation led to the conclusion that of radiograph is very useful, especially during the mixed the longitudinal monitoring of panoramic radiographs dur- dentition, for early detection and prevention of all problems ing the mixed dentition is a very valuable, easy technique disturbing the normal development of occlusion. that enables detection of developmental anomalies during Especially during the mixed dentition as a diagnostic the transitional dentition. Today the author strongly recom- tool for early-age orthodontic treatment, the following are mends this easy and very useful technique to all practitio- important aspects that should be carefully evaluated on a ners, especially pediatric dentists and orthodontists. panoramic radiograph before any orthodontic treatment: The transitional dentition is one of the most critical stages of the dentition, and many eruption problems, whether • Position and pattern of fully emerged as well as emerging hereditary or environmental, emerge during this stage. permanent teeth Longitudinal panoramic radiograph monitoring is a careful • Sequence of permanent tooth eruption serial monitoring technique that any practitioner can perform • Asymmetric eruption for young patients during transitional dentition to watch for • Comparison of crown height levels on the left and right developmental anomalies that may arise at these ages. sides The technique the author recommends is to take one • Obstacles preventing eruption panoramic radiograph when the patient is around the age • Abnormal tooth malformations (gemination, fusion, dens of 6 years (during the eruption of the permanent fi rst molar) in dente, or dilaceration) and then two more panoramic radiographs at 8 and 10 years • Exfoliation and pattern of primary teeth root resorption of age. Careful comparison of two or three consecutive • Tooth number and supernumerary teeth or congenitally radiographs of a patient at this stage of the dentition missing teeth can easily reveal any abnormal developmental processes • Eruption problems, such as impaction, ectopic, transposi- emerging between radiographs and therefore can enable tion, or ankylosis early detection and intervention. The following three cases • Bone density and trabeculation illustrate the advantages of longitudinal monitoring of • Cysts, odontomas, tumors, and other bone defects or panoramic radiographs and proper intervention. pathologic lesions • Third and second molar positions, inclinations, and rela- tionships to the fi rst molars and ramus edge • Shape of the condylar head and ramus height • Comparison of the left and right condylar heads and rami

The characteristics and management of these problems are discussed in their related chapters in part 2 of this book. Chapter 10 introduces a simple and practical technique for application of panoramic radiographs to assess canine im- paction.

60

Bahreman_CH03.indd 60 3/18/13 2:33 PM Longitudinal Panoramic Radiograph Monitoring

Case 3-1

This case confi rms the importance of longitudinal radiographic evaluation, indicating how early interven- tion could have helped this little girl. Figures 3-23a to 3-23c are three consecutive radiographs found in her record. A periapical radiograph reveals the fi rst sign of a problem, that is, asymmetric eruption of the central incisors at age 7 years. A panoramic radiograph taken about 15 months later shows the eruption of both central incisors and the asymmetric position of the lateral incisors. A third radiograph, a panoramic radiograph taken about 7 months later, reveals that the left lateral incisor had erupted while the right lateral incisor remained unerupted. The important, detectable abnormal sign in this radiograph is the abnormal position of the maxillary permanent right canine in relation to the unerupted lateral incisor; unfortunately, no intervention was performed at this point, and the patient did not return until 3 years later. Figures 3-23d and 3-23e present the last panoramic and occlusal views, showing the complete resorption of the permanent lateral incisor root.

Possible intervention: Assessment of the available serial radiographs indicates that the best treatment option was early inter- vention and extraction of the maxillary primary right canine when the fi rst (see Fig 3-23b), or even the second (see Fig 3-23c), panoramic radiograph was taken. Extraction of the maxillary primary right canine would have facilitated and accelerated eruption of the permanent lateral incisor, moving this tooth away from the canine forces and preventing root resorption (see Figs 3-23d and 3-23e).

a b

c d

Fig 3-23 (a) Periapical radiograph showing asymmetric eruption of the maxillary central incisors. (b) Panoramic radiograph taken about 15 months later, showing the eruption of both central incisors and the asymmetric position of the lateral incisors. (c) Panoramic radiograph taken 7 months after the fi rst panoramic radio- graph, revealing that the right lateral incisor remains unerupted. Panoramic (d) and occlusal (e) radiographs taken 3 years later. In the absence of treatment, the e permanent lateral incisor has undergone complete root resorption.

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Bahreman_CH03.indd 61 3/18/13 2:33 PM 4 Space Management in the Transitional Dentition

Fig 4-17 Fixed unilateral sliding loop space Fig 4-18 Gurin lock space regainer. Fig 4-19 Band and U-loop space regainer. regainer. (Courtesy of Great Lakes Orthodontics.)

Fig 4-20 Molar distalizer with Nance anchorage. (a) Space loss at the time of abappliance placement. (b) Space regained at the end of treatment.

Fig 4-21 Mandibular molar distalizer. (Courtesy Fig 4-22 Pendulum distalizer with spring Fig 4-23 Distal jet appliance for molar distal- of Great Lakes Orthodontics.) activation on the right molar. The distalizer ization. (Courtesy of Great Lakes Ortho- in this image also includes a screw for dontics.) expansion.

This type of unilateral regainer is recommended in cases is inserted in the palatal tube, making the spring removable where the force is to be directed only to the molar in the (Fig 4-22). The appliance can be activated at each appoint- maxillary dentition. ment. This type of distalizer is indicated for the permanent dentition, in cases of space loss or Class II molar correc- Sliding loop and lingual arch. This appliance is designed tion. similarly to the sliding loop regainer, but it includes a lingual holding arch connected to the opposite molar band to pro- Distal jet appliance. The distal jet appliance is also a fi xed vide anchorage and prevent adverse effects on the anterior unilateral or bilateral distalizer with an acrylic resin button component (Fig 4-21). for anchorage. Bands are cemented to the anterior abut- ment, and two bars with open coil spring slide to embed- Pendulum appliance (molar distalizer). The pendulum ded tubes for activation. The bars connected to the molar appliance is a fi xed bilateral or unilateral molar distalizer. It palatal tube can be removed, and the push coil can be re- is designed with two bands cemented to the primary fi rst activated (Fig 4-23). molars or the premolars and an acrylic resin button touch- ing the palate to provide good anchorage. One end of a 2 × 4 bonding. Molar distalization and space regaining can β-titanium spring is embedded in acrylic and the other end be achieved as a part of 2 × 4 bonding in patients who need

88

Bahreman_CH04.indd 88 3/18/13 2:57 PM Space Regaining

a b

Fig 4-24 (a to d) Push coil and 2 × 4 bonding to regain space for the maxillary second c d premolars.

ab

Fig 4-25 Sectional bracketing to open space for the maxillary right premolar.

c d

Fig 4-26 Hawley removable space regainers with jackscrews. (a and b) Bilateral removable regainers for the maxilla. (c) Bilateral removable regainer for the mandible. (d) Unilateral removable regainer for the maxilla.

incisor alignment (such as space closure, crossbite correc- molar. Sectional bracketing of this segment, leveling with a tion, or midline shift) during the early or middle mixed denti- sectional archwire, and placement of a push coil between tion. A light force can be applied to molars by a push coil the tipped molar and premolar can open space and upright inserted between lased incisors and the permanent molar the adjacent teeth. tube (Fig 4-24). Removable space regainers Sectional bracketing. In patients with normal occlusion and space loss in one quadrant, minor tooth movement and Removable appliances can also be used for space regaining space regaining can be achieved by sectional bracketing. as well as space maintenance. This can be accomplished by Figure 4-25 shows a patient with a good Class I mandibular incorporating different springs or screws in the appliance, and maxillary left dentition. The problem is space loss at the either unilaterally or bilaterally. A Hawley appliance with maxillary right second premolar site that has resulted from different modifi cations is a simple, effective appliance that mesial tipping of the molar and distal tipping of the fi rst pre- can be used for all of these purposes (Fig 4-26).

