Management of Developing Dentition PDF

Course Name: Management of Developing Dentition Speaker: Dr. Ahmed Saaed Program: How to study orthodontics Outline: 1-Primary dentition stage 2_Mixed dentition stage Stages of tooth development : 1. Prenatal 2. Predentate 3. 1ry 4. 2ry 5. Permanent dentition Cleft lip and...

Course Name: Management of Developing Dentition Speaker: Dr. Ahmed Saaed Program: How to study orthodontics Outline: 1-Primary dentition stage 2_Mixed dentition stage Stages of tooth development : 1. Prenatal 2. Predentate 3. 1ry 4. 2ry 5. Permanent dentition Cleft lip and palate: Caused by: teratogenic drugs as aspirin, nicotine, and anticonvulsant folic acid deficiency illness and infection Treatment: Multidisciplinary approach: 1. Plastic surgery 2. Audiology 3. Speech pathology 4. Otolaryngology 5. Orthodontist 6. Oral MFS 7. Psychologist 8. Geneticist 9. Pediatrician Time table of management: Lip surgery at 3 months by Millard operation Hard, soft palate primary closure at 9-12 months by lengenbeck operation bone grafting at 8-11 years years Curve of growth: maxilla growth increases greatly from 1-5 years mandible growth increases greatly from 5-18 years Theory of growth control: Functional matrix theory : bone growth according to functional needs and as a response to soft tissue growth refer to hydrocephaly and microcephaly Predentate stage: from 0-6 months the alveolar arches at birth called gum pads anterior open bite is present Contact at the molar area only Maxillary gum pads are wider than mandibular There is total overlapping of maxillary gum pad It lies in class 2 type of relation Precociously erupted primary teeth (pre-erupted teeth or early infansive teeth are teeth that erupt during the 2nd or 3rd months) Complications: interfere with feeding Risk of aspiration Traumatic injury to the baby's tongue or mother's breast If the treatment option is extraction, certain precautions should be taken Avoid extraction up to the 10th day of life to prevent hemorrhage Assessing the need to administer vitamin K before extraction (.05-.1 mg/IU) Eruption cyst: Accumulation of fluid over the tooth follicle preventing its eruption Failure or delayed eruption May be localized or generalized Localized: mechanical obstruction Generalized: genetics o syndrome x-ray is required Primary dentition stage From 6 months to 6 years Primate space: -Present between (lateral incisor, canine in the maxilla –canine, first molar in the mandible ) -Usually, there's deep bite and overjet Primary dentition problems: Hypodontia Supernumerary Eruption cyst Delayed eruption Mixed dentition: starts by the eruption of 6 and replacement of anterior teeth deep bite reduced due to eruption of the first molar. Ugly duckling stage Early mesial shift: The mandibular 1st molar closes the primate space distal to canine and this allows the 1st permanent molar to erupt in class 1 molar relationship. Problems in mixed dentition: Impacted primary molar or ectopic eruption. Infra occluded 1ry molar. Submerged 1ry molar Impacted canine Midline diastema Eruption cyst Early loss of deciduous Supernumerary or hypodontia Early loss of primary tooth: Balancing extraction: By extraction of the contralateral tooth of the same arch Designed to minimize midline shift Compensating extraction: By extraction of atooth from the opposing quadrant Designed to minimize occlusal interference and maintain occlusal relationship Space maintainers: Space usually closed within 6 months after exo Construct space maintainer immediately after extraction Best approach is to construct space maintainer before exo and deliver it at the exo appointment It's not recommended to wait and see if space loss will occur Types: 1. Band and loop 2. Distal shoe space maintainer 3. Lingual arch 4. Nance 5. Trans-palatal arch Tooth number : Supernumerary teeth: o is one that is additional to normal series o Most commonly in anterior maxilla M>F CLP, Cleidocranial dysostosis Prevalence 1% in primary dentition -2% in permanent dentition Causes: Dichotomy of tooth bud Hyperactivity of dental lamina Genetic influence Problems with supernumerary : Prevent eruption of permanent teeth (after surgical removal 89% of teeth erupt spontaneously ) Crowding and poor appliance Very low risk of root resorption or cyst changes Types of supernumerary teeth: Small peg shaped: Close to the midline May erupt Usually one or two Tend not to prevent eruption of teeth but may displace adjacent teeth(crowding) Tuberculate: Tend not to erupt Paired Barrel shaped, no roots One of the main causes of failure of eruption of permanent incisors Supplemental : The same form of normal tooth Hypodontia: Developmental absence of one or more teeth F>M Most common with: L5,U2,U5,L1 Genetic link Higher incidence with :CLP,down syndrome,ectodermal dysplasia Clinical presentation: Delayed or asymmetric eruption Retained deciduous tooth Absent deciduous tooth Ectopic canine: 2%-3% Palatal>buccal Aetiology :multi factorial Crypt displacement Long eruption path Small-absent laterals Crowding (buccal) Genetic factors Class 2 division 2 Palpation from age of 9-10 years : Delayed eruption of canine Retained deciduous canine Unable to clinically palpate Distal tipping of 2s Chang in color of U 2 HOW TO ASSES PROGNOSIS OF ECTOPIC CANINE? Position from the midline Angle Depth of impaction Primary failure of eruption Tooth that has a complete failure of eruption mechanism Generalized (cleidocranial dysostosis , down's ,etc.) Extremely rare Localized (other causes, crowding, dilacerations) Posterior teeth open bite distal to the first molar Deciduous teeth submerged molars Ankylosis after failure of eruption 2ry failure of eruption: Unexplained cessation of further eruption after a tooth has penetrated the oral mucosa Thumb sucking: Feature of malocclusion: Anterior open bite or reduced open bite Retroclined lower incisors Increased overjet V shaped upper arch Increased skeletal vertical dimension Management at 6 years: Non appliance: Glove on hand Bitter flavored nail varnish +ve reinforcement with reward With appliance URA with palatal crib Fixed appliance in severe cases 1st permanent molar with poor prognosis: There's several difficulties in the management of hypominarlized permanent molars: Sensitivity Young age at restoration time(difficult to manage) Bonding challenges Unclear orthodontic development Wide/open apex Preventive treatment is the most important Timing of extraction: The optimum age is 8.5-9.5 years for lower 6 because of the mesial drift potential when the roots of the lower 7 is starting to calcify. The extraction of the upper first permanent molar should be considered when extraction lower. No need to extract lower 6 if upper 6 is to be extracted. Retained deciduous teeth : Infra occluded or submerged Tooth fails to achieve or maintain its occlusal relationship with adjacent or opposing teeth Can result in ankylosis of 1ry tooth Congenital absence of permanent successors extraction of a submerged 1ry tooth is only necessary under the following condition there is a danger of the tooth disappearing below the gingival level root formation of the permanent tooth is about to complete consideration should be given to building up the occlsal surface Impacted 1st permanent molar after 8 years >disalization of neibouring before 8years>elastic separators Dilacerations: may be due to: trauma developmental Ugly duckling stage: at 8-10 years old Handout written by Dr.Amira Nasser