incisor guidance ppt
TRANSCRIPT
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D362-Q362
Division of Orthodontic & Paediatric Dentistry
University of Western Ontario
Dr. Sahza Hatibovic-Kofman
INCISOR GUIDANCE and
ECTOPIC ERUPTION
2004-2005
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INCISOR GUIDANCE
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GUIDING THE DEVELOPING
DENTITION
LOWER INCISOR CROWDING IN THE
EARLY MIXED DENTITION
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SPECIFIC OBJECTIVES:
1. Know how to approach the problem oflingually erupting lower incisors.
2. Know when to assess a child patients toothsize-arch length relationship.
3. Identify when discing of lower cuspids isrequired.
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SPECIFIC OBJECTIVES (cont):
4. Explain leeway space control and the role ofthe mandibular lingual arch in assistinglower incisor alignment.
5. Be able to design an appliance to improvelower incisor alignment.
_____________________________________
REQUIRED READING:
Preceding material in this Syllabus.
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REQUIRED READING:
(In manual)
Article: Early Mixed Dentition Developmental Module
Article: Management of lower incisor crowding in theearly mixed dentition. T. Foley, G. Wright,
S. Weinberger, Journal of Dentistry for
Children, May-June, 1996, pp 169-174.
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ESSENTIAL FACTORS FOR A SMOOTH
TRANSITION FROM PRIMARY TO
PERMANENT DENTITION
1. Primate space
2. General spacing
3. Preservation of leeway space
4. Sequences of eruption
5. Tooth size and jaw in harmony
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Crowding and protrustion of the
incisors must be considered two
aspects of the same thing: how
crowded and irregular the incisors are
reflects both how much room is
available and where the incisors are
positioned relative to the supporting
bone.
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THE AIMS OF THIS
PRESENTATION ARE:
Identify WHY incisor guidance is needed.
List WHAT is to be considered.
Indicate WHEN incisor guidance is
appropriate.
Suggest HOW incisor guidance is performed.
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WHY INCISOR GUIDANCE?
To help prevent orthodontic relapse.
Prevent unnecessary periodontic problems.
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WHAT VARIABLES ARE TO BE
CONSIDERED?
Interdental spacing.
Intercanine distance.
Increase of the arch perimeter.
Size ratio between the primary and permanentteeth.
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PROBABILITY OF CROWDING
1 - 4 YEARS
CROWDINGNO SPACE
0-3 MM SPACE
3-6 MM SPACE
> 6 MM SPACE
PERMANENT
- 10/10- 7/10
- 5/10
- 2/10
- 0/10
B. C. LEIGHTON
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WHEN AND HOW TO TREAT??
Continue to observe the case.
Disc primary teeth.
Extract primary teeth.
Refer to an orthodontist.
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CASES TO OBSERVE
Those < 2mm. crowding mayresolve into good alignment. (Profitt)
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CASES FOR DISCING
Those with 3 4 mm. arch crowding.
The goal is to transfer the anterior crowdingposteriorly into the leeway space.
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CASES FOR EXTRACTION
When arch crowding is 4 to 9 mm.
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The goal is improve incisor alignment(unraveling), perhaps preventing periodontalproblems and improving post-orthodontic
stabliity.
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WHEN TO REFER??
Most class I cases having more than 10 mm.
crowding should be referred to an orthodontic
specialist by general dentists and (perhaps
paediatric dentists).
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7 years old 9 years old 14 years old
Changes in the axial inclination due to the eruption of the maxillary anterior
teeth (Broadbent, 1957).
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BENEFITS OF EARLY
TREATMENT
Avoid unnecessary periodontal problems.
Enhance the long term stability of orthodontic
treatments.
Involve more clinicians in guiding the
developing dentition.
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D362 / Q362
Division of Orthodontic & Paediatric DentistryUniversity of Western Ontario
Dr. Sahza Hatibovic-Kofman
ECTOPIC ERUPTION AND
SPACE REGAINING2004-2005
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ECTOPIC ERUPTION
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GENERAL OBJECTIVE:
To discuss the problem of ectopic
eruption generally.
