INCISOR GUIDANCE AND ECTOPIC /fixed orthodontic courses by IDA

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INCISOR GUIDANCE:

INCISOR GUIDANCE www.indiandentalacademy.com

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www.indiandentalacademy.com INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com

GUIDING THE DEVELOPING DENTITION:

GUIDING THE DEVELOPING DENTITION “LOWER INCISOR CROWDING IN THE EARLY MIXED DENTITION” www.indiandentalacademy.com

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SPECIFIC OBJECTIVES: 1. Know how to approach the problem of lingually erupting lower incisors. 2. Know when to assess a child patient’s tooth size-arch length relationship. 3. Identify when discing of lower cuspids is required. www.indiandentalacademy.com

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SPECIFIC OBJECTIVES (cont): 4. Explain leeway space control and the role of the mandibular lingual arch in assisting lower incisor alignment. 5. Be able to design an appliance to improve lower incisor alignment. _____________________________________ REQUIRED READING: Preceding material in this Syllabus. www.indiandentalacademy.com

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REQUIRED READING: (In manual) Article: Early Mixed Dentition Developmental Module Article: Management of lower incisor crowding in the early mixed dentition. T. Foley, G. Wright, S. Weinberger, Journal of Dentistry for Children, May-June, 1996, pp 169-174. www.indiandentalacademy.com

ESSENTIAL FACTORS FOR A SMOOTH TRANSITION FROM PRIMARY TO PERMANENT DENTITION:

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 www.indiandentalacademy.com

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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. www.indiandentalacademy.com

THE AIMS OF THIS PRESENTATION ARE: :

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. www.indiandentalacademy.com

WHY INCISOR GUIDANCE?:

WHY INCISOR GUIDANCE? To help prevent orthodontic relapse. Prevent unnecessary periodontic problems. www.indiandentalacademy.com

WHAT VARIABLES ARE TO BE CONSIDERED?:

WHAT VARIABLES ARE TO BE CONSIDERED? Interdental spacing. Intercanine distance. Increase of the arch perimeter. Size ratio between the primary and permanent teeth. www.indiandentalacademy.com

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PROBABILITY OF CROWDING:

PROBABILITY OF CROWDING 1 ° - 4 YEARS CROWDING NO 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 www.indiandentalacademy.com

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WHEN AND HOW TO TREAT??:

WHEN AND HOW TO TREAT?? Continue to observe the case. Disc primary teeth. Extract primary teeth. Refer to an orthodontist. www.indiandentalacademy.com

CASES TO OBSERVE:

CASES TO OBSERVE Those < 2mm. crowding may resolve into good alignment. (Profitt) www.indiandentalacademy.com

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CASES FOR DISCING:

CASES FOR DISCING Those with 3 – 4 mm. arch crowding. The goal is to transfer the anterior crowding posteriorly into the leeway space. www.indiandentalacademy.com

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CASES FOR EXTRACTION:

CASES FOR EXTRACTION When arch crowding is 4 to 9 mm. www.indiandentalacademy.com

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The goal is improve incisor alignment (unraveling), perhaps preventing periodontal problems and improving post-orthodontic stabliity. www.indiandentalacademy.com

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WHEN TO REFER??:

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). www.indiandentalacademy.com

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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). www.indiandentalacademy.com

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BENEFITS OF EARLY TREATMENT:

BENEFITS OF EARLY TREATMENT Avoid unnecessary periodontal problems. Enhance the long term stability of orthodontic treatments. Involve more clinicians in guiding the developing dentition. www.indiandentalacademy.com

D362 / Q362 Division of Orthodontic & Paediatric Dentistry University of Western Ontario Dr. Sahza Hatibovic-Kofman:

D362 / Q362 Division of Orthodontic & Paediatric Dentistry University of Western Ontario Dr. Sahza Hatibovic-Kofman ECTOPIC ERUPTION AND SPACE REGAINING 2004-2005 www.indiandentalacademy.com

ECTOPIC ERUPTION:

ECTOPIC ERUPTION www.indiandentalacademy.com

ECTOPIC ERUPTION:

ECTOPIC ERUPTION GENERAL OBJECTIVE: To discuss the problem of ectopic eruption generally. To discus the problem of ectopic eruption the canine and first permanent molar and its management. www.indiandentalacademy.com

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SPECIFIC OBJECTIVES: 1. Define ectopic eruption. 2. Know the frequency of ectopically eruption first permanent molars. 3. Explain the reasons for ectopic eruption occurring with first permanent molars. 4. Distinguish between a reversible and non-reversible ectopic eruption. www.indiandentalacademy.com

