mixed dentition
TRANSCRIPT
Treatment
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Definition:
Is the treatment provided to a patient during the mixed dentition and occasionally late primary dentition (6-12 years). “Preventive and interceptive orthodontics” were terms used in the past to describe orthodontic treatment in children.
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Benefits of early treatment:
1)Influence jaw growth in positive manner.
2)Harmonize width of dental arches.
3)Improve eruption patterns.
3)Lower risk of trauma.
4)Correct bad oral habits.
5)Improve esthetics.
6)Shorten and simplify treatment.
7)Reduce impaction.
8)Improve speech problems.
9)Preserve or gain space.
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Clinical problems include
Dento-alveolar problems(non-skeletal)
-Space problems.
-Eruption problems.
-Occlusal RS.
Skeletal problems:
-Skeletal (cl.II & III).
-Skeletal posterior
crossbite.
-Skeletal openbite.
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Treatment
Dento-alveolar problems:
Space problems’ treatment include:
A) Space maintenance.
B) Space loss treatment.
C) Spacing treatment.
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A- Space maintenance
Space maintenance for missing primary teeth with adequate space.
- Indicated in:
1- Adequate space.
2- All unerupted teeth present.
3- More than six-month delay before successor erupt.
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Appliances include:
1) Band and loop space maintainers
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- Indicated when E is lost before
the eruption of 6.
- The shoe will guide the
eruption of the first molar
preventing it from occupying
the space of the second molar.
2) Distal shoe space maintainer:
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3) Lingual arch space maintainer
Indicated when multiple posterior teeth are missing.
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4) Partial denture
Indicated for bilateral posterior space maintenance with loss of 1ry incisors (esthetics).
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B) Space loss treatment
Crowding could be due to:
- Space deficiency.
or - Space loss.
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ManagementManagement of space deficiencyof space deficiency
Moderate(3-5mm)
��Arch expansion
Severe(5-9mm)
Expansion/Extraction
V.Severe(7-10mm)
Serial extraction
Mild(2-3mm)
Interproximal reduction ofB & C
Minimal(<2mm)
No treatment
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Arch expansion for moderate crowding
Removable expansion appliance with screw
Fixed W-arch expansion appliance
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Serial extraction
Def:
“Is an interceptive measure in the form of a planned sequence of tooth removal to reduce crowding. It is done during the transition from 1ry to permanent dentition.”
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•Criteria for serial extraction:
1)No skeletal Discrepancy.
2)Class I molar RS.
3)Normal overbite.
4)Space deficiency of 10mm or more.
5)No congenitally missing teeth.
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CLASS I MIXED DENTITIONSEVERE CROWDINGSERIAL EXTRACTION
PRETREATMENT
ORTHOGNATHICSTRAIGHT/SLIGHTLY CONVEXLIPS RELAXED
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SERIAL EXTRACTION
PRETREATMENTMIDDLE MIXED DENTITIONCLASS IAVERAGE OVERJET+
ANTERIOR CROSSBITEAVERAGE OVERBITEPOSTERIOR CROSS-BITE(RIGHT MOLARS)
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POSTERIOR MOLAR CROSSBITE(RIGHT SIDE)MIDLINES COINCIDE
SEVERE CROWDING-MAXILLARY ARCHMOLAR ROTATION
SERIAL EXTRACTION
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SERIAL EXTRACTION
SEVERE CROWDINGMANDIBULAR ARCH
EXCESSIVE CURVE OF SPEE(DEEP OVERBITE)
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SERIAL EXTRACTION
INTRA-ORAL (PERI-APICAL)RADIOGRAPHS
CEPHALOMETRICRADIOGRAPH
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SERIAL EXTRACTION
PROGRESSPRIMARY CANINES EXTRACTEDAWAITING ERUPTION OF FIRST PREMOLARS
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SERIAL EXTRACTION
FIRST PREMOLARS ERUPTING
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SERIAL EXTRACTION
INTRA-ORAL RADIOGRAPHS
PROGRESS
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SERIAL EXTRACTION
EXTRACTION OF FIRST PREMOLARSAND ERUPTION OF CANINES
LOWER LINGUAL HOLDING ARCH
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Management of space loss(space regaining)
Localized space loss (3mm or less):
*Maxillary include:
-Removable/fixed space regainer appliance.
-Headgear.
*Mandibular include:
-Lingual arch.
-Lip bumper
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Maxillary space regainers
a) Removable space regainer
b) Fixed space regainer
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c) High-pull headgear
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Mandibular space regainers
a) Lingual arch
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b) Lip bumper
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CREATE SPACEHOLD/DISTALIZE LOWER MOLARADVANCE INCISORSTRANSVERSE EXPANSION (DENTAL)
MANDIBULAR LIP BUMPER
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CREATE SPACEDISTALIZE UPPER MOLAR
SPACE LOSSPENDULUM APPLIANCEUNILATERAL/BILATERAL
POST TREATMENTNANCE HOLDING ARCH
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PENDULUM APPLIANCE-Unilateral
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TRANSPALATALBAR- Unilateral
REMOVABLEAPPLIANCE-Sectional screw
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Space loss >3mm:
Extraction should be evaluated against space
regaining. Consultation with orthodontist is
necessary.
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Anterior dentoalveolar crossbite
Caused by:
- Over retention of upper 1ry incisor.
- Lack of space.
- Lingual development of permanent incisor
tooth bud.
Must be ttt as soon as diagnosed.
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Treatmentof cross-bite
Removable appliancewith finger spring
Removable appliancewith finger spring
If space inadequate;Space regaining then crossbite
correction
If space inadequate;Space regaining then crossbite
correction
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Cross-bite appliance with double palatal spring (arrow)
Pre-treatment
Post-treatment
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Transverse RS problems
Causes:
- Cheek sucking habit.
- Mouth breathing habit.
Treatment:
- Removable appliance with acrylic plate
with screw.
- Fixed appliance (W- arch).
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Removable appliance with screw
Unilateral posterior cross-bite
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5 MONTHS
2 TURNS/WEEK
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MAXIMUM INTERCUSPATION
INITIAL CONTACT POSITION
TRANSVERSE DIMENSIONRIGHT UNILATERAL POST. CROSSBITEFUNCTIONAL SHIFT
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DENTAL+?SKELETAL EXPANSIONQUADHELIX EXPANDER
FIXED BANDS AND REMOVABLE WIRE
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DENTAL+?SKELETAL EXPANSIONREMOVABLE EXPANDER
FULL COVERAGE ACRYLICCLASPSMIDLINE EXPANSION SCREW
EXPANSION KEY
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FIXED ACRYLICEXPANDER
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Vertical RS
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Anterior openbite
Caused by finger sucking habit
Is the failure of anterior teeth to
overlap
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Fixed habit breaking appliance