Management of the Management of the Developing Dentition, Developing Dentition, Missing, Extra and Ectopic Missing, Extra and Ectopic teethteeth
Aims:Aims:
lOverview of changes from deciduous to permanent dentition
lCommon problems and their managementlPrinciples of treatment for missing, extra
and ectopic teeth
Changes from deciduous to Changes from deciduous to permanent dentitionspermanent dentitions
Ages of dentitionsAges of dentitions
lPrimary Dentition: 6mths - 6yrs
lMixed Dentition: 6yrs - 10/12yrs
lPermanent Dentition: 10/12yrs +
‘‘IdealIdeal’’ Deciduous dentitionDeciduous dentition
lSpaced incisorslAnthropoid spaceslNormal incisor
relationshiplDistal surfaces of E’s
aligned
Variations in Deciduous Variations in Deciduous occlusionocclusion
lSpaced Incisors: 33% spaced 3% crowded
lAnthropoid spaces: Absent -13% upper 22% lower
lIncisor relationship: lOB:
19% ideal 20% increased 37% reduced 24% AOB
lOJ 72% increased
Variations in Deciduous Variations in Deciduous occlusionocclusion
lDistal surfaces of E’s 55% Class I 26% Class II 4% Class III
Variations in Deciduous Variations in Deciduous occlusionocclusion
Changes in Deciduous Changes in Deciduous dentitiondentition
lSpaces change:lD-E spaces closelapparent increase in
incisor spacing
lIncisor relationship: OB - reduces (attrition) OJ - reduces (growth)
lAntero-Posterior: 50% molars/canine relationships change
lArch Dimension: slight increase in width and length
Changes in Deciduous Changes in Deciduous dentitiondentition
Changes to accommodate Changes to accommodate Permanent dentitionPermanent dentition
lSpaced primary dentitionlIncrease in arch dimensions:
Width increase - molar and canines Length increase - to accommodate molars
Changes to accommodate Changes to accommodate Permanent dentitionPermanent dentition
‘Ugly duckling’ phase
Eruption sequenceEruption sequence
lmore important than age of eruptionlcontra-lateral expected within 6mths
1. 66 1
(6yrs)
2. 12
(7-8yrs)
3. 2 (8yrs)
4. 3
(9-10yrs)
5. 5 4 34
(10-12yrs)
6. 77 5
(12yrs)
Eruption sequenceEruption sequence
Common ProblemsCommon Problemsin mixed dentition and in mixed dentition and
SolutionsSolutions
Deciduous extraction'sDeciduous extraction's
lRetain/restorelExtract and space maintainlExtract and ‘balance’
Avoid if possible
Options:
Deciduous extraction'sDeciduous extraction'sProblems
lSpace loss Caries/loss of DE - mesial drift
Deciduous extraction'sDeciduous extraction'sProblems
lCentre line loss esp. unilateral loss of C
Early loss
Deciduous extraction'sDeciduous extraction'sProblems
lOver eruption of opposing teeth minimal problem
Serial ExtractionPoor solution
lExtract C’s as 2’s erupt to allow incisors to align
lExtract D’s - 6mths before normal loss to hasten eruption of 4’s
lExtract 4’s
lClass I skeletal patternlClass I occlusionlMild - moderate crowdinglALL teeth present
Serial ExtractionPoor solution
Requirements:
lAdvantages:may avoid appliance treatment consolidation of crowding to premolar region
lDisadvantages:3 sets of extraction's Does NOT prevent need for appliances OB increases
Serial ExtractionPoor solution
Extraction of CExtraction of C’’ss
l2’s erupting lingual/palatalloss of C’s may allow spontaneous correction
lLower incisor crowding loss of C’s may allow spontaneous correction
lPalatally displaced 3 loss of C’s may allow spontaneous correction
Extraction of CExtraction of C’’sslLower incisor crowding
loss of C’s may allow spontaneous correctionl NB: loss of space for 3|
Management of problemsManagement of problems
lObservelDisimpactlExtract E - results in space loss
Impacted upper 6
lExtract if deflecting/impeding eruption
Management of problemsManagement of problemsRetained deciduous teeth/roots
lAnterior crossbitescorrect - ensure space is available
lPosterior crossbitescorrect - if deviation is associated
Management of problemsManagement of problemsCrossbites of permanent teeth
Management of problemsManagement of problemsCrossbites of permanent teeth
lRadiographs lDetermine cause for failurelRefer if appropriate
Management of problemsManagement of problemsNon eruption of teeth
Management of problemsManagement of problemsNon eruption of teeth
Management of problemsManagement of problemsNon eruption of teeth
lDetermine cause displacement on closure – correct crossbite? asymmetrical loss - balance?
lRefer as appropriate
Management of problemsManagement of problemsCentre line shift
Management of problemsManagement of problemsSubmerging teeth
lCause: anklylosis - ‘cracked cup’ percussion
lProblems: Space loss Delayed eruption Over eruption of opposing teeth Alveolar defects
lManagement wait and see extract - if submerging totally
Management of problemsManagement of problemsSubmerging teeth
HabitsHabitsDepends upon habit and duration
lProblems: AOB OJ increased Arch asymmetry Crossbites
lManagement :‘talk to stop’reminder plate
Habits Habits -- the cluesthe clues
Habits Habits -- the cluesthe clues
Habits Habits -- solutionssolutions
Management of problemsManagement of problemsWhen to Refer
lGross crowdinglTraumatic occlusionslGross skeletal/arch discrepancies
Management missing teethManagement missing teeth
Hypodontia – few missing
Oligodontia – many missing
Anodontia – all missing
Management missing teethManagement missing teeth
Treatment options:1. Accept2. Maintain the space3. Redistribute the space4. Close the space
Interdisciplinary planning required
Management missing teethManagement missing teeth
Redistribute the space
Management missing teethManagement missing teeth
Close the space
Management missing teethManagement missing teethRefer!!!
Management extra teethManagement extra teeth
Supernumary e.g. mesiodens
Supplemental
Management extra teethManagement extra teeth
Treatment options:
1. Removal (supplemental)
2. Use best placed (supernumary)
Management Ectopic teethManagement Ectopic teeth
Buccal or Palatal ?
Management Ectopic teethManagement Ectopic teethBuccal or Palatal ?
Open Exposure
TractionTraction
Closed Exposure(gold chain)
C retained, no root resorption
Extract C
Management Ectopic teethManagement Ectopic teethBuccal
Traction
Closed Exposure(gold chain)
Management Ectopic teethManagement Ectopic teethPalatal
Open Exposure
Traction
Management Ectopic teethManagement Ectopic teeth
SummarySummary
lMaintain deciduous dentitionlAvoid serial extractionlIf extraction's unavoidable - balancelEnsure all teeth present before extractinglCorrect simple problems
lIf in doubt - refer
Further readingFurther readinglMitchell L
orthodonticslFoster TD
A textbook of orthodontics Chp3 Development of the occlusion
lProffit WR Contemporary orthodontics Chps ‘Development of orthodontic problem ‘ and ‘Treatment of preadolescent children’
lMitchell & Mitchell Handbook of clinical dentistry Chp ‘Orthodontics’
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