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Timing of Orthodontic Treatment

Timing of Orthodontic Treatment. By Masuda Begum, Claire Boultby , Claire Prescott, Radika Mistry , Aarti Prasher, Ronit Patel, Emily Moul & Harriet Morse. Aims. Orthodontic treatment during: Primary dentition Early mixed dentition Late mixed dentition Permanent dentition.

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Timing of Orthodontic Treatment

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  1. Timing of Orthodontic Treatment By Masuda Begum, Claire Boultby, Claire Prescott, RadikaMistry, Aarti Prasher, Ronit Patel, Emily Moul & Harriet Morse

  2. Aims • Orthodontic treatment during: • Primary dentition • Early mixed dentition • Late mixed dentition • Permanent dentition

  3. Aware of…. • Normal dental & skeletal patterns - eruption dates - definitions of skeletal r’ships • Allows recognition of abnormalities

  4. Primary Dentition • Time for observation & prediction • Observation to ensure no problems with development & growth • Early detection prevent malocclusion becoming worse

  5. Predictions • Lack of spacing crowding • No spacing= 70% chance of crowding • < 3mm space = 50% chance of crowding • Like at least >6mm space in 1 dentition • Supernumery 35-50% supernumeraries in permanent

  6. Observations made in deciduous dentition Increased Overjet Crowding Decreased overbite and lower incisors protruding Open Bite

  7. What does the literature say? • PietilaI et al (2008) -assessments of children carried out before age of 7 • Moyers et al (1988) - early intervention take adv of normal growth, - tooth positioning easier & easier to treat habits (e.g. Digit sucking) • Sustain & maintain desired outcome over long period of time

  8. Early Mixed Dentition • Phase I treatment - interceptive • Preserve space in U & L arch for permanent dentition • Treatment begins approx. at 7yrs of age • Treatment include removable appliance or extractions

  9. Problems to intercept • Deflected permanent teeth • Premature loss of deciduous teeth Deflected teeth

  10. Problems to treat • Instanding teeth • Crossbites with mandibular displacement • Recreating space for lost incisors • Supernumery teeth

  11. Late Mixed Dentition • Majority of orthodontic treatment done at this stage • Investigate missing teethe.g. Canines • Functional appliances work best in this stage  growth spurts

  12. Problems to treat • Ectopic canines – screen pts at 10 yrs ( check for bulge in sulcus) • Poor quality 1st permanent molars – extraction? • Skeletal problems

  13. Permanent Dentition • Treat as soon as all permanent teeth erupt • Quicker treatment, provided cooperation • Main problem is lack of growth • Impact -class III malocclusions - overbite

  14. Class III malocclusion • Mild/moderate - camouflaging with fixed braces • Severe – surgical intervention once growth ceased • 2 options for this: • align Uarch & then orthognathic surgery • combined surgery & orthodontics in adulthood • Relapse if carried out too early

  15. Overbite reduction • Difficult with lack of growth • Adults cannot tolerate bite-planes • Alternative - intrude the incisors

  16. Conclusion • Aware of the norm • Primary- observation & early detection • Early mixed- interceptive treatment • Late mixed- • Permanent- camouflaging & surgery

  17. References/ Further Reading • www.goldreichorthodontics.com/children.php (Pictures) • Yang EY & Kiyak HA. Orthodontic treatment timing: a survey of orthodontists. Am J. Orthodontic dentofacial orthodontics. 1998 January: 113 (1), 96-103. • Pietila I, Pietila T et al. Orthodontists’ views on indications for and timing of orthodontic treatment in Finnish public oral health care. European Journal of orthodontics.Feb 2008, 30(1): 46-51 • Moyers RE. Handbook of orthodontics, 4th ed. Chicago: Year Book Medical Publishers; 1988. p. 346-7, 433-4 • The timing of orthodontic treatment. DiBiase A. Dental Update. 29(9):434-41, 2002 Nov.  • Early Orthodontic Treatment: What are the imperatives? G. THOMAS KLUEMPER, D.M.D., M.S., CYNTHIA S. BEEMAN, D.D.S., PH.D. and E. PRESTON HICKS, D.D.S., M.S., M.S.D. JADA. Vol 131:613-620, May 2000 • An Introduction to Orthodontics Laura Mitchell • Removable Orthodontic Appliances K.G Isaacson; J.D Muir; R.T Reed 2002 THANK YOU

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