Management of Developing Dentition 2 PDF

Management of developing dentition 2  Learning objectives  To describe the management of common problems that occur in mixed dentition.  To identify mixed dentition problems.  To understand what orthodontic cases to refer and when.  Contents Abnormalities of erup...

Management of developing dentition 2  Learning objectives  To describe the management of common problems that occur in mixed dentition.  To identify mixed dentition problems.  To understand what orthodontic cases to refer and when.  Contents Abnormalities of eruption and exfoliation Mixed dentition problems Planned extraction of decidious teeth What to refer and when?  Abnormalities of eruption and exfoliation Early detection of any abnormalities in tooth development and eruption is essential to give the apportunity of interceptive action to be taken * interceptive ↓ or tho > - developing dention Abnormalities of eruption Natal and and exfoliation Neonatal teeth Eruption cyst Failure of/ delayed eruption  Natal and Neonatal teeth Natal tooth: A tooth which is present at brith Neonatal tooth: A tooth which erupts within the mobile 1st month of life - - anterior man  It arises most commonly in the anterior - mandible, and are typically a lower incisor - - which has erupted prematurely They can be mobile, due to incomplete - root formation - Extraction is indicated if the tooth isS mobile and it interferes with breastfeeding - -  Eruption cyst An eruption cyst is caused by an accumulation of fluid or blood in the follicular space overlying the -- crown of an erupting tooth They usually rupture spontaneously, but very occasionally marsupialization may be necessary  Failure of/ delayed eruption Indicators of abnormalities which needs further investigations: - A disruption in the normal sequence of eruption. - An asymmetry in eruption pattern between contralateral teeth.  Mixed dentition problems Premature loss Infra-occluded Retained of deciduous (submerged) deciduous teeth teeth primary molars Impacted first Supernumerary permanent Dilaceration teeth molars First permanent molars of poor Median Habits long-term diastema prognosis Premature loss of decidious teeth When the decidious teeth are crowded, and a primary tooth is extracted, the adjacent teeth will drift or tilt around the space provided. The extent depends on: degree of crowding, patient’s age, and the site. - More crowding → more teeth will move - Younger the child → greater the potential for drifting - In maxilla → more potential for mesial drift ) type of bone (cancellous ↳ bone) upper 6  Premature loss of Deciduous Has little impact, because they shed early in incisor mixed dentition Deciduous Unilateral loss → centerline shift - canine Solution→ balance with2 contralateral extraction Unilateral loss → centerline shift Deciduous first molar Solution→ keep under watch and later if - - indicated balance with contralateral extraction - If extracted early → 1st permanent molar will drift Deciduous - mesialy second - molar Solution → try to avoid extraction or if its necessary space maintainer to be given ·  Space maintenance Best space maintenance → the tooth When not possible → space maintaner (band and loop) to be used, with regualr - - follow ups and OHI  samearch - - opposite arch  Retianed deciduous teeth A difference of more than 6 months - between the shedding of contralateral teeth should be regarded with suspicion. Provided that the permanent successor is present Retained primary teeth should be extracted, particularly if they are causing deflection of the permanent tooth  3 ·  Infra-occluded (submerged) primary molars When the tooth fails to achieve or maintain its occlusal relationship with adjacent or opposing teeth. Submerged teeth occurs in around 1-9% of children  If the premenant successor is present, and in a good position, extraction of submerged primary tooth is nessesary under following conditions: - There is a danger of the tooth dissapearing below gingival level - Root formation of the premanent tooth is nearing completion  In the buccal segments, if the permanent successor is missing → preservation of the primary molar will preserve bone, the best space maintainer Therefore, consideration should be given to building up the occlusal surface to maintain occlusal relationships. If this is not practicable then extraction may be indicated. Impacted first permanent molars Impaction of a first permanent molar tooth against the second deciduous molar occurs in approximately 2–6% of children Its is indicative of crowding. It most commonly occurs in the upper arch  t option - After extraction of second Spontaneous deciduous molar eruption - It is rare after 8 years of age - Tightening a brass separating wire* ↓ Mild cases around the contact of 2 teeth for 2 months impacte 2nd option ↳ ane 0-Severe cases - Distalization of permanent molar and dis impact it  Dilaceration Dilaceration is a distortion or bend in the root of a tooth. - It usually affects the upper central and/or # lateral incisor due nauma to especially in Class I division 1 - - * in walma = enamel + dentin - Affects an isolated central incisor be affected. will * enamel + dentin X affected in developmental - Occurs more in females cases. Developmental Aetiology - Crown is turned upward and labially - - No disturbance of enamel and dentine seen ↳ we it's developmental ↳ Not Wamma. - Intrusion of deciduous incisor leads to displacement of developing permanent tooth germ - Developing permanent tooth crown displaces Trauma palataly - Hypoplasia of enamel and dentine seen , and the the number of teeth involved depends on the extent of the trauma  Management: - tooth C - In severe cases → removal of the affected C - Mild cases → expose the crown surgically and apply traction to align the tooth -  Supernumerary teeth & A supernumerary tooth is one that is additional to the normal series. Prevalence: Or - In permanent