To discus the problem of ectopic eruption
the canine and first permanent molar andits management.
ECTOPIC ERUPTION
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SPECIFIC OBJECTIVES:
1. Define ectopic eruption.
2. Know the frequency of ectopicallyeruption first permanent molars.
3. Explain the reasons for ectopic eruptionoccurring with first permanent molars.
4. Distinguish between a reversible andnon-reversible ectopic eruption.
SPECIFIC OBJECTIVES ( ti d)
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SPECIFIC OBJECTIVES (continued):
5. Know methods for correcting ectopic
molar eruption.
6. Explain why long term follow-up is neededfor corrected ectopic eruption cases.
REQUIRED READING
Article: Weinberger, S., Wright, G., The
Unpredictability of primary molar resorptionfollowing ectopic eruption of permanentmolars, Journal of Dentistry for Children,Nov-Dec, 1987.
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REQUIRED READING (continued)
Article: Weinberger, S., Correction of bilateralectopic eruption of first permanent molarsusing a fixed appliance, PediatricDentistry, Nov-Dec, 1992, Vol 14, No. 6
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Malposition of a permanent tooth
bud can lead to eruption in the
wrong place, and usually the toothon its way resorbs the tooth that it
is not supposed to resorb.
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ANOMALIES OF POSITION
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ECTOPIC ERUPTION
OF THE
FIRST PERMAMENT MOLAR
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Reported prevalance of ectopic
eruption of the first permanent molars
Authors Year of study
Country Number Of CHILDREN
Children With NUMBER
Ectopic EruptionPERCENT
Cheyne & Wessels 1947 USA 500 9 2
Young 1957 USA 1,619 52 2
O'Meara 1962 USA 315 6 2
Pulver 1968 USA 831 26 3.1
Bjerklin & Kurol 1981 Sweden 2,903 126 4.3
Mackerle-Heporauto 1981 Switzer-land
543 32 6
Kimmel et al 1982 USA 5,277 250 3.8
Kurol-1986
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TWO TYPES OF ECTOPIC MOLARS
ARE:
1. REVERSIBLE OR JUMP.
2. IRREVERSIBLE OR LOCK TYPE.
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HOW MANY WAYS ARE THERE TO
MANAGE ECTOPIC ERUPTION
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A ligature wire is passed through beneath the
contact and then twisted tightly.
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REGAINING SPACE IN THEMIXED DENTION
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GENERAL OBJECTIVE:
Diagnose and regain the space loss.
REGAINING SPACE IN THE MIXED
DENTITION
SPECIFIC OBJECTIVES:
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1. Explain how space loss occurs in the
posterior region.
2. Describe indications for space regainingin regards to the magnitude of space loss.
3. Describe the differences betweenmaxillary and mandibular arch spaceregaining.
4. Describe indications for tipping andbodily tooth movement to regain thespace.
SPECIFIC OBJECTIVES (continued):
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( )
5. List the diagnostic aids required prior to
initiating space regaining.
6. Present the maximum amount of spacethat can likely be regained with removable
appliances and the time for the treatment.
7. Describe the most commonly usedappliances for space regaining, such as:
(a) removable applicant with fingerspring
SPECIFIC OBJECTIVES (continued):
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( )
7. (b) removable appliance with jackscrew
(c) fixed appliance with coil spring
(d) lip bumper
REFERENCE:
Proffit, Contemporary Orthodontics, 2nded., 1993, Chapter 13, pp. 382-387
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Space regaining proceduresshould be limited to re-establishing
3 mm. Or less of space in alocalized area.
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Generally, space is easier to regain
in the maxillary arch than in the
mandibular arch.
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Space lost from tipping can be
regained when the crown of the
tooth is tipped back to its original
position, but space lost by bodily
tooth movement requires that the
tooth be bodily repositioned.
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If space loss is bilateral, the limit of
space regaining is about 4 mm. for
the total arch, or 2 mm. per
quadrant.
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Croll
Kesling
Halterman
Weinberger
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CLOSELY OBSERVE
CORRECTED ECTOPIC
ERUPTION CASES
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