Normal : Deciduous dentition Early Treatment ♦ OB: Moderate to Shallow ♦ OJ: 3mm Columbia University ♦ occlusion: Flush terminal plane School of Dental and Oral Surgery ♦ Buccal OJ: Positive all around

Dr. Shany Park 2006

Normal occlusion: Early Treatment Deciduous dentition ♦ Preventive Orthodontic treatment ♦ Spacing: ♦ Interceptive orthodontic treatment – Generalized spacing ♦ Phase I treatment – Primate Spacing

Normal Occlusion: Normal Occlusion: Deciduous dentition Early Mixed dentition ♦ Age: 2 ½ to 5 ½ years old ♦ OB: Shallow ♦ OJ: Shallow ♦ Molar Occlusion: – Mesial step or Flush terminal will shift to Cl I molar occlusion

1 Normal Occlusion: Abnormal Occlusion Early Mixed dentition ♦ No Primate spaces ♦ Diastema (ugly duckling stage) ♦ Mild crowding is accepted

Normal Occlusion: Abnormal Occlusion Early Mixed dentition

♦ Lee way space: – Maxilla: 1.5 mm each side – Mandible: 2.5 mm each side

Normal Occlusion: Abnormal Occlusion Early Mixed dentition

2 Abnormal Occlusion Abnormal Occlusion

Abnormal Occlusion Early Treatment: Benefits

♦ Guide growth ♦ Reduce chance of extraction or surgery ♦ Reduce phase II treatment time ♦ Esthetics

Abnormal Occlusion When do we treat early?

♦ Functional problems ♦ Higher chance for Trauma ♦ Space Management ♦ Esthetics

3 Increased susceptibility to Functional Problems Trauma ♦ Crossbites ♦ Severe Class II – Functional shift – Increased OJ •Anterior – Trauma to maxillary central • Lateral – Constriction of maxilla • Narrow maxilla • Narrow smile

Functional Problems Space Management

♦ Class III ♦ Severe Crowding: Serial Extraction – Overgrowth of mandible – Guided Eruption – Deficient growth of maxilla – Extraction of ♦ Openbite – Extraction of permanent teeth – Tongue thrusting habit – Thumb sucking habit – Prolonged use of Pacifier – Foreign object biting habit

Functional Problems Space Management

♦ Mouth breather ♦ Space Conservation: Space loss – Adenoid face – Interproximal caries – Long face syndrome – Early loss of deciduous teeth • Tongue rests on mandible instead of touching the palate – Early extractions of deciduous teeth – Maxillary constriction – Posterior • Clockwise rotation of mandible –Anterior Openbite • Dry mouth – Increased caries rate – Increased Gingival inflammation

4 Esthetics Posterior Crossbite treatment: Palatal Expander ♦ Improve smile Palatal Expander ♦ Self-esteem issues ♦ ♦ Porter Arch appliance appliance ♦ Some diastema is normal stage of dental maturation

Posterior Crossbite: Rapid Palatal Expander (RPE) Lateral functional shift

Posterior Crossbite treatment: Elimination of midline shift Palatal Expander

5 Treatment: RPE & 2x4 Posterior crossbite

Anterior Crossbite: Treatment: RPE and 2x4 Anterior functional shift

4/17/02

CR CO

9/6/02

Treatment: RPE & Reverse pull Anterior & Posterior crossbite Headgear

6 Anterior Crossbite Treatment: Treatment: Bonded RPE with Reverse Pull Headgear 2 mo. progress

Removable Finger Spring Treatment: Bonded RPE with Appliance with posterior bite Reverse Pull Headgear plate 2 mo. progress

Class III Openbite: Thumb sucking habit

7 Treatment: Openbite: Treatment Blue Grass 3 mo. progress Tongue Guard Tongue rake Blue grass

Removable Tongue Crib Increased risk for trauma

Openbite: Thumb sucking habit Increased risk for trauma Blue grass appliance

♦ 2/16/02 ♦ 5/19/02

8 Treatment: Serial Extraction Headgear &/or Bite plate

Space Management Serial Extraction

♦ Serial Extraction ♦ Initial stage: – 4 incisors erupting per arch with lack of space

♦ Extraction of deciduous canines: – Allow permanent incisors to align

Serial Extraction Serial Extraction

♦ Extraction of first deciduous molars: – Allow first to erupt ahead of canines

♦ Extraction of first premolars – Allow canines to erupt – Extract second deciduous molars to allow eruption of second premolars

9 Removable Space maintainer Serial Extraction Pedo partial ♦ 13 year old girl without serial extraction

♦ 13 year old girl with serial extraction

Space conservation Fixed unilateral appliance ♦ Interproximal caries –Restoration ♦ Early loss of deciduous teeth ♦ Distal shoe ♦ Band & Loop – Space maintainer – Space regainer ♦ Extractions – Space maintainer ♦ Crown & Loop – Space regainer ♦ Missing teeth

Removable space maintainer Fixed Bilateral appliance

♦ Nance appliance ♦ Transpalatal Arch (TPA)

10 Lower Lingual Holding Arch

Esthetics: Self-esteem

Summary

♦ Early Orthodontic treatment: – Guide growth to more favorable direction – Reduce the chance of extraction or surgery – Reduce phase II treatment time length – Esthetics

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