Management of orthodontic problem with special consideration

1. 1 Management of orthodontic problem Management of orthodontic problem with special consideration with special consideration Prepared by: Prepared by: Dr Mohammed Alruby Dr Mohammed Alruby يمعلاب كبيصيو كينيع يف هبحت اصخش عضت نا مللاا M Management anagement of orthodontic problem of orthodontic problems s with special consideration with special consideration Dr. Dr. Mohammed Alruby Mohammed Alruby

2. 2 Management of orthodontic problems with special consideration 1-Management of occlusal relationship problems 2-Management of eruption problems 3-Management of space problems Management of occlusal relationship problems: 1-Posterior cross bite 2-Eliminate mandibular shift 3-Anterior cross bite 4-Anterior open bite Management of eruption problems: 1-Over-retained primary teeth: = when approximately ¾ of the root of permanent tooth id formed, this the time of exfoliation of deciduous teeth or should be removed to prevent bleeding and gingival inflammation that can cause pain = most over retained primary maxillary molars have buccal or lingual large root intact = most over retained primary mandibular molars have mesial or distal root still intact and hindering the exfoliation 2-Ectopic eruption: If both mandibular primary canines are lost, the permanent incisors can tip lingually which reduces the arch circumferences and increase the crowding, a passive lingual arch is used to prevent lingual tipping and maintained adequate space. N: B: eruption is ectopic when the permanent tooth causes resorption of primary tooth other than that is supposed to replace or resorb the adjacent tooth = at approximately age of 10 years if the primary canine is not mobile and there is no palpable facial canine, so ectopic eruption should be considered = ectopic eruption of canine is 1% to 2% and may be lead to: impaction of canine or/and resorption of roots of lateral or central incisors so early diagnosis is very important to prevent root resorption = if permanent canine is overlap less than half of root lateral incisors so 91% chance to present in normal position = if the canine overlap more than one half of root of lateral incisors so the chance for normal position is 64% = if resorption of permanent lateral or central incisors is start so, it should be surgically exposed and use orthodontic procedure to repositioning of it in normal position 3-Supernumerary tooth 4-Delayed eruption of incisors: When incisors failed to erupt more than one year past the normal eruption time and adjacent one is erupted so start to repositioning: -Prepare the space for the tooth -Surgically exposure of the tooth: will erupt rapidly -If deeply positioned need exposure of crown and reposition by orthodontic treatment using metal chain or elastic chain in heavy wire or overlay Nickel titanium wire to apply force M Management anagement of orthodontic problem of orthodontic problems s with special consideration with special consideration Dr. Dr. Mohammed Alruby Mohammed Alruby

3. 3 -Final root positioning is left until the final stage of treatment 5-Ankylosed primary teeth: = especially primary molars, the permanent tooth fails to resorb the primary one because high bony attachment at cervical region = this delayed eruption of permanent teeth and deflect from the normal way = extract the primary tooth and allow normal eruption of permanent one or repositioning orthodontically = when ankylosed tooth has no permanent successor, to avoid overeruption of opposing one so extract the deciduous tooth and plane for prosthetic replacement N: B: the longer the ankylosed primary tooth is left in place, the greater the chance of long term defect because alveolar bone is not formed at this area, but extraction of primary has little defect of bone 6-Transposition: 7-Impact of radiology therapy and bisphosphonate: The children that treat with cancer has risk for: -Shortened root -Tooth fails to erupt -Limited root displacement -Tooth fails to developed For orthodontic treatment: must use very light force until reach to good occlusion Management of space problem Firstly, should do careful diagnosis of the case of space analysis to estimate the amount of space problem and which type of problems either crowding or spacing N: B: Tanka and Johnston prediction: One half of mesiodistal width of lower four incisors equals: -+ 10.5mm = width of mandibular canine and premolars in one quadrant -+ 11mm = width of maxillary canine and premolars in one quadrant 1-Space maintainer: = By early loss of primary tooth, so some problems can appear after time due to drifting of the teeth so space maintainer is indicated = if more than one half of the roots to 2/3 is formed so space maintainer is not necessary = types of space maintainer: -Band and loop space maintainer -Partial denture space maintainer -Distal shoe extension space maintainer -Lingual arch space maintainer 2-Space regaining: Space problem can create by drift of permanent teeth in the space specially during early 6 months’ space loss up to 3mm can re-established by simple appliances with good prognosis but greater than 3mm require more treatment to achieve good results M Management anagement of orthodontic problem of orthodontic problems s with special consideration with special consideration Dr. Dr. Mohammed Alruby Mohammed Alruby

4. 4 Maxillary space regainer: = generally space regainer in maxilla is easy than in lower arch because the anchorage in upper is high by using palatal vault or use headgear = molars can regain about 2-3mm by using full wear appliance = Activated spring 2mm produce 1mm movement /month = in some cases we use coil spring with fixed appliance (bracket) Mandibular space regaining: = use space regainer similar to that for maxillary arch but it more prone to breakage = for unilateral space regaining, the best choice is fixed appliance with lingual arch to support tooth movement = for unilateral due to lingual incisor tipping use lip bumper or fixed appliance with lingual arch 3-Crowding: = when transition from primary to mixed dentition there is 2mm crowding that may resolve spontaneously and in some cases only disking of enamel surface of primary canine is indicated but should not permanent teeth because it may lead to arch discrepancy after time = in some cases where crowding amount is large need more space to relieve crowding M Management anagement of orthodontic problem of orthodontic problems s with special consideration with special consideration Dr. Dr. Mohammed Alruby Mohammed Alruby