89

Bahreman_CH04.indd 89 3/18/13 2:57 PM 8 Orthodontic Management of Supernumerary Teeth

a b c

d e f

g h Fig 8-5 (a to h) Various supernumerary teeth, affecting occlusion in many different ways.

ab

Fig 8-6 Supplemental mandibular supernu- Fig 8-7 (a) Parapremolar supernumerary teeth preventing eruption of mandibular premo- merary tooth (arrow) causing crowding, mid- lars. (b) Paramolar supernumerary teeth damaging the permanent fi rst molar roots. line shift, and arch asymmetry. Early Recognition and Clinical examination Clinical Signs of Hyperdontia Clinical examination of children during the primary or mixed dentition is discussed in detail in chapter 3. When assess- ing supernumerary teeth in the developing occlusion of Development of supernumerary teeth can occur any time a child, the clinician must consider the number, size, and during the primary dentition, mixed dentition, and the per- form of teeth, the eruption time, the sequence of eruption, manent dentition. They are almost always harmful to adja- the position of each tooth, and local and general factors cent teeth and to the occlusion. Most cases of supernumer- that can affect occlusion during transitional changes. The ary teeth are asymptomatic and are usually found during following are clinical signs of the presence of supernumer- routine clinical or radiologic investigations. Therefore, early ary teeth: recognition of and treatment planning for supernumerary teeth are important components of the preliminary assess- • Abnormal pattern and abnormal sequence of eruption ment of a child’s occlusal status and oral health, which is • Delayed eruption based on careful clinical and paraclinical examinations. • Absence of eruption

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Bahreman_CH08.indd 196 3/19/13 8:49 AM 9 Diagnosis and Management of Abnormal Frenum Attachments

Case 9-2

A 10-year, 8-month-old girl exhibited a Class II division 1 malocclusion and maxillary and mandibular incisor protrusion. In addition, an invasive frenum attachment caused severe maxillary incisor crowding, displacement, and cystic formation (Figs 9-19a to 9-19e).

Treatment: The treatment plan included removal of the frenum, the cyst, and all abnormal soft tissue attachment and extrac- tion of the four fi rst premolars, carried out as a serial step-by-step extraction. After the surgical procedure and tissue healing, a removable maxillary Hawley appliance was inserted to achieve slow, minor incisor alignment, and use of a lower holding arch for about 1 year was followed by step 1 of the extraction series: removal of the maxillary primary canines, both maxillary primary fi rst molars, and both mandibular primary fi rst molars. Figure 9-19f shows alignment of the maxillary incisors and the canine bulges before serial extraction. Step 2 was extraction of all four fi rst premolars. Maxillary anchorage was prepared with a Nance appliance, and the lower holding arch was removed as reciprocal anchorage. Step 3 of the extraction sequence was removal of the remaining primary second molars. This was followed by maxillary and mandibular bonding to start maxillary canine retraction. Then mandibular and later anterior retrac- tion and space closure were accomplished. Some mesial movement of the mandibular molars was allowed, in order to achieve a Class I molar relationship (Figs 9-19g to 9-19k).

a b c

d e

f g h

i j k

Fig 9-19 Treatment of a 10-year, 8-month-old girl with a Class II division 1 malocclusion and maxillary and mandibular protru- sion. An invasive frenum attachment has caused tooth displacement, maxillary incisor crowding, and formation of a cyst. (a to c) Pretreatment occlusion. (d) Pretreatment panoramic radiograph. (e) Pretreatment cephalometric radiograph. (f) Tissue heal- ing and some incisor alignment. The arrows show canine bulge. (g to i) Posttreatment occlusion. (j) Posttreatment panoramic radiograph. (k) Posttreatment cephalometric radiograph.

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Bahreman_CH09.indd 218 3/19/13 9:00 AM 10 Early Detection and Treatment of Eruption Problems

3 C2 1

a b c

d e f

g h i

j k l

Fig 10-18 Management of an ectopic maxillary canine that has caused resorption of the permanent central incisor root and subsequent exfoliation. (a to c) Pretreatment occlusion. (d) Pretreatment panoramic radiograph. (e to h) Occlusion during active treatment and level- ing. The canine bracket has a higher K distance to achieve elongation. (i to l) Posttreatment occlusion, after end of active treatment and reshaping of the canine to mimic the central incisor. 1—permanent central incisor; 2—permanent lateral incisor; 3—permanent canine; C—primary canine.

transposition (Fig 10-19). In complete transposition, both Tooth Transposition the crowns and the entire root structures of the involved teeth are displaced to abnormal positions. In incomplete Another kind of eruption disturbance is tooth transposition, transposition, only the crown of the involved tooth is trans- or positional interchange of two adjacent teeth, especially posed, and the root apices remain in place. their roots. Tooth transposition is a rare but clinically diffi - Transposition is sometimes accompanied by other dental cult developmental anomaly. Depending on the transposed anomalies, such as peg-shaped lateral incisors, congenitally teeth and their position, normal eruption of adjacent teeth missing teeth, crowding, overretained primary teeth, dilac- can be affected, root anatomy can be damaged, and erup- erations, and rotation of adjacent teeth. tion of the affected teeth can be delayed. This eruption Displacement of one tooth from one quadrant across the disturbance was fi rst defi ned in 1849 by Harris,50 who de- midline to the other side of the arch has very rarely been re- scribed tooth transposition as an “aberration in the position ported, but according to Shapira and Kuftinec51 these types of the teeth.” of anomalies should be considered ectopically erupted Transposed teeth are classifi ed into two types of tooth teeth, not transposed teeth. displacement: complete transposition and incomplete

244

Bahreman_CH10.indd 244 3/19/13 9:55 AM Simple Dental Crossbite

Case 11-9: Anterior dental crossbite

A 10-year-old girl in the middle mixed dentition presented with a Class III molar relationship on the right side because of space loss, 0- to 1-mm overbite and overjet, and three maxillary incisors in crossbite. Treatment had been delayed, causing severe crowding of the mandibular incisors and ectopic eruption of the mandibular right lateral incisor (Figs 11-18a to 11-18f).

Treatment: Because of the severe crowding and displacement of incisors, the treatment plan incorporated fi xed appliances with maxillary and mandibular 2 × 6 bonding. The fi rst step in treatment was 2 × 4 maxillary bonding, mandibu- lar fi rst molar occlusal bonding to disocclude the anterior segment, and placement of 0.016-inch nickel-titanium maxillary arches (cinched back) for leveling and release of abnormal anterior contact. The second step was placement of 0.016-inch stainless steel maxillary arches with an open U-loop mesial to the molar tube (extended arch length) to procline the maxillary incisors out of crossbite. The third step was mandibular 2 × 4 bonding: fi rst with 0.014-inch nickel-titanium archwire because of severe crowding and later with 0.016-inch nickel-titanium archwire for further leveling. The fourth step was use of an open U-loop to place an extended-length stainless steel archwire against the mandibular molar tube to achieve minor mandibular incisor proclination in order to gain space and align the man- dibular incisors. The final step was bonding the permanent canines after eruption for fi nal anterior alignment. Figures 11-18g to 11-18k show the treatment outcome.

a b c

d e f

g h i

Fig 11-18 Management of incisor cross- bite in a 10-year-old girl. The locked oc- clusion has resulted in severe displace- ment and crowding of the mandibular incisors as well as ectopic eruption of the mandibular right central incisor. (a to e) Pretreatment occlusion. (f) Pretreat- ment panoramic radiograph. (g to j) Post- treatment occlusion. (k) Posttreatment j k panoramic radiograph.

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Page numbers with “t” denote tables; those with “f” denote fi gures; those with “b” denote boxes

