incisor guidance ppt

8/3/2019 Incisor Guidance Ppt

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D362-Q362

Division of Orthodontic & Paediatric Dentistry

University of Western Ontario

Dr. Sahza Hatibovic-Kofman

INCISOR GUIDANCE and

ECTOPIC ERUPTION

2004-2005


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INCISOR GUIDANCE


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GUIDING THE DEVELOPING

DENTITION

LOWER INCISOR CROWDING IN THE

EARLY MIXED DENTITION


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SPECIFIC OBJECTIVES:

1. Know how to approach the problem oflingually erupting lower incisors.

2. Know when to assess a child patients toothsize-arch length relationship.

3. Identify when discing of lower cuspids isrequired.


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SPECIFIC OBJECTIVES (cont):

4. Explain leeway space control and the role ofthe mandibular lingual arch in assistinglower incisor alignment.

5. Be able to design an appliance to improvelower incisor alignment.

_____________________________________

REQUIRED READING:

Preceding material in this Syllabus.


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REQUIRED READING:

(In manual)

Article: Early Mixed Dentition Developmental Module

Article: Management of lower incisor crowding in theearly mixed dentition. T. Foley, G. Wright,

S. Weinberger, Journal of Dentistry for

Children, May-June, 1996, pp 169-174.


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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


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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.


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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.


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WHY INCISOR GUIDANCE?

To help prevent orthodontic relapse.

Prevent unnecessary periodontic problems.


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WHAT VARIABLES ARE TO BE

CONSIDERED?

Interdental spacing.

Intercanine distance.

Increase of the arch perimeter.

Size ratio between the primary and permanentteeth.


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PROBABILITY OF CROWDING

1 - 4 YEARS

CROWDINGNO 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


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WHEN AND HOW TO TREAT??

Continue to observe the case.

Disc primary teeth.

Extract primary teeth.

Refer to an orthodontist.


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CASES TO OBSERVE

Those < 2mm. crowding mayresolve into good alignment. (Profitt)


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CASES FOR DISCING

Those with 3 4 mm. arch crowding.

The goal is to transfer the anterior crowdingposteriorly into the leeway space.


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CASES FOR EXTRACTION

When arch crowding is 4 to 9 mm.


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The goal is improve incisor alignment(unraveling), perhaps preventing periodontalproblems and improving post-orthodontic

stabliity.


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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).


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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).


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BENEFITS OF EARLY

TREATMENT

Avoid unnecessary periodontal problems.

Enhance the long term stability of orthodontic

treatments.

Involve more clinicians in guiding the

developing dentition.


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D362 / Q362

Division of Orthodontic & Paediatric DentistryUniversity of Western Ontario

Dr. Sahza Hatibovic-Kofman

ECTOPIC ERUPTION AND

SPACE REGAINING2004-2005


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ECTOPIC ERUPTION


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GENERAL OBJECTIVE:

To discuss the problem of ectopic

eruption generally.

To discus the problem of ectopic eruption

the canine and first permanent molar andits management.

ECTOPIC ERUPTION


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1. Define ectopic eruption.

2. Know the frequency of ectopicallyeruption first permanent molars.

3. Explain the reasons for ectopic eruptionoccurring with first permanent molars.

4. Distinguish between a reversible andnon-reversible ectopic eruption.

SPECIFIC OBJECTIVES ( ti d)


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SPECIFIC OBJECTIVES (continued):

5. Know methods for correcting ectopic

molar eruption.

6. Explain why long term follow-up is neededfor corrected ectopic eruption cases.

REQUIRED READING

Article: Weinberger, S., Wright, G., The

Unpredictability of primary molar resorptionfollowing ectopic eruption of permanentmolars, Journal of Dentistry for Children,Nov-Dec, 1987.


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REQUIRED READING (continued)

Article: Weinberger, S., Correction of bilateralectopic eruption of first permanent molarsusing a fixed appliance, PediatricDentistry, Nov-Dec, 1992, Vol 14, No. 6


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Malposition of a permanent tooth

bud can lead to eruption in the

wrong place, and usually the toothon its way resorbs the tooth that it

is not supposed to resorb.


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ANOMALIES OF POSITION


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ECTOPIC ERUPTION

OF THE

FIRST PERMAMENT MOLAR


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Reported prevalance of ectopic

eruption of the first permanent molars

Authors Year of study

Country Number Of CHILDREN

Children With NUMBER

Ectopic EruptionPERCENT

Cheyne & Wessels 1947 USA 500 9 2

Young 1957 USA 1,619 52 2

O'Meara 1962 USA 315 6 2

Pulver 1968 USA 831 26 3.1

Bjerklin & Kurol 1981 Sweden 2,903 126 4.3

Mackerle-Heporauto 1981 Switzer-land

543 32 6

Kimmel et al 1982 USA 5,277 250 3.8

Kurol-1986


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TWO TYPES OF ECTOPIC MOLARS

ARE:

1. REVERSIBLE OR JUMP.

2. IRREVERSIBLE OR LOCK TYPE.


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HOW MANY WAYS ARE THERE TO

MANAGE ECTOPIC ERUPTION


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A ligature wire is passed through beneath the

contact and then twisted tightly.


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REGAINING SPACE IN THEMIXED DENTION


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GENERAL OBJECTIVE:

Diagnose and regain the space loss.

REGAINING SPACE IN THE MIXED

DENTITION



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1. Explain how space loss occurs in the

posterior region.

2. Describe indications for space regainingin regards to the magnitude of space loss.

3. Describe the differences betweenmaxillary and mandibular arch spaceregaining.

4. Describe indications for tipping andbodily tooth movement to regain thespace.



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( )

5. List the diagnostic aids required prior to

initiating space regaining.

6. Present the maximum amount of spacethat can likely be regained with removable

appliances and the time for the treatment.

7. Describe the most commonly usedappliances for space regaining, such as:

(a) removable applicant with fingerspring



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( )

7. (b) removable appliance with jackscrew

(c) fixed appliance with coil spring

(d) lip bumper

REFERENCE:

Proffit, Contemporary Orthodontics, 2nded., 1993, Chapter 13, pp. 382-387


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Space regaining proceduresshould be limited to re-establishing

3 mm. Or less of space in alocalized area.


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Generally, space is easier to regain

in the maxillary arch than in the

mandibular arch.


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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.


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If space loss is bilateral, the limit of

space regaining is about 4 mm. for

the total arch, or 2 mm. per

quadrant.


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Croll

Kesling

Halterman

Weinberger


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CLOSELY OBSERVE

CORRECTED ECTOPIC

ERUPTION CASES


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