Preventive orthodontics is that part of orthodontic practice which is concerned with the patient’s and the parents education, supervision of the growth and development of the dentition and the cranio-facial structures, the diagnostic procedures undertaken to predict the appearance of malocclusion and the treatment procedures instituted to prevent the onset of malocclusion
- • PARENT EDUCATION
- • CARIES CONTROL
- • CARE OF
- • DECIDIOUS DENTITION
- • MANAGEMENT OF ANKYLOSED TOOTH
- • MAINTENANCE OF TOOTH SHEDDING TIME TABLE
- • CHECKUP FOR ORAL HABITS
- • OCCLUSAL EQUILIBRIATION
- • PREVENTION OF DAMAGED OCCLUSION
- • EXTRACTION OF SUPERNUMERARY TEETH
- • SPACE MAINTENANCE
- • MANAGEMENT OF DEEPLY LOCKED 1ST PERMANENT MOLAR
- • MANAGEMENT OF ABNORMAL FRENAL ATTACHEMENTS
- EDUCATION OF THE PARENTS
- • Parents should be educated for maintaining good oral hygiene
- • Parents should be taught the correct method of brushing the child teeth
- • Mother is also advised against the prolonged use of pacifiers that can have a detrimental effect on the dentition
- • Young’s mother also advised on matters pertaining to prevention of nursing bottle syndrome
- CARIES CONTROL
- • Caries involving the proximal surfaces of the deciduous teeth is not restored leads to loss of arch length
- • Loss of arch length can result in discrepancies b/w the arch length and tooth material when the bigger teeth erupts
- • Bitewing radiographs are valuable aid in detection of caries. Once caries is detected proper restoration of affected tooth is done
- CARE OF DECIDUOUS DENTITION
- • Preventive orthodontics include care of the deciduous dentition by way of prevention and timely restoration of carious teeth
- • The deciduous teeth are excellent natural space maintainers until developing permanent teeth erupts
- • Some preventive procedures such as application of topical fluorides and pit and fissure sealants help in preventing caries
- EXTRACTION OF SUPERNUMERARY TEETH
- • Presence of supernumerary and supplemental teeth can interfere with eruption of nearby normal teeth
- • Presence of unerupted mesiodens prevents two maxillary centre incisors from approximating each other.
- ELIMINATING OCCLUSAL INTERFERENCE
- • All functional prematurities should be eliminated as they lead to deviations in mandibular path of closures and predispose to bruxism
- MAINTENANCE OF TOOTH SHEDDING TIME TABLE
- • There should not be more than 3 months difference in shedding of deciduous teeth and eruption of permanent teeth.
MANAGEMENT OF ABNORMAL FRENAL ATTACHMENTS
- • The presence of a thick anf fleshy maxillary labial frenum that is attached relatively low prevents the maxillary central incisiors from approximating each other producing a midline diastema.
- • Presence of ankyloglossia or tongue tie prevents normal functional development due to lowered position of the tongue and abnormalities in speech and swallowing.
- DEEPLY LOCKED PERMANENT 1ST MOLARS
- • The deciduous second molars occasionally have a prominent distal bulge that prevents eruption of first permanent molars.
- • Slicing the distal surface of the second deciduous molar helps in guiding the eruption of the first permanent molars.
