Normal occlusion: Deciduous dentition Early Treatment ♦ OB: Moderate to Shallow ♦ OJ: 3mm Columbia University ♦ Molar 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 incisors • 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 deciduous teeth ♦ 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 crossbite • 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 ♦ Quad Helix ♦ 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 premolars 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 11.