D362-Q362 Division of Orthodontic & Paediatric Dentistry University of Western Ontario Dr.

Sahza Hatibovic-Kofman

INCISOR GUIDANCE and ECTOPIC ERUPTION 2004-2005

INCISOR GUIDANCE

GUIDING THE DEVELOPING DENTITION

LOWER INCISOR CROWDING IN THE EARLY MIXED DENTITION

SPECIFIC OBJECTIVES: 1. Know how to approach the problem of lingually erupting lower incisors. 2. Know when to assess a child patients tooth size-arch length relationship. 3. Identify when discing of lower cuspids is required.

SPECIFIC OBJECTIVES (cont): 4. Explain leeway space control and the role of the mandibular lingual arch in assisting lower incisor alignment. 5. Be able to design an appliance to improve lower incisor alignment. _____________________________________ REQUIRED READING: Preceding material in this Syllabus.

REQUIRED READING: (In manual)

Article: Early Mixed Dentition Developmental Module Article: Management of lower incisor crowding in the early mixed dentition. T. Foley, G. Wright, S. Weinberger, Journal of Dentistry for Children, May-June, 1996, pp 169-174.

ESSENTIAL FACTORS FOR A SMOOTH TRANSITION FROM PRIMARY TO PERMANENT DENTITION 1. 2. 3. 4. 5. Primate space General spacing Preservation of leeway space Sequences of eruption Tooth size and jaw in harmony

Crowding incisors

and must

protrustion be

of

the two how

considered

aspects of the same thing:

crowded and irregular the incisors are reflects both how much room is available and where the incisors are positioned relative to the supporting bone.

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.

WHY INCISOR GUIDANCE?

To help prevent orthodontic relapse. Prevent unnecessary periodontic problems.

WHAT VARIABLES ARE TO BE CONSIDERED?

Interdental spacing. Intercanine distance. Increase of the arch perimeter. Size ratio between the primary and permanent teeth.

PROBABILITY OF CROWDING
1 - 4 YEARS
CROWDING NO 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

WHEN AND HOW TO TREAT??

Continue to observe the case. Disc primary teeth. Extract primary teeth. Refer to an orthodontist.

CASES TO OBSERVE

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

CASES FOR DISCING

Those with 3 4 mm. arch crowding.

The goal is to transfer the anterior crowding posteriorly into the leeway space.

CASES FOR EXTRACTION

When arch crowding is 4 to 9 mm.

The goal is improve incisor alignment (unraveling), perhaps preventing periodontal problems and improving post-orthodontic stabliity.

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).

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).

BENEFITS OF EARLY TREATMENT

Avoid unnecessary periodontal problems. Enhance the long term stability of orthodontic treatments. Involve more clinicians in guiding the developing dentition.

D362 / Q362 Division of Orthodontic & Paediatric Dentistry University of Western Ontario Dr. Sahza Hatibovic-Kofman

ECTOPIC ERUPTION AND SPACE REGAINING 2004-2005

ECTOPIC ERUPTION

ECTOPIC ERUPTION
GENERAL OBJECTIVE: To discuss the problem of ectopic eruption generally. To discus the problem of ectopic eruption the canine and first permanent molar and its management.

SPECIFIC OBJECTIVES: 1. Define ectopic eruption. 2. Know the frequency of ectopically eruption first permanent molars. 3. Explain the reasons for ectopic eruption occurring with first permanent molars. 4. Distinguish between a reversible and non-reversible ectopic eruption.

SPECIFIC OBJECTIVES (continued): 5. Know methods for correcting ectopic molar eruption. 6. Explain why long term follow-up is needed for corrected ectopic eruption cases. REQUIRED READING
Article: Weinberger, S., Wright, G., The Unpredictability of primary molar resorption following ectopic eruption of permanent molars, Journal of Dentistry for Children, Nov-Dec, 1987.

REQUIRED READING (continued)

Article: Weinberger, S., Correction of bilateral ectopic eruption of first permanent molars using a fixed appliance, Pediatric Dentistry, Nov-Dec, 1992, Vol 14, No. 6

Malposition of a permanent tooth bud can lead to eruption in the wrong place, and usually the tooth on its way resorbs the tooth that it is not supposed to resorb.

ANOMALIES OF POSITION

ECTOPIC ERUPTION OF THE FIRST PERMAMENT MOLAR

Reported prevalance of ectopic eruption of the first permanent molars

Authors Cheyne & Wessels Young O'Meara Pulver Bjerklin & Kurol Mackerle-Heporauto Kimmel et al Year of study 1947 1957 1962 1968 1981 1981 1982 Country USA USA USA USA Sweden Switzerland USA Number Of Children With
CHILDREN NUMBER

Ectopic Eruption
PERCENT

500 1