A Anterior Bolton discrepancy, 209 tooth size and, discrepancy Acellular cementum, 23 Anterior crossbite between, 106–107 Achondrodysplasia, 230 case studies of, 320f–322f transitional dentition changes Acrodynia, 236 cephalometric evaluation of, 316 in, 38 Active holding arch, 82, 83f Class III malocclusion and, 316 physiologic changes in, 29 Active lingual arch, 92 clinical examination of, 316 required space in, 53 Adenoid facial type, 146 differential diagnosis of, 316 symmetry of, 52, 53f Age of patient Hawley appliance for, 319 Arnold expander, 363, 363f midline diastema and, 210 illustration of, 49f, 257f Asymmetric tooth eruption, 240–241 for orthodontic screening, 7 incisor, 317, 318f, 321f Atavism theory, 192 serial extraction considerations, maxillary canine impaction and, Autotransplantation 117 257f canine impaction treated with, 265 space loss affected by, 76 in mixed dentition, 321f disadvantages of, 171 Agranulocytosis, 236 simple lateral incisor hypodontia treated Alginate, 51 defi nition of, 316 with, 171 Alkaline phosphatase, 20, 235 etiology of, 317, 318f mandibular second premolar Allergies incidence of, 316 hypodontia treated with, 174 hypodontia and, 162 signs of, 317 mouth breathing and, 147 single-incisor, 320f B Alveolar bone, 24 treatment of, 319, 347f–351f Band and loop space maintainer, 82, Alveolar process Anterior open bite 83f development of, 225 anterior tongue thrust and, 142 Band and occlusal bar, 84, 84f function of, 26 illustration of, 49f Band and pontic, 84, 84f growth of, 26 lisping caused by, 50 Band and U-loop space regainer, 87, maxilla and mandible relationship thumb sucking as cause of, 133, 134f 88f to, 37 Anterior provisional partial denture, Behavioral evaluation, 43 Alveolar ridge, 233 84–85, 85f Behavioral modifi cation, for non- Ameloblasts, 18, 19f, 20 Anterior teeth nutritive sucking, 135 Amelogenesis, 20 early loss of, 84 Bipupillary plane, 56 Amelogenesis imperfecta, 19 protrusion of, 90 Bite guards, 152 Amelogenin, 21 Anterior tongue thrust, 141, 141f Bite plate, 403–404, 404f Anchored space regainers, 87–89, 88f Apposition, 21 Bitewing radiographs, 58 Angle’s classifi cation of Arch Blanching test, 211, 211f malocclusion, 3, 150 collapse of, 6, 6f, 339, 344f Bluegrass appliance, 136, 137f Ankyloglossia, 215f, 215–216 crowding in, 52 Bolton analysis, 54, 78, 79f Ankylosis dental cast evaluation of, 52 Bolton discrepancy, 115, 127, 128f, case studies of, 285f–286f development of, 28 209 defi nition of, 281 form of, 52 Bone morphogenetic protein 2, 23 dentition effects of, 282, 282f–283f length of Bone remodeling, 228 diagnosis of, 283 defi nition of, 53 Brachycephalic head shape, 45 etiology of, 281–282 incisor proclination for Brodie syndrome, 360f, 360–361, lateral tongue thrust and, 141 increasing, 91 372f–373f management of, 283–284 loss of, 282 Bruxism, 151–152 permanent teeth, 31 palatal canine impaction and, 255 Buccal canine impaction, 254, 257f, prevalence of, 281 primary dentition’s role in, 30 263–264 primary teeth, 31, 165, 281 reduction of, during transitional Buccal crossbite, 360, 372f–374f treatment of, 283–284 dentition, 115 Bud stage, 17f–18f, 17–18 Anodontia, 158 417

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C treatment of Convex facial profi le, 47f, 117 Calcospherites, 21 camoufl age, 297 Coronoid process, 26 Camoufl age treatment early, 294 Corrective orthodontic treatment, 4 for Class II malocclusion, 297 extraoral traction, 298–299 Craniofacial growth for open bite, 380 functional appliances, 298 dentition development and, 15, Canines growth modifi cation and occlusal 25–27 crescent moon–shaped root guidance, 297–299 description of, 5, 116 resorption of, 118, 119f headgear, 298–300 genetic infl uences on, 5 eruption of HLH technique, 299–302, mouth breathing effects on, 148 ectopic, 165, 243, 244f 308f–309f, 314f occlusion affected by, 116 before premolar eruption, lip bumper, 300–301, 301f Crossbite 239–240 modifi ed Hawley appliance, 300, anterior. See Anterior crossbite. mandibular. See Mandibular 300f central incisor, 179f canines. one-phase, 302, 310f–315f functional. See Pseudo–Class III maxillary. See Maxillary canines. orthognathic surgery, 297 malocclusion. permanent two-phase, 301–302, 302f–309f posterior. See Posterior crossbite. ectopic eruption of, 165, 243, 244f variations of, 295f skeletal Class III malocclusion and, eruption of, 37, 38b Class III malocclusion comparisons between, 331b primary anterior crossbite and, 316 thumb sucking as cause of, 133, early loss of, 403 case studies of, 333f–351f 134f extraction of, 261–262 causes of, 329 unilateral, 6, 7f overretained, 246 classifi cation of, 331 Crowding premature exfoliation of, 118 crossbite and, comparisons arch, 52 serial extraction of, 120 between, 331b degree of transposition of, 245–246, 255 dentofacial characteristics of, 329 space analysis and, 79 unerupted, bulging of, 118 hereditary, 334f, 342f–343f space loss affected by, 76 Cap stage, 18, 18f mandibular prognathism with, of incisors. See Incisor(s), Cartilage calcifi cation, 21 330, 341f, 346f crowding of. Casts, dental, 51–54 pretreatment evaluation of, 329 of mandibular incisors, 38–39 Cellular cementum, 23 prevalence of, 329–330 of molars, 91f Cementoblasts, 22f, 23 pseudo– Crown Cementogenesis, 23 case studies of, 325f–329f epithelial coverage of, 24 Cementum defi nition of, 323 permanent, primary root acellular, 23 delayed treatment of, 324, 330 resorption and, 32 cellular, 23 multiple incisor involvement in, Crown and bar, 84, 84f formation of, 23 323 Crown and pontic, 84, 84f Central diastema, 36 removable appliances for, 324, Curve of Spee, 53–54, 79, 404 Central incisors 324f Curve of Wilson, 361 eruption of, before maxillary signs of, 323 Cuspal height, 400 lateral incisor eruption, 240 treatment of, 323–324, 324f Cusps, enamel knot’s role in maxillary serial extraction in, 123 formation of, 20 anterior crossbite caused by, 317, skeletal, 329–330 Cyst formation, 18 318f treatment of diastema between, 205 after incisor eruption, 338, D overretained, 317 338f–346f Deep bite supernumerary, 199f–200f chin cap with spurs, 332, 332f case studies of, 405f–413f Cephalometric radiographs, 66–67, in early mixed dentition, 333 cuspal height effects on, 400 68b, 101f, 116–117, 258, 296 early strategies for, 331–332 defi nition of, 397 Cervical headgear, 3 face mask–chin cap combination, degree of, 397 Cervical loop, 22, 22f 332, 332f dental, 397–398, 402–403 Chemotherapy, 162–163 factors that affect, 331b development of, 397 Chin cap with spurs, 332, 332f interceptive, 335f–336f differential diagnosis of, 399–400 Clark’s rule, 258 in late mixed dentition, 344f etiology of, 397–399 Class I malocclusions, serial in primary dentition, 333, 334f factors that affect, 400 extraction in, 119–122, 121f, Cleft lip and palate, 163 impinging, 6, 6f, 202f, 206, 209, 124f–126f Cleidocranial dysostosis, 231 310f, 314f, 405f Class II malocclusion Clinical examination mandibular forward growth and, case studies of, 302f–315f ankylosed primary molars, 283 397 cephalometric analysis of, 296 anterior crossbite, 316 morphologic characteristics of, 399 characteristics of, 294 delayed tooth eruption, 232 periodontal disease and, 401 diagnosis of, 295–296 description of, 44 relapse of, 399 division 1, 301–302, 407f differential diagnosis of, 142–143 reverse, 336f division 2, 302, 410f hyperdontia, 196–197 skeletal, 398–399, 403–404 early treatment of, 9, 294 posterior crossbite, 361 treatment of facial height effects on, 294 before serial extraction, 116 appliances for, 404–405 growth patterns, 294 tongue thrust, 142–143 delayed, 400 historical background of, 3 Closing the drawbridge, 383, 383f early, 401 jaw characteristics in, 295b Computed tomography scans, 59, in mixed dentition, 403–404, 412f morphologic characteristics of, 59f, 258–259 in permanent dentition, 401–402 295, 295b Concave profi le, 47, 47f in primary dentition, 403 panoramic radiograph of, 62f Concomitant hypodontia and strategies for, 402–405 prevalence of, 294 hyperdontia, 165 Deep overbite, 303f serial extraction in, 122–123 Condylar hypertrophy, 361, 361f Deglutition, 139–140 transverse dimension Condylar hypotrophy, 361 De-impactor spring, 242, 243f considerations, 294 Congenital hypothyroidism, 230 418