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SPECIFIC OBJECTIVES (continued): 5. Know methods for correcting ectopic molar eruption. 6. Explain why long term follow-up is needed for corrected ectopic eruption cases. REQUIRED READING Article: Weinberger, S., Wright, G., “The Unpredictability of primary molar resorption following ectopic eruption of permanent molars”, Journal of Dentistry for Children, Nov-Dec, 1987. www.indiandentalacademy.com

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REQUIRED READING (continued) Article: Weinberger, S., “Correction of bilateral ectopic eruption of first permanent molars using a fixed appliance”, Pediatric Dentistry, Nov-Dec, 1992, Vol 14, No. 6 www.indiandentalacademy.com

Malposition of a permanent tooth bud can lead to eruption in the wrong place, and usually the tooth on its way resorbs the tooth that it is not supposed to resorb.:

Malposition of a permanent tooth bud can lead to eruption in the wrong place, and usually the tooth on its way resorbs the tooth that it is not supposed to resorb. www.indiandentalacademy.com

ANOMALIES OF POSITION:

ANOMALIES OF POSITION www.indiandentalacademy.com

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ECTOPIC ERUPTION OF THE FIRST PERMAMENT MOLAR:

ECTOPIC ERUPTION OF THE FIRST PERMAMENT MOLAR www.indiandentalacademy.com

Reported prevalance of ectopic eruption of the first permanent molars:

Reported prevalance of ectopic eruption of the first permanent molars

TWO TYPES OF ECTOPIC MOLARS ARE: 1. REVERSIBLE OR “JUMP”. 2. IRREVERSIBLE OR “LOCK” TYPE. :

TWO TYPES OF ECTOPIC MOLARS ARE: 1. REVERSIBLE OR “JUMP”. 2. IRREVERSIBLE OR “LOCK” TYPE. www.indiandentalacademy.com

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HOW MANY WAYS ARE THERE TO MANAGE ECTOPIC ERUPTION:

HOW MANY WAYS ARE THERE TO MANAGE ECTOPIC ERUPTION www.indiandentalacademy.com

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A ligature wire is passed through beneath the contact and then twisted tightly. www.indiandentalacademy.com

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REGAINING SPACE IN THE MIXED DENTION:

REGAINING SPACE IN THE MIXED DENTION www.indiandentalacademy.com

REGAINING SPACE IN THE MIXED DENTITION:

REGAINING SPACE IN THE MIXED DENTITION GENERAL OBJECTIVE: Diagnose and regain the space loss. www.indiandentalacademy.com

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SPECIFIC OBJECTIVES: 1. Explain how space loss occurs in the posterior region. 2. Describe indications for space regaining in regards to the magnitude of space loss. 3. Describe the differences between maxillary and mandibular arch space regaining. 4. Describe indications for tipping and bodily tooth movement to regain the space. www.indiandentalacademy.com

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SPECIFIC OBJECTIVES (continued): 5. List the diagnostic aids required prior to initiating space regaining. 6. Present the maximum amount of space that can likely be regained with removable appliances and the time for the treatment. 7. Describe the most commonly used appliances for space regaining, such as: (a) removable applicant with finger spring www.indiandentalacademy.com

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SPECIFIC OBJECTIVES (continued): 7. (b) removable appliance with jackscrew (c) fixed appliance with coil spring (d) lip bumper REFERENCE: Proffit, Contemporary Orthodontics, 2nd ed., 1993, Chapter 13, pp. 382-387 www.indiandentalacademy.com

Space regaining procedures should be limited to re-establishing 3 mm. Or less of space in a localized area. :

Space regaining procedures should be limited to re-establishing 3 mm. Or less of space in a localized area. www.indiandentalacademy.com

Generally, space is easier to regain in the maxillary arch than in the mandibular arch. :

Generally, space is easier to regain in the maxillary arch than in the mandibular arch. www.indiandentalacademy.com

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.:

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. www.indiandentalacademy.com

If the primary second molar has been lost prematurely in a single quadrant, up to 3 mm. of space may be regained by tipping the molar back distally.:

If the primary second molar has been lost prematurely in a single quadrant, up to 3 mm. of space may be regained by tipping the molar back distally. www.indiandentalacademy.com

If space loss is bilateral, the limit of space regaining is about 4 mm. for the total arch, or 2 mm. per quadrant.:

If space loss is bilateral, the limit of space regaining is about 4 mm. for the total arch, or 2 mm. per quadrant. www.indiandentalacademy.com

Croll Kesling Halterman Weinberger:

Croll Kesling Halterman Weinberger www.indiandentalacademy.com

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CLOSELY OBSERVE CORRECTED ECTOPIC ERUPTION CASES:

CLOSELY OBSERVE CORRECTED ECTOPIC ERUPTION CASES www.indiandentalacademy.com

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www.indiandentalacademy.com Thank you www.indiandentalacademy.com Leader in continuing dental education

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