dentition: 2% Or - In primary dentition: less than 1% Any supernumerary in decidious dentiton is often followed by - a supernumerary in the permenant dentition *  Aetiology: Genetic ~ Occurs more in Males ~ In - cleft patients supernumeraries are commonly found in the region of theO cleft Supernumerary teeth can be described according to their morphology or position in the arch Supernumerary & Supplemental: it resembles a tooth and occurs at the you will end of a tooth series extract the most distal Morphology of. - - ② Conical: Peg shaped supernumerary, mostly occurs - between the central incisors ③ Tuberculate: barrel shaped, and any other supernumerary which does not fall into the conical of - supplemental category E This type is associated with failure of eruption ↳ important for exam. ⑪ Odontome: its rare - ⑨ Compound: Cluster or collection of small tooth-like = structure O & Complex: An amorpous mass of enamel and dentine cauliflower Supernumerary ①- Mesiodens: between the central incisors 80% of the supernumeraries Position of Distomolar: Distal to the arch - Paramolar: adjacent to the molar ③  Effects of Management Supernumerary xC - Extraction of the supernumerary C Failure of eruption: - Space creation - If no spontaneous eruption in - one year, orthodontic exposure to be carried out S - - Removal of the supernumerary Displacement - Fixed orthodontic mechanotherapy C C - Removal of the supernumerary Crowding - Fixed orthodontic mechanotherapy ~ G C - It can be left in situ under radiographic No effect observation ⑥ - If erupted palataly → Extraction - -  Habits Three rules Frequency 1 Intensity Z 3 Duration ↳ for habit lo cause malo clusion  Presistant thumb or digit sucking habit for long duration may act as an orthodontic force Severity of the malocculsion depends on the duration and intensity of the habit  Common features assosiated with habits: ① - Proclination of upper inciosrs Class It C - division 1 ② - Retroclination of lower incisors & - Anterior open bite or shallow bite ④ - Narrowing of upper arch First permanent molars of poor long term prognosis Factors have to be considered before taking the decision of extraction: here we Ompromising - 6s are rarely the first tooth of choice for extraction in orthodontic treatment enchorage - Its removal often compromises anchorage & - Heavily restored or badly decayed 6s - Presence of all premanent teeth → if any tooth is abscent, the extraction in that quadrant should be avoided - InO G uncrowded dentition, avoid extraction of 6s as - space clousre will be difficult - Extraction of 6 relieves the crowding of buccal segment, and has little effect on labial segment crowding - Serious consideration should be given to extracting the opposing upper first permanent - T molar, to prevent mesial drift and over-eruption of the opposing tooth  important *** In the lower arch, a good spontaneous result is more likely if: (a) The lower second permanent molar has developed as far as its bifurcation (b) The angle between the long axis of the crypt of the lower second permanent molar and the first permanent molar is between 15°and 30° (c)The crypt of the second molar overlaps the root of the first molar(a space between the two reduces the likelihood of good space closure).  Median diastema Prevelance: - 98% of 6-years-old - 49% of 11-years-old - 7% of 12-18-years old  Physiological (normal dental development) Proclination of the upper labial segment Familial or racial trait Aetiology Prominent fraenum. Small teeth in large jaws (a spaced dentition) Midline supernumerary Missing teeth tooth/teeth  Factors to be considered regarding median diastema: - When the fraenum is placed under tension there is blanching of the incisive papilla. - Radiographically, a notch can be seen at the crest of the interdental bone between the upper central incisors - The anterior teeth may be crowded. Management of Median diastema Perapical radiograph → to exclude the presence of a midline supernumerary to tooth - important - C If diastema is less than 3mm in developing dentition → No intervention C If diastema is greater than 3 mm and lateral incisors are present → spcae clos\use is nesessary to open the space for the canines to erupt Planned extraction of decidious teeth Serial extraction: - Historical approach that involves a planned sequence of extractions of (C’s and D’s) - It allows the crowded incisors to align during mixed dentiton phase - Indication: Class I cases with moderate crowding and when OPG shows all the premenant teeth are in good position  Indications for extraction of decidious canines: 0 - In crowded arch when the lateral incisors are pushed palatally in the upper arch or labially in the lower arch ②- InS class III malocclusion ⑤ - Improve position of a- displaced permenant canine ~ What to refer and when??? 1) cleft lippalate 2) close t any to ↳ it's easier manage early  Decidious dentiton Cleft lip and /or palate ( if patient is not under the care of a cleft team) Other craniofacial anomalies ( if patient is not under care of a multidisplinary team)  Mixed dentiton Severe Class III skeletal problems. Delayed eruption of the permanent incisors. Presence of a supplemental incisor Impaction or failure of eruption of the first permanent molars. First permanent molars of poor long-term prognosis where forced extraction is being considered.  Ectopic maxillary canines Hypodontia. Marked mandibular displacement on closure and/or anterior crossbites which compromise periodontal support. Patients with medical problems where monitoring of the occlusion would be beneficial. Pathology (e.g. cysts).  Early permenant dentiton twin block can - be given Growth modification in skeletal class II malocclusion When upper incisors are at risk of trauma (due to incompetent lips and increased overject)  bastIV AlBeem DiFarsi. I * * 5) II/2024 #*. Thank you 2 39 pm G : * or tho lecture * & LT592 * Free - - mess - 211