True benefits of early orthodontic treatment
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Transcript of True benefits of early orthodontic treatment
Why treat early
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
Possible treatments: Removable expansion – slow expansion Fixed expansion – slow/fast expansion (Quad-Helix, W-arch) Fixed expansion – rapid expansion (RPE)
Early treatments with proven benefits
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
Excessive protrusions and diastemasThese may lead to injury or avulsionsThey are often reasons why kids get teasedThus, they affect the child’s self-esteemAs the condition persists, the mandibular lip
may become entrapped behind the maxillary incisors, further perpetuating the problem
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
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
Ectopic molarsThese are best treated when they are
discoveredThey 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
Severe arch length discrepancies>10mm space requiredShallow to normal overbiteFuller lips/profileClass I malocclusion
Serial extraction, if successful, would still necessitate comprehensive orthodontic treatment
Early treatments with proven benefits
Pseudo Class III patientsClass 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
True Class III malocclusions due to a maxillary retrusionThis condition is best treated early between
the ages of 8-10This is a time when the maxilla is undergoing
active growth which can be modified to the patient’s advantage
Early treatments with proven benefits
Space maintenanceThere 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
Space maintenance In the mixed dentition, crowding was expected
in 85% of patientsHowever, 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
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
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
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
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.