early orthodontics

8/3/2019 Early Orthodontics

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www.dentistpro.org to find more
http://www.dentistpro.org/http://www.dentistpro.org/


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Early Orthodontic Treatmentswhat are the imperatives-

JADA vol.131,May 2000

Dr Prathibha Rani Swww.dentistpro.org to find more


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College of Diplomates of American board ofOrthodonticsin Quebec city,Canada on July 13, 1997


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Various questions asked What is early treatment?

Do you perform early tretment?how often

Type of treatment

Benefits

Treatment time?

Quality of treatment? www.dentistpro.org to find


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What is preventiveorthodontictreatment?


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What is interceptiveorthodontictreatment?


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What iscomprehensiveorthodontic

treatment?


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How can a child'sgrowth affectorthodontic

treatment?


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What is two-phase treatment?

Two-phase treatment - two stages. The first is theinterceptive orthodontic phase and the second is thecomprehensive orthodontic phase

Phase I-Precedes conventional treatment protocol

Primary/Transitional dentition


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Two-phase treatment

The goal

Time and complexity of fixed-appliance therapy

Early treatment -beneficial in termsof the long-term care of orthodontic patients is

controversial


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Does early treatment workbetter than a later? greater ability to modify skeletal growth;

improved patient self-esteem and parentalsatisfaction;

better and more stable result;

less-extensive therapy is required later;

reduced potential for iatrogenic tooth damagesuch as trauma, root resorption anddecalcification.


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Orthodontists - phase I less complex malocclusions witha lower treatment priority than subjects in an untreatedcontrol group

E l T t t Of


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Early Treatment Of

Class II Malocclusion

Evidence -improvement, ifnot complete correction, of

the Class II malocclusion

E l T t t Of


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Early Treatment Of


Is facial growth altered-dentoalveolar changes?

If facial growth is altered,

permanent effect or simplya short-term response thatwill be negated bysubsequent growth?

Is the mechanism of changeacting on the maxilla, themandible or both?

E l T t t Of


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Early Treatment Of


Headgear

E l T t t Of


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Early Treatment Of


Randomized clinical trial is generally considered to bethe gold standard for clinical research.

E l T t t Of


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Early Treatment Of


Tulloch and colleagues-extractions-bionatorgroup>headgear or controlgroups


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RCT Ghafari and colleagues

-63 pts with class II 7-13 yrs

Headgear- maxilla

FR-II - mandibularposition

As a result oftreatment, the sagittaldiscrepancy wasreduced in both groups.

E l T t t Of


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Early Treatment Of


Dentition-Molar andcanine - headgearoverjet correction - FR-II,

Treatment timing Class II similar in bothphases


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Early Treatment Of

Class II Malocclusion Keeling and collegues-Headgear and Bionator-short

term skeletal changes.

Enhanced mandibular growth compared to control

E l T t t Of


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Early Treatment Of


Both the single-andtwo-phase approachesare effective incorrecting the Class II

malocclusion.PRE

POST


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Early Treatment Of

Class II Malocclusion They do view early Class II

treatment as an effectivemeans of reducing thedifficulty of and priority forphase 2.

In class II div 1 and Class IIdiv 2

Over jet >9mm and deepoverbite with gingivaltrauma

Earl Class III


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Early Class III

Treatment

Use of protractionheadgear

skeletal crossbite


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Early Class III

Treatment Protocol in facemask-12

ounces of force on themaxilla for 14 hours aday

Orthodontic responses-

Contraindicated-excessive vertical


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Early Class III

Treatment Facemask therapy

primary/ earlytransitional dentition,

Patency of thecircummaxillary sutures


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Early Class III

Treatment Ideal time-Early

maturational stage1-4

Depends on developingdentition


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Early Class III

Treatment Kapust and colleagues determined the

effects of facemask therapy -63 pts of 4-13years

Improvement in the soft-tissue profile.


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Pre and post treatment of class III occlusion



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Early treatment of Transverse

Discrepancies

Unilateral/bilateral crossbite-dental/skeletaldicrepancies

Spillane and Mc Namara-Expansion in transitionaldentition is stable.


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Discrepancies Child with lateral functionalshift-Early orthopedic

correction

Compensagtory/habitualmovement


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Discrepancies Palatal constriction

Premature contactoccurs

Mandibular shift

Condyles-asymmetrical

in their fossae


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Transverse discrepancy

Facial asymmetry

Maxillary expansion

Early treament


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Early treatment of arch-length

discrepancy Normal arch

development

Transitional-mild incisorcrowding

Continued growth anddevelopment


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Proffit and Fields,

1.Normal growth

2.As the succedaneous incisors replace their primary

counterparts they flare forward,gaining 1 to 2 mmof arch length.


discrepancy


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discrepancy

3. Mandibular arch-primate space


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discrepancy


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discrepancy Transitional diastema-

concern for the parents

Self correcting

If larger


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discrepancy Anterior crowding-

posterior space

Leeway space

Lingual holding arch/lipbumper-lower arch

Trans palatal/head gear-upper


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discrepancy

Gianelly- 80%

Optimal timing-Latetransitional dentition

Late transitional is ideal


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discrepancy Early intervention-

Severe crowding.

Malpositioning-unfavorable wearpatterns.

Serial extraction-Earlytransitional dentition,aplliance phase-earlypermanent.


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Summary

Early orthodontic treatment-Effective and desirable.

ClassII-early/late equally beneficial

ClassIII-early orthopedic treatment

Palatal expansion-midpalatal suture

Timing-specific needs of the pts

Arch-length



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