- Causes of space loss
- • Premature loss of primary teeth
- • Unrestored proximal carious lesions
- • Loss of permanent incisors due to trauma
- • Congenitally missing teeth
- • Ectopic eruption of permanent teeth
- • Dental malformation
- Indications of Space Maintainers
- • After premature loss of deciduous teeth if space shows signs of closing
- • Use of space maintainer will make future orthodontic treatment less involved
- • To improve phonetics, esthetics and mastication
- • To avoid supraeruption of opposing teeth
Contraindications of SpaceMaintainers
- • Congenital absence of permanent teeth
- • Two third root completion of the erupting permanent teeth
- • More space available than required to accommodate the permanent successor
- • Un co-operative patient
- • Patient with poor oral hygiene
- Acrylic partial dentures with clasps
- Full or complete dentures
- Removable distal shoe space maintainer
- 1. Aesthetics
- 2. Lack of abutment
- 3. Cleft palate patients – obturation of defect
- 4. Permanent teeth not fully erupted – difficult to adapt bands
- 5. Multiple loss of deciduous teeth
- 1. Lack of cooperation
- 2. Epileptic patients
- 3. Allergy to acrylic
- 1. Easy to clean , esthetic
- 2. less chairside time
- 3. Maintain vertical dimension
- 4. Tissue born – less strain on abutment
- 5. Tissue stimulation – accelerate eruption of teeth
- 1. Chances of breakage
- 2. Difficult to adapt due to bulk
- 3. Lateral jaw growth may be restricted if clasps are incorporated
- 4. Tissue irritation
- Fixed space maintainers
- 1. Band and bar space maintainer
• Unilateral space loss
• Bilateral space loss with unerupted incisors
2.Crown and bar space maintainer
• Distal shoe space maintainer Non functional space maintainer
- Band and loop space maintainer
- Crown and loop space maintainer
- Fixed Lingual arch
- Fixed removable type lingual arch
BONDED SPACE MAINTAINERS
- Nance holding arch
- Transpalatal arch
Interceptive orthodontics has been defined as phase of the science and art of orthodontics employed to recognize and eliminate potential irregularities and malpositions of the developing dento-facial complex.
The procedures undertaken in interceptive orthodontics include
- 1. Serial extraction
- 2. Correction of developing crossbite
- 3. Control of abnormal habits
- 4. Space regaining
- 5. Muscle exercises
- 6. Interception of skeletal malrelation
- 7. Removal of soft tissue or bony barrier to enable eruption of teeth
1. This method involves planned extraction of certain deciduous teeth and later specific permanent teeth in an orderly sequence and predetermined pattern to guide the erupting permanent teeth into a more favorable position.
2. Serial extraction is an interceptive orthodontic procedure when one can recognize and anticipate potential irregularities in the developing dentofacial complex.
• Arch length-tooth material discrepancy
• Physiologic tooth movement
• Class-I Malocclusion
• Patients with straight profile and pleasing appearance.
• Arch length deficiency- absence of physiologic spacing
• Ectopic eruption of teeth
• Mesial migration of buccal segment
• Crowded upper and lower anteriors
• Ankylosis of one or more teeth
• Lower anterior flaring
• Spaced dentition
• Open bite and deep bite
• Midline diastema
• Class II and class III malocclusion
• Extensive caries
• Mild dispropotion
• Reduces duration of multibanded fixed treatment.
• Better oral hygiene.
• More physiologic
• More stable
• Lesser retention period
• It requires clinical judgment.
• Takes 2-3years.
• Patient cooperation is needed.
• Ditching exist.
• Tendency of developing tongue thrust.
DEVELOPING ANTERIOR CROSSBITE
• It should be treated at an early age so as to prevent minor orthodontic problem progressing into dentofacial anomaly.
• It can be of three types
- 1) Dentoalveolar anterior crossbite
- 2) Skeltal anterior crossbite
- 3) Functional crossbite
Interception of habits
Habits that affects oral structure are :
• Thumb sucking
• Tongue thrusting
• Mouth breathing
• This is considered normal up to 2 and half to 3 years of age.
• Persistence of this habit beyond3and half to 4 years of age have a damaging influence.
• It is interceptive by use of habit breakers.
• Tongue thrust :- It is defined as a condition in which tongue make contact with any teeth anterior to molars during swallowing.
• This is treated by use of habit breakers.
• Mouth breathing :-has a profound effect on dento -facial region.
• Obstructive mouth breathing is the result of nasal polyps, nasal tumors and deviated nasal septum.
• Vestibular screen is used to intercept habit.
• If a primary molar is lost early and space maintainers are not used , a reduction in arch length by mesial movement of the first molar occurs.
• The space lost can be regained by distal movement of the first molar.
• The space regaining procedures are undertaken at an early age prior to the eruption of the second molar.