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Delayed exfoliation, of primary Diastema, 36, 94, 179f Enamel matrix, 20–21 dentition, 31 central, 94, 179f Enamel organ, 18, 18f Dental caries, 31 midline. See Midline diastema. Epithelial cuff, 24 Dental casts Dichotomy theory, 192 Epithelial thickening, 16, 16f arch form and symmetry Digit sucking, 132–136, 134f Examination(s) evaluations using, 52 Digital imaging, 59 clinical. See Clinical examination. description of, 51–52 Distal drift, 76–77 extraoral. See Extraoral occlusion evaluations using, 52 Distal jet appliance, 88, 88f examination. before serial extraction, 116 Distal shoe, 82 photographic evaluation. See Dental follicle Distal step terminal plane, 29f, 29–30, Photographic evaluation. anatomy of, 22–23 33f radiographic. See Radiographs. fi broblasts of, 24 Distraction osteogenesis, 360 Exfoliation, of primary dentition permanent, congenital absence Divergence of the face, 47 description of, 30–32, 229 of, 31 Dolichocephalic head shape, 45, 146f early, 235–236 tooth eruption affected by, 227 Down syndrome, 163, 231, 245 External enamel epithelium, 18 Dental history, 43–44 Drift, 26, 76–77 Extraction. See also Serial extraction. Dental lamina “Dual bite,” 51 early-age orthodontic treatment development of, 16f, 16–17 Dwarfi sm, 230 effects on need for, 11–12 magnifi cation of, 16f space creation through, 90 Dental occlusion. See Occlusion. E Extraoral anchorage, 3 Dental retrusion, 56 E space, 110, 110f Extraoral examination Dentigerous cyst, 193, 194f Early exfoliation, of primary elements of, 44–45 Dentin dentition, 31 frontal facial evaluation, 45–46, 46f apposition of, 21 Early-age orthodontic treatment lateral facial evaluation, 46–47 formation of, 20 advantages of, 66 Extraoral photography hypoplasia of, 21 benefi ts of, 11–12 facial esthetics, 55–56, 57f interglobular, 21 clinical evidence about, 10 frontal view, 54–57, 55f mineralization of, 20–21, 23 controversy associated with, 9–11 lateral view, 55–56 Dentin fl uorosis, 21 costs of, 11 oblique view, 55 Dentin matrix protein-2, 23 current interest in, 6–7 Extraoral radiographs, 58–59 Dentinogenesis, 20 defi nition of, 4 Extraoral traction, for Class II Dentinogenesis imperfecta, 19 dentition monitoring during, 9 malocclusion, 298–299 Dentition goals of, 8 ankylosis effects on, 282, 282f–283f growth patterns and, 10–11 F bruxism effects on, 152 lack of training in, 12 Face intraoral examination of, 48–49, 49f misconceptions about, 10–11 description of, 131 monitoring of, during early-age modern views on, 41 embryologic development of, 15 orthodontic treatment, 9 objectives of, 4 vertical growth of, 380 Dentition development one-phase, 8 Face mask–chin cap combination, craniofacial growth and, 15, 25–27 patient benefi ts, 11 332, 332f description of, 15 phases of, 8–9 Facial asymmetry, 56, 57f, 361f neonatal, 27f, 27–28 practitioner benefi ts, 12 Facial esthetics permanent, 19 professional encouragement of, 12 composition of, 45 postnatal, 28 rationale for, 7 early-age orthodontic treatment primary. See also Primary reasons for, 4–7 benefi ts for, 11 dentition. results with, 11–12 evaluation of, 44 bud stage of, 17f–18f, 17–18 single phase of, 8, 10 malocclusion effects on, 9 calcifi cation stage of, 20–21 strategy of, 4, 8 photographic evaluation of, 55–56, cap stage of, 18, 18f timing of, 7–8, 298 57f crown stage of, 21, 21f two-phase, 9–10 primary dentition’s role in, 30 early bell stage of, 18f, 18–19 Ectoderm, 22 Facial evaluation initiation stage of, 16f–17f, 16–17 Ectodermal dysplasia, 163 frontal, 45–46, 46f late bell stage of, 19f–20f, 19–20 Ectomesenchymal cells, 19–20, 23–24 lateral, 46–47 molecular level of, 22–23 Ectomesenchyme, 16–17 Facial form, 44 morphodifferentiation stage of, Ectopic eruption Facial height, 294 19f–20f, 19–21 defi nition of, 241 Facial profi les, 47, 47f root formation, 22, 22f permanent canines, 243, 244f Facial proportion studies of, 22–23 permanent fi rst molars, 241–242, evaluation of, 46, 46f retarded, 238–239 242f frontal, 56, 57f Dentogingival junction prevalence of, 241 head posture and, 148 development of, 24 Ectopic impacted canines, 260 lateral, 56, 57f tissues of, 24 Ellis lingual arch, 82, 83f Facial symmetry, 45–46, 46f Desmosomes, 18 Embryonic period, 15 Facial trauma, 162 Developmental spaces, 28–29 Enamel Facial typing, 45 Diagnostic database, 42 apposition of, 21 Family medical history, 43–44 Diagnostic process formation of, 20 Fiber-reinforced composite resin description of, 51 mineralization of, 20–21 fi xed partial denture, 170 goal of, 41 tetracycline discoloration of, 21 Fibroblast growth factors, 23 interview, 42–44 Enamel hypoplasia, 21 Fibroblasts, 228 questionnaire, 42–44 Enamel knot Finger sucking, 132–136, 134b, 134f, schematic diagram of, 42, 42f in cusp formation, 20 378, 378f, 381–382 steps involved in, 42 defi nition of, 17 illustration of, 18f

419

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First molars Gubernaculum dentis, 227 lateral incisors distalization of, 91, 91f Guidance theory, of maxillary canine autotransplantation for, 171 ectopic eruption of, 241–242, 242f impaction, 254–255 canine substitution for space mandibular Gum pads, 27, 27f, 140 closure, 168–169 maxillary fi rst molar and, 37 Gurin lock regainer, 87, 88f case studies of, 176f–178f, mesial shift of, 38 184f–185f permanent, 32 H impaction caused by, 274 maxillary Haas expander, 93, 94f, 363, 363f management of, 168–171 ectopic eruption of, 119, 119f, 243f Halterman appliance, 242, 243f maxillary, 208f mandibular fi rst molar and, 37 Hand-wrist radiographs, 59 midline diastema caused by, 208, vertical palisading of, 119, 119f, 124 Hard tissues. See Dentin; Enamel. 208f Fixed expanders, 93–94, 94f, 362– Hawley appliance prosthesis for, 169–171, 171f 364, 363f–364f anterior crossbite treated with, 319 management of, 167–168 Fixed orthodontic appliances, 136, 137f bruxism treated with, 152 mandibular second premolars, Fluorosis, dentin, 21 Class II malocclusion treated with, 172–174, 180f–181f Flush terminal plane, 29f, 29–30, 33, 299–300 microdontia and, 164 33f as habit breaker, 136, 137f occlusion affected by, 157, 166 Fourth germ layer, 22 modifi ed, 300, 300f, 324f, 406f partial, 163 Frenectomy, 214, 215f, 217f as removable distalizer, 92 prevalence of, 158, 159t, 162 Frenotomy, 216 space maintenance using, 86, 86f soft tissue affected by, 166 Frenum space regaining using, 89, 89f space closure, 168–169, 173 maxillary labial, 207 tongue thrust treated with, 145f syndromes associated with, morphogenesis of, 206–207 Headgear 163–164 structure of, 206–207 Class II malocclusion treated with, systemic diseases associated with, Frenum attachment abnormalities 298–300 162 ankyloglossia, 215–216 high-pull, 299 treatment of, 167–168 case studies of, 216f–222f historical background of, 3 Hypophosphatasia, 235–236 differential diagnosis of, 210–211 J-hook, 299 Hypopituitarism, 230 in infants, 214 patient’s cooperation in using, 299 Hypoplasia management of sagittal expansion using, 92 dentin, 21 in adults, 211–212 Hemifacial microsomia, 163 enamel. See Enamel hypoplasia. delayed, 212 Hereditary crowding, of incisors, Hypothyroidism, 230 frenectomy, 214, 215f, 217f 118–119, 119f Hyrax expander, 93–94, 94f, 363, 363f in infants, 214 Hertwig’s epithelial root sheath, 22, in mixed dentition, 212–213, 213f 22f, 24 I in primary dentition, 213–214 Histodifferentiation Image shift principle, 258 results of, 213f description of, 18, 19f Impinging deep bite, 6, 6f, 202f, 206, two-phase, 213 developing abnormalities during, 19 209, 310f, 314f, 405f midline diastema. See Midline Holoprosencephaly, 207 Implant-supported restorations, diastema. Homeobox genes, 22, 161 173–174 occlusion affected by, 210 Hyperactivity theory, 192 Incisor(s) radiographs of, 211, 211f Hyperdontia. See also anterior crossbite, 317, 318f, 321f signs of, 211, 211f Supernumerary teeth. crowding of Frontal cephalometric radiographs, 67 case studies of, 198f–202f acquired, 118 Frontal view, 54–55, 55f clinical examination of, 196–197 Bolton discrepancy, 115, 127, 128f Functional crossbite, 359–360. defi nition of, 17 causes of, 106–107 See also Pseudo–Class III hypodontia and, 165–166, 192 characteristics of, 107–108 malocclusion. management of, 197–198 in Class I malocclusions, 119–122, Functional matrix, 6, 131 occlusion affected by, 196, 197f 121f, 124f–126f prevalence of, 189–190, 190t–191t in Class II malocclusions, 122–123 G radiographic examination of, 197 in Class III malocclusions, 123 Genetic theory, of maxillary canine Hypodontia classifi cation of, 107–108 impaction, 255–256 autotransplantation for, 171, 174 description of, 95, 105 Gingival groove, 27 case studies of, 174f–185f environmental, 118 Glossectomy, 49 central incisors, 180f–181f hereditary, 118–119, 119f Glycosaminoglycans, 18 clefts associated with, 163 intervention for, 107 Groper fi xed anterior prosthesis, 85 clinical signs of, 167 measurement of, 117 Growth modifi cation techniques defi nition of, 17, 158 minor, 108 Class II malocclusion treated with, dental anomalies associated with, in mixed dentition, 95, 105–106 297–299 164–165 moderate, 108–114, 109f–114f open bite treated with, 382–383, dentoskeletal patterns affected by, prediction of, 106 383f 166 prevention of, 107 Growth patterns description of, 157 serial extraction for. See Serial Class II malocclusion, 294 distribution of, 160t extraction. early-age orthodontic treatment in Down syndrome, 163 severe, 115, 117, 120, 121f, 264 and, 10–11 early recognition of, 167 tooth size–arch length incisor position and crowding environmental factors, 161–163 discrepancy as cause of, affected by, 111 ethnicity and, 159t–160t 106–107, 123 mixed dentition space analysis, 53 etiology of, 160–163 in transitional dentition, 110 sagittal expansion and, 90–91 sex and, 159t–160t transverse expansion for, 93 serial extraction considerations, genetic factors, 160–161 eruption of 117–118 in hemifacial microsomia, 163 asymmetric, 36 space analysis and, 79 hyperdontia and, 165–166, 192 central diastema persistence Growth status evaluation, 43 during, 36

420

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Class III malocclusion treatment description of, 47, 116 M after, 338, 338f–346f paraclinical evaluation, 51 Macroglossia mandibular central incisors, 34, 34f soft tissues, 49–51 description of, 49, 49f mandibular lateral incisors, 34, 34f temporomandibular joint function, tongue thrust associated with, 141, maxillary central incisors, 35, 35f 51 141f maxillary lateral incisors, 35–36, 36f tongue, 49–51, 50f Malocclusions permanent, 34f–36f, 34–36 Intraoral photography, 58 Angle’s classifi cation of, 3, 150 problems during, 36, 36b Intraoral radiographs, 58 Class I, 119–122, 121f, 124f–126f impaction of Irradiation, 162–163 Class II. See Class II malocclusion. case studies of, 275f–280f Class III. See Class III malocclusion. early detection and diagnosis of, J environmental factors associated 273 Jaw with, 293 etiology of, 273 fracture of, 246 etiology of, 42 interceptive treatment of, 274 ontogenesis of, 25, 25f facial esthetics affected by, 9 odontoma as cause of, 273 Jaw muscles, 26 speech problems and, 50, 150–151 supernumerary teeth as cause of, J-hook headgear, 299 thumb/fi nger sucking as cause of, 273, 274f, 279f Jumping the bite, 298 133, 134f, 137f trauma as cause of, 273 Juvenile hypothyroidism, 230 treatment of, 115 inclination of, 53, 56, 79, 91, 117 Juvenile rheumatoid arthritis, 26 untreated, problems secondary to, 9 intrusion of, 402 Mandible labial movement of, 91 L anatomy of, 25, 25f lateral Lasers, 214 anterior shift of, 325f–326f mandibular, 34, 34f Lateral cephalometric radiographs, displacement of, 247 maxillary, 35–36, 36f 4, 258 masticatory muscle attachment splaying of, 118, 119f Lateral expansion, 93 to, 26 lip position and, 53 Lateral facial evaluation, 46–47 normal closure pattern of, 400 mandibular Lateral facial proportion, 56, 57f positions of, 297 crowding of Lateral incisors retrusion of, 412f Bolton discrepancy as cause hypodontia of Mandibular arch, 49f of, 127, 128f autotransplantation for, 171 Mandibular canines description of, 38–39, 91, 105, canine substitution for space eruption of, 37 107, 114f, 207, 406f closure, 168–169 impaction of, 265 eruption of, 34, 34f case studies of, 176f–178f permanent, eruption of, 37 gingival recession at, 118 management of, 168–171 primary maxillary palatally displaced maxillary early extraction of, 36 eruption of, 35–36, 36f canines associated with, 255 premature loss of, 35, 98f, 102f space closure with, 94 prosthesis for, 169–171, 171f Mandibular condyle overretained, 32f mandibular ankylosis of, 26 periodontal condition of, 91 eruption of, 34, 34f growth of, 26–27 primary transposition of, 245, 249f Mandibular fi rst molars early loss of, 81f, 85 maxillary extraction of, 247f overretained, 274, 317, 318f eruption of, 35–36, 36f, 240 maxillary fi rst molar and, 37 roots, delayed resorption of, 109f microdontia of, 208, 208f mesial shift of, 38 sequential stripping of, 109 supernumerary, 194f permanent, 32 spaces between, 28 transposition of, 250f Mandibular fi rst premolar eruption proclination of, 34f, 91–92 microdontia of, 208, 208f before canine eruption, 239–240 root resorption of peg-shaped, 274 description of, 37 delayed, 34f, 109f proclination of, 36, 36f Mandibular growth description of, 256 supernumerary, 198f asymmetric, 7f, 25, 46f splaying of, 118, 119f transposition of, 245, 249f–250f, direction of, 26 Incisor liability, 33–34, 36 252f–253f impinging deep bite effects on, 6 Inconstant swallowing, 142 Lateral jaw radiographs, 58–59 insuffi cient, 19 Infantile swallowing, 140, 142 Lateral tongue thrust, 141f, 141–142 malocclusions caused by problems Initiation stage, 16f–17f, 16–17 Lateral view, 55–56 with, 25 Intercanine arch width, 34 Leeway space, 78, 80, 95, 276f at mandibular condyle, 26 Interceptive treatment Ligand for receptor activator for occlusion affected by, 106 defi nition of, 4 nuclear factor κB, 30 temporomandibular joint-related of incisor impaction, 275 Lingual crossbite, 360, 360f factors that affect, 26 of maxillary canine impaction, Lip bumper, 91–92, 92f, 299, 300–301, Mandibular incisors. See also 260–262 301f Incisor(s). patient expectations about, 43 Lip dysfunction, 209, 209f, 398 central, 34, 34f Interdental fi bers, 207 Lip line, 169 crowding of Interdental spacing, 79 Lip position, 56, 57f Bolton discrepancy as cause of, Interglobular dentin, 21 Lip proportion, 56, 57f 127, 128f Interincisal angle, 400 Lip seal, 382 description of, 38–39, 49, 91, 105, Intermolar width, 92 Lip strain, 55f 107, 114f, 207 Interproximal wedging technique, Lisping, 50 inclination of, 79 242, 242f Locked occlusions, 6f, 6–7, 113f lateral, 34, 34f Intertransitional periods, 28 Longitudinal panoramic radiographs, proclination of, 350f Interview, 42–44 60, 61f–65f, 116 relative position of, 397 Intraoral examination Lower holding arch, 82, 83f, 109f Mandibular molar distalizer, 88, 88f components of, 116 Lower lip dysfunction, 403 Mandibular plane–occlusal plane dentition, 48–49, 49f angle, 400

421

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Mandibular prognathism, 330, 341f, Mechanotherapy permanent, 53 346f incisor impaction treated with, 277f primary Mandibular second molars with selective extraction, for open ankylosis of, 165, 281, 282f, 285f eruption of, maxillary second bite, 383 extraction of, 74, 120–121, 121f, molar eruption before, 240 tongue thrust treated with, 143, 143f 173 impaction of, 119, 119f Meckel’s cartilage, 25 long-term retention of, 172 terminal plane, 32, 33f Medical history, 43–44 submerged, 285f Mandibular second premolars, 172– Mentolabial sulcus, 56, 57f second. See Second molars. 174, 180f–181f Merrifi eld analysis, of space, 78 Molar distalizer Mastication, 30 Mesial drift, 26, 76–77 with Nance anchorage, 87–88, 88f Masticatory muscles, 26 Mesial occlusion. See Class III pendulum appliance as, 92, 92f Maternal rubella, 162 malocclusion, skeletal. Morphodifferentiation stage, 19f–20f, Maxillary arch Mesial shift, 38, 347f 19–21 collapse of, 6, 6f, 339, 344f Mesial step terminal plane, 29f, Mouth breathing constriction of, 355, 357, 359 29–30, 33, 33f adenoid tissue location Maxillary bone, 25 Mesiodens, 194, 208, 208f evaluations, 150 Maxillary canines. See also Canines. Mesocephalic head shape, 45 clinical examination of, 149–150 displacement of, 266f–267f Microdontia dentofacial characteristics of, 146, eruption before premolars, 239 hypodontia and, 164 146f, 148–149 impaction of illustration of, 163f etiology of, 147 autotransplantation of, 265 lateral incisors, 208, 208f evaluation of, 149–150 buccal, 254, 257f, 263–264 Midline diastema general body growth associated case studies of, 266f–272f case studies of, 216f–222f with, 147–148 clinical examination of, 257–258 causes of, 207–210 lip incompetence associated with, consequences of, 256–257 anterior Bolton discrepancy, 209 150 early detection of, 257–260 impinging deep bite, 209 maxillofacial complex affected by, ectopic, 260, 262f, 268f lateral incisor hypodontia, 208, 146–147 etiology of, 254–256 208f occlusion effects of, 146–147 interceptive treatment of, 260–262 lip dysfunction, 209, 209f open bite caused by, 378 labial, 256 mesiodens, 208, 208f orthodontic management of, 150 odontoma as cause of, 269f–271f odontoma, 208 posterior crossbite secondary to, orthodontic procedures for, 264 overview of, 207–208 356–357 palatal, 254–256, 263 pathologic tooth migration, 210, postural changes associated with, panoramic radiographs of, 259f, 210f 146–148 259–260 defi nition of, 205 problems associated with, 149, 149t position of, 262 differential diagnosis of, 210–211 signs of, 146f, 147–149 prevalence of, 254 etiology of, 206–210 treatment of, 150 proximity of, to adjacent teeth, 259 sex and, 206 Moyers mixed dentition analysis, 78 radiographic evaluation of, management of MSX1, 23 258f–259f, 258–260 in adults, 211–212 MSX2, 23 signs of, 258 delayed, 212 MSX genes, 161 space defi ciency as cause of, in infants, 214 Multirooted teeth, 22 266f–267f in mixed dentition, 212–213, 213f Muscular dystrophy, 26 step-by-step management of, 264b in primary dentition, 213–214 surgical exposure of, 262–264, 263f results of, 213f N treatment of, 260–265 two-phase, 213 Nance analysis, of space, 54, 77–78 Maxillary fi rst molars occlusion affected by, 210 Nance holding arch, 83, 84f ectopic eruption of, 119, 119f, 243f prevalence of, 206 Nasal obstruction, 147, 149 mandibular fi rst molar and, 37 radiographs of, 211, 211f Nasolabial angle, 56, 57f vertical palisading of, 119, 119f, 124 shape of, 211, 211f Nasomaxillary complex, 27, 146 Maxillary incisors. See also Mineralization, of hard tissues, Natal teeth, 27–28 Incisor(s). 20–21, 23 Neonatal dentition central, 35, 35f Mixed dentition development of, 27f, 27–28 delayed treatment of midline anterior crossbite in, 317, 318f, 321f gum pads, 27, 27f, 140 diastema until complete deep bite in, 403–404, 412f natal teeth, 27–28 eruption of, 212 early, Class III malocclusion Neural crest cells, 15, 22 fl aring of, 133 treatment in, 333 Non-nutritive sucking labial migration of, 401 frenum attachment abnormalities case studies of, 137f–138f lateral in, 212–213, 213f clinical examination of, 134 description of, 35–36, 36f incisor crowding in defi nitions of, 132 eruption of, 35–36, 36f, 240 description of, 95, 105–106 etiology of, 132–133 microdontia of, 208, 208f serial extraction for, 115. See also fi nger, 132–136, 134b, 134f supernumerary, 194f Serial extraction. midline diastema caused by, 209, liability, 36 Moyers analysis of, 78 209f permanent, 319 open bite management in, 382 occlusion effects, 133 protrusion of, 36f posterior crossbite in, 367f open bite caused by, 378, 378f, secondary spacing, 36, 36f space analysis of, 52–54, 78 381–382, 384f Maxillary intercanine distance, 29 transverse expansion during, 93 pacifi ers, 136, 139 Maxillary second molars Modifi ed Hawley appliance, 406f posterior crossbite caused by, 356 eruption of, before mandibular Molar(s) prevalence of, 133 second molar eruption, 240 distalization of, 91 thumb, 132–136, 134b, 134f terminal plane, 32, 33f fi rst. See First molars. treatment of mesially tipped, 91 age of intervention, 135 behavioral modifi cation

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techniques, 135 etiology of, 378–380 P description of, 135–138, 137f–138f fi nger sucking as cause of, 378, Pacifi ers, 136, 139 orthodontic appliances, 138, 139f 378f, 381–382, 384f Palatal appliance, 136, 137f genetic factors, 378–379 Palatal crossbite, 360 O morphologic characteristics of, 379 Palatal expansion, orthopedic, 93 Obstructive sleep apnea syndrome, mouth breathing as cause of, 378 Palatal plane–occlusal plane, 400 148 non-nutritive sucking as cause of, Panoramic radiographs, 60, 61f–65f, Occlusal bite plate, 152 378, 378f, 381–382, 384f 116, 259f, 259–260 Occlusal development overview of, 377–378 Paraclinical evaluation, 51, 116–117 craniofacial growth effects on, 116 serial extraction in patients with, 123 Parathyroid hormone receptor 1, 230 environmental factors, 5–6 skeletal, 379 Parathyroid hormone-related protein, factors that affect, 37 tongue force abnormality as cause 230 form and function in, 6, 24–25 of, 378, 379f Patient chief complaint of, 43 genetic factors, 5 tongue guards for, 143, 143f compliance of, 11–12 hypodontia effects on, 157 tongue thrust and, 140, 141f, 142, early-age orthodontic treatment locked occlusions effect on, 6f, 6–7 379, 381, 387f. See also Tongue benefi ts for, 11 long process of, 5 thrust. medical history of, 44 mechanisms that affect, 5–6 treatment of Peak height velocity, 59 prenatal stage of, 16–27 camoufl age, 380 Pedo temporary bridge, 85 tongue’s role in, 27 closing the drawbridge, 383, 383f Pendulum appliance, 88, 88f, 92, 92f Occlusal interferences, 6, 6f–7f early, 380–383 Periapical abscesses, 31, 31f Occlusal radiographs, 58, 258, 258f growth modifi cation, 382–383, 383f Periapical radiographs, 58, 211, 211f, Occlusal system, 47 lip seal, 382 258 Occlusion mechanotherapy with selective Periodontal disease, 49, 401 Class I, 47 extraction, 383 Periodontal ligament dental cast evaluation of, 52 in mixed dentition, 382 collagen fi bers of, 24, 25f frenum attachment abnormalities orthognathic surgery, 380 description of, 22 effect on, 210 posterior facial height–anterior development of, 24, 25f hyperdontia effects on, 196, 197f facial height ratio increase, formation of, 23 hypodontia effects on, 166 383, 383f remodeling of, 228 importance of, 25 strategies for, 380 tooth eruption affected by, 227–228 locked, 6f, 6–7, 113f type I, 381, 384f–386f Periodontitis, 236 mandibular growth effects on, 106 type II, 381, 387f Permanent dentition midline diastema effects on, 210 type III, 381, 388f–396f ankylosis of, 31 mouth breathing effects on, vertical growth pattern associated eruption of, 30 146–147 with, 390f formation of, 19 normal, 397 Oral cavity, 48 nonsyndromic agenesis of, 160 pacifi er sucking effects on, 139 Oral drive theory, 132 premature eruption of, 235–236 preparation of, for prosthetics, 174 Oral habits, abnormal transposition of, 164 sagittal evaluation of, 52 arch collapse affected by, 77 Photographic evaluation serial extraction and, 117 bruxism, 151–152 applications of, 54 space loss and, 76 early-age orthodontic treatment extraoral. See Extraoral thumb sucking effects on, 133, 134f effects on control of, 12 photography. type of, 52 midline diastema caused by, 209, intraoral, 58 vertical dimension of, 293 209f before serial extraction, 116 Odontoblastic process, 20 mouth breathing. See Mouth Physical growth evaluation, 43 Odontoblasts, 18–20, 19f, 30 breathing. Pierre Robin syndrome, 49–50 Odontoma non-nutritive sucking. See Non- Porter appliance, 93, 94f, 362, 363f canine impaction caused by, nutritive sucking. Posterior crossbite 269f–271f overview of, 131 Brodie syndrome, 360–361, description of, 18, 192–193, 193f, time of appearance, 132 372f–373f 200f–201f, 208, 255 tongue thrust. See Tongue thrust. buccal, 360, 372f–374f incisor impaction caused by, 273 Oral infections, 236 case studies of, 364f–374f midline diastema caused by, 208 Orofacial structure, 47 clinical examination of, 361 Oligodontia Oronasal complex, 24 defi nition of, 355 case study of, 182f–183f Oronasal functional matrix, 27 delayed treatment of, 357, 358f computed tomography of, 59, 59f Orthodontic appliances, for non- differential diagnosis of, 361–362 defi nition of, 158 nutritive sucking, 138, 139f early treatment of, 359, 362–366 management of, 167 Orthodontic forces, 3 etiology of, 356–357 microdontia and, 163f Orthodontic screening, 7 functional shift as cause of, 359f One-phase orthodontic treatment, Orthodontic treatment illustration of, 49f 5, 8 canine impaction, 264 lateral mandibular shift caused Open bite early-age. See Early-age by, 51 anterior orthodontic treatment. lingual, 360, 360f anterior tongue thrust and, 142 historical background of, 3 mandibular shift and, 365f–366f, illustration of, 49f one-phase, 5 369f–371f lisping caused by, 50 scientifi c evidence regarding, 6 maxillary arch constriction thumb sucking as cause of, 133, two-phase, 5, 9–10 associated with, 355, 357, 359 134f Osteoblasts, 24 in mixed dentition, 367f case studies of, 384f–396f Osteoclastogenesis, 228, 230 morphologic characteristics of, 355 cephalometric evaluation of, 380f Osteogenesis, 228 mouth breathing as cause of, classifi cation of, 381 Osteoprotegerin, 30 356–357 dental, 379 Outer enamel epithelium, 18 palatal, 360 differential diagnosis of, 379–380 Overjet, 303f, 310f, 391f paraclinical evaluations, 362

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prevalence of, 355, 357 importance of, 30 periapical, 58, 211, 211f in primary dentition, 368f initiation stage of, 16f–17f, 16–17 before serial extraction, 116 scissors bite, 360 late bell stage of, 19f–20f, 19–20 supernumerary teeth, 197, 197f thumb sucking as cause of, 133, life history stages of, 16 RANK. See Receptor activator for 134f loss of nuclear factor κB. treatment of premature, 74 RANKL. See Ligand for receptor appliances, 362–364, 363f–364f space lost after, 75 activator for nuclear factor κB. Arnold expander, 363, 363f molecular level of, 22–23 Rapid palatal expander, 364, 364f bonded expander, 364, 364f morphodifferentiation stage of, Receptor activator for nuclear factor delayed, 357 19f–20f, 19–21 κB, 30 early, 359, 362–366 overretained, 172 Reciprocal induction, 20 fi xed expanders, 362–364, posterior crossbite in, 368f Reduced dental epithelium, 24 363f–364f premature loss of, 74 Reminder therapy, for non-nutritive Haas expander, 363, 363f root formation, 22, 22f sucking, 135 Hyrax expander, 363, 363f root resorption of, 32, 282 Removable bite plate appliance, 403 quad helix, 362–363, 363f sequential stripping of, 109 Removable expanders, 94 rapid expander with occlusal spacing in, 28, 29f Removable orthodontic appliances, coverage, 364, 364f studies of, 22–23 136, 137f, 243, 298, 324, 324f removable expanders, 364, 364f terminal plane of, 29f, 29–30 Removable partial denture, for lateral variations of, 358–361, 359f Primary epithelial band, 16 incisor hypodontia, 170 W-arch for correction of, 93 Primary failure of tooth eruption, Removable space maintainers, Posterior facial height–anterior facial 236–238, 237f 85f–86f, 85–86 height ratio, 383, 383f Primary molars Removable space regainers, 89f, Posterior teeth ankylosis of, 37, 165 89–90 extrusion of, 402 extraction of, 241 Retained infantile swallow, 140 mesial migration of, 402 Primate spaces, 28, 29f Reward therapy, for non-nutritive Postnatal development of dentition, 28 Profi le sucking, 135 Preameloblasts, 20 lateral, 55 Ricketts’ esthetic line, 56 Premolars photographic evaluation of, 55 Root development, 117 eruption of space analysis and, 79 Root formation description of, 37–38, 38b types of, 47, 47f, 53 illustration of, 22, 22f E space preservation for, 110, 110f Prosthesis tooth eruption and, 227 maxillary canine eruption before, fi ber-reinforced composite resin Root resorption 239 fi xed partial denture, 170 crescent moon–shaped, 118, 119f second molars eruption before, lateral incisor hypodontia primary tooth, 32 239 managed with, 169–171 regulation of, 30 mandibular, 238f removable partial denture, 170 Rule of fi fths, 46, 56, 57f second Pseudo–Class III malocclusion ankylosis of, 165, 165f case studies of, 325f–329f S hypodontia of, 172–174, defi nition of, 323 Sagittal expansion, 90–92, 91f–92f, 180f–181f delayed treatment of, 324, 330 99f transposition of, 247f, 282, 283f multiple incisor involvement in, Schwartz removable slow expander, supernumerary, 195 323 94f transposition of, 245 removable appliances for, 324, Scissors bite, 360 Preventive orthodontic treatment, 4 324f Second molars Primary dentition signs of, 323 eruption of, before premolars, 239 ankylosis of, 31 treatment of, 323–324, 324f mandibular bud stage of, 17f–18f, 17–18 Psychologic problems, 11 impaction of, 119, 119f calcifi cation stage of, 20–21 Puberty, 59 terminal plane, 32, 33f canines maxillary, 32, 33f early loss of, 403 Q Second premolars extraction of, 261–262 Quad helix, 93, 94f, 136, 137f, 362– hypodontia of, 172–174, 180f–181f overretained, 246 363, 363f transposition of, 247f, 282, 283f premature exfoliation of, 118 Questionnaire, 42–44 Secondary spaces, 28–29 serial extraction of, 120 Secondary spacing, 36, 36f cap stage of, 18, 18f R Sectional bracketing, 89, 89f Class III malocclusion treatment in, Radiation therapy, 236 Sequential selective enamel 333, 334f Radiographs stripping, 90 classifi cation of, 28 ankylosis, 283 Sequential stripping of primary crown stage of, 21, 21f bitewing, 58 teeth, 109 deep bite in, 403 canine impaction, 258f–259f, Serial extraction delayed exfoliation of, 31 258–260 in Class I malocclusions, 119–122, dental lamina, 16f, 16–17 cephalometric, 66–67, 68b, 101f, 121f, 124f–126f early bell stage of, 18f, 18–19 116–117 in Class II malocclusions, 122–123 early exfoliation of, 31 delayed tooth eruption, 234, 234f in Class III malocclusions, 123 eruption of digital, 59 clinical examination before, 116 delayed, 233b extraoral, 58–59 crowding measurements before, description of, 28 hand-wrist, 59 117 evaluation of, 48 intraoral, 58 defi nition of, 115 exfoliation of, 30–32, 229, 235–236 lateral jaw, 58–59 description of, 9 frenum attachment abnormality longitudinal, 60, 61f–65f diagnostic procedures before, management in, 213–214 occlusal, 58 116–117 hypodontia of, 172 panoramic, 60, 61f–65f, 116 historical background of, 115

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mandible, 122–123 diagnostic procedures used in, Temporomandibular joint maxilla, 122–123 77–80 function assessments, 51 occlusal considerations, 117 fundamentals of, 73–77 malfunction of, 401 in open bite, 123 planning for, 77–80 Terminal plane, 29f, 29–30, 32, 33f paraclinical examinations before, treatment options for, 80–95 Tetracycline-related enamel 116–117 Space regainers, 87–90, 88f–89f discoloration, 21 planning for, 117–119 Space regaining, 86–90, 88f–89f, 97f, Three-phase treatment plan, 8 sequence of, 120–122 102f Thumb sucking, 132–136, 134b, 134f, skeletal pattern and, 117–118 Space supervision 209, 209f, 384f timing of, 120 case study of, 100f–101f Tongue Single-tooth implant, for combination approach, 110–111 clinical examination of, 142 lateral incisor hypodontia, defi nition of, 95 dysfunction of, 142 169–170, 171f E space preservation, 110, 110f force abnormality of, open bite Skeletal deep bite, 398–399 methods of, 109–111 caused by, 378, 379f Skeletal maturation assessment, 59 sequential stripping of primary functions of, 49–51, 50f Skeletal maturity, 59 teeth, 109 occlusal development affected by, Sleep disorders, 148 Speech 27 Sliding loop regainer, 87–88, 88f development of, 30 posture of, 50, 50f Social evaluation, 43 physiology of, 150 size of, 49–50, 142 Soft tissue Speech problems tonsil effects on, 50f evaluation of, 49–51, 66 early incisor loss and, 85 Tongue crib–transpalatal arch hypodontia effects on, 166 malocclusion and, 50, 150–151 appliance, 136, 137f, 382, 383f Soft tissue profi le, 91, 117, 312f soft tissue causes of, 151 Tongue guard, 143, 143f Somatic swallowing, 142 tongue thrust as cause of, 142 Tongue thrust Space analysis Staley and Kerber analysis, of space, anterior, 141, 141f Bolton, 54, 78, 79f 78 bilateral, 141–142 considerations in, 79–80 Stellate reticulum, 18, 19f, 30 case studies of, 138f, 144f–145f defi nition of, 77 Step-type anterior arch, 383, 383f classifi cation of, 140 Merrifi eld, 78 Stomion plane, 56 clinical examination of, 142–143 methods of, 54 Stomodeum, 16f, 16 complex, 140 mixed dentition, 52–54 Straight facial profi le, 47f defi nition of, 139 Moyers, 78 Stratum intermedium, 18, 19f development of, 140 Nance, 54, 77–78 Subnasale line, 56 etiology of, 140–141 Staley and Kerber, 78 Sucking, non-nutritive. See Non- lateral, 141f, 141–142 study casts for, 52–54 nutritive sucking. macroglossia associated with, 141, Tanaka and Johnston, 78 Sudden infant death syndrome, 139, 141f types of, 77–78 148 mechanotherapy for, 143, 143f Space closure “Sunday bite,” 51 myofunctional therapy for, 143 canine substitution for, 168–169 Supernumerary teeth. See also open bite caused by, 140, 141f, 142, description of, 74–75, 94 Hyperdontia. 379, 381, 387f frenectomy before, 215f case studies of, 198f–202f oral habit training for, 143 mandibular second premolar classifi cation of, 194, 194b problems associated with, 142 hypodontia, 173 defi nition of, 189 retained infantile, 140 Space creation early recognition of, 197 simple, 140 case studies of, 96 ectopic eruption of, 194–195 speech problems secondary to, defi nition of, 90 ethnicity and, 190, 191t 142 maxillary canine impaction treated etiology of, 192 treatment of, 143, 143f–145f with, 261 sex and, 190, 191t types of, 141–142 moderate incisor crowding treated genetic syndromes associated Tongue-tie. See Ankyloglossia. with, 110 with, 192 Tooth agenesis. See Hypodontia. sagittal expansion for, 90–92, incisor impaction caused by, 273, Tooth buds, 17, 17f, 19, 25, 28, 225, 91f–92f, 99f 274f, 279f 246 sequential selective enamel late development of, 195, 202 Tooth development. See Dentition stripping, 90, 109 location of, 190, 191t development. tooth extraction for, 90 management of, 197–198 Tooth emergence, 75–76, 229. See transverse expansion for, 92–94, maxillary canine impaction and, also Tooth eruption. 94f, 99f 255 Tooth eruption Space maintainers multiple, 190 abnormal sequence of, 239–241 functional fi xed, 84f, 84–85 orthodontic considerations after ankylosis. See Ankylosis. nonfunctional fi xed removal of, 198 asymmetric, 48, 240–241 bilateral, 82, 83f prevalence of, 189–191, 190t–191t bone remodeling effects on, 228 unilateral, 82 radiographic examination of, 197, cellular bases of, 228 qualities of, 81 197f characteristics of, 229 removable, 85f–86f, 85–86 Swallowing defi nition of, 28, 225 Space maintenance physiology of, 50, 139–140, 381 delayed, 48, 232–235, 233b, 233f contraindications for, 80–81 types of, 142 dental follicle effects on, 227 defi nition of, 80 description of, 24 indications for, 80 T disturbances of, 229–231, 231b space closure as, 74–75, 94 Tanaka and Johnston analysis, of ectopic space maintainers for. See Space space, 78 defi nition of, 241 maintainers. Taurodontism, 162, 164–165 permanent canines, 243, 244f Space management Temporomandibular disorders, 152 permanent fi rst molars, 241–242, case studies of, 96–102 242f prevalence of, 241

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eruptive phase of, 226 Tooth migration, 26, 210, 210f, 247 Transpalatal arch, 82, 83f factors that disturb Tooth movement Transposition. See Tooth achondrodysplasia, 230 bone support in edentulous areas transposition. cleidocranial dysostosis, 231 achieved through, 171 Transverse expansion Down syndrome, 231 early-age orthodontic treatment indications for, 93 genetic, 230–231 effects on need for, 12 space creation through, 92–94, 94f, hypothyroidism, 230 Tooth size–arch length discrepancy 99f local, 231 description of, 106–107 Trauma overview of, 229–230 space defi ciency caused by, 123 ankylosis caused by, 282 systemic, 230 Tooth transposition facial, 162 factors that infl uence, 76 case studies of, 249f–253f incisor impaction caused by, 273 failure of, 236–238, 237f in children, 246f Treatment planning general pattern of, 80 complete, 244, 250f cephalometric radiography for, 67 guidance of, 95 defi nition of, 244 description of, 41–42 hydrostatic pressure and, 227 dental anomalies associated with, serial extraction, 117–119 mechanisms of, 226–228 244 Trisomy 21. See Down syndrome. molecular bases of, 228 description of, 164 2 x 4 bonding, 88–89, 89f, 97, 122, periodontal ligament effects on, diagnosis of, 248 319, 324 227–228 etiology of, 246–247 Two-phase orthodontic treatment, 5, phases of, 226 incidence of, 245 9–10 posteruptive phase of, 226 incomplete, 244, 248 prediction of, 75–76 treatment of, 248 U pre-eruptive phase of, 226 Tooth-supported restorations “Ugly duckling” stage, 35f, 35–36, primary dentition, 28 lateral incisor hypodontia 205, 257, 258f retarded, 238–239 managed with, 169–170 Upper lip–lower lip height ratio, 46, root formation and, 227 mandibular second premolar 47f sequence of, 37 hypodontia managed with, Utility arch, 404 stages of, 229 173–174 timing of, 76 Tooth-supporting tissues, 22f, 23–24 V tooth transposition. See Tooth Transcription factors, 23 Vertical dimension of occlusion, 293 transposition. Transitional dentition Vertical drift, 26 Tooth germs, 28, 226 defi nition of, 32 Vestibular lamina, 17, 17f Tooth grinding. See Bruxism. dimensional arch changes during, Visceral swallowing, 142 Tooth impaction 38 defi nition of, 254 eruption problems, 60 W ectopic, 260, 262f, 268f incisor crowding during, 110 W-arch, 93, 94f, 362, 363f incisors. See Incisor(s), impaction panoramic radiographs of, 116 Warford analysis, 260, 261f of. phase I, 32–34, 33f–34f Wax bite, 51 mandibular canines, 265 phase II, 34f–36f, 34–36 Weinberger appliance, 242, 243f maxillary canines. See Maxillary phase III, 37 Wiskott-Aldrich syndrome, 236 canines, impaction of. Wnt signaling pathway, 161

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