Transcript True benefits of early treatment

True benefits of early
orthodontic treatment
Children’s Dental World
Dr. Milos Lekic
Why treat early
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Malocclusions may be diagnosed early
Up until 10 years ago there hasn’t been
evidence to point clinicians towards early or late
treatment
Our desire to help patients with concerns and
self-esteem considerations
Commercial influence as manufacturing has
been ahead of science
‘Practice Efficiency’
Early treatments with proven
benefits
Posterior and anterior crossbites
 Crossbites associated with mandibular
shifts may lead to a true skeletal
discrepancy as the mandible develops
asymmetrically in the direction in which it
is shifting
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Possible treatments:
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Removable expansion – slow expansion
Fixed expansion – slow/fast expansion (Quad-Helix, W-arch)
Fixed expansion – rapid expansion (RPE)
Early treatments with proven
benefits
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Ankylosed teeth
 Orthodontic
treatment is usually warranted as the
contralateral successor tooth is erupting
 The successor permanent tooth may need guided
eruption
 Ankylosed teeth may be used for anchorage
purposes
 It was shown that prolonged retention of ankylosed
teeth may lead to a decreased development of the
associated alveolar bone
Early treatments with proven
benefits
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Excessive protrusions and diastemas
 These
may lead to injury or avulsions
 They are often reasons why kids get teased
 Thus, they affect the child’s self-esteem
 As the condition persists, the mandibular lip
may become entrapped behind the maxillary
incisors, further perpetuating the problem
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A 2x4 appliance may be used to correct the protrusion or to close
the diastema space
Maxillary fixed appliance may be combined with a headgear
However, the three randomized randomized control trial studies
showed that there may be no true benefit with an early two-phase
treatment involving headgears or functional appliances
Early treatments with proven
benefits
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Severe anterior or lateral open bites
 These conditions need to be addressed early
 If there is a habit associated with the condition,
the
habit itself must be dealt with
 The most common cause is a prolonged thumb
sucking habit
 If the habit is treated before the permanent anterior
dentition erupts, the open bite may resolve
spontaneously
 If open bites are of true skeletal nature, they will
require comprehensive treatment later on
Early treatments with proven
benefits
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Ectopic molars
 These
are best treated when they are
discovered
 They are most commonly found as the
maxillary first molars erupt
 If left untreated, ectopic molar eruption may
lead to early primary molar loss as well as
arch length loss
Early treatments with proven
benefits
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Severe arch length discrepancies
 >10mm
space required
 Shallow to normal overbite
 Fuller lips/profile
 Class I malocclusion
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Serial extraction, if successful, would still
necessitate comprehensive orthodontic
treatment
Early treatments with proven
benefits
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Pseudo Class III patients
 Class
III patients which have a discrepancy
between centric relation and maximum
intercuspation may have a pseudo Class III
 This condition should be treated before it
develops into a true Class III malocclusion
Early treatments with proven
benefits
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True Class III malocclusions due to a
maxillary retrusion
 This
condition is best treated early between
the ages of 8-10
 This is a time when the maxilla is undergoing
active growth which can be modified to the
patient’s advantage
Early treatments with proven
benefits
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Space maintenance
 There
were two major studies performed with
the aim of assessing treatment of crowding in
the mixed dentition
 Both studies evaluated the mandibular
dentition as it generally dictates the strategy
for future maxillary arch treatment
Early treatments with proven
benefits
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Space maintenance
 In
the mixed dentition, crowding was expected
in 85% of patients
 However, when the leeway space was
accounted for and preserved with a lower
lingual holding arch, 68% of patients exhibited
no crowding in the permanent dentition and
87% exhibited crowding of less than 2mm in
the permanent dentition
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Thus, a large proportion of young patients may be well managed
simply by preserving the mandibular arch space
There is a philosophy of treatment which dictates that early maxillary
expansion treatment will remove the constraining influences on the
mandibular arch and allow it to develop laterally
However, studies have shown that with such treatment, the
mandibular intercanine width changes by less than 1mm
Early treatments with proven
benefits
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Space maintenance
 Treatment
time for lingual arch space maintenance
can be in the late mixed dentition
 One major exception is the early loss of a primary
canine in which case the opposite canine should be
removed and a lingual holding arch inserted
 The treatment with only a simple lingual holding arch
has been found to be stable in 76% of cases 9 years
into retention
Early treatments with proven
benefits
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Space regaining
 If
moderate space regaining is needed in the
mandibular arch, up to 1mm, it may be accomplished
with a lip bumper
 It was shown that if more than 1mm of arch length
needs to be gained, the final outcome will be unstable
 In addition, lateral expansion as a way of gaining
space will be unstable as it was shown that
mandibular intercanine width tends to relapse to its
pre-treatment values
References
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White L. Early Orthodontic Intervention. American Journal of Orthodontics and Dentofacial Orthopedics
1998;113(1):24-28.
www.asoorg.au
www.alpersdental.co.nz
www.umnedudent.al
www.azur-orthodontics.com
www.cypressbraces.com
www.kiferdentalspecialist.com
Gianelly AA. Treatment of Crowding in the Mixed Dentition. American Journal of Orthodontics and Dentofacial
Orthopedics 2002;121(6):569-571.
Gianelly AA. Crowding, Timing of Treatment. Angle Orthodontist 1994;64:415-8.
Brennan M, Gianelly AA. The use of the Lingual Arch in the Mixed Dentition to Resolve Crowding. American
Journal of Orthodontics and Dentofacial Orthopedics 2000;117:81-5.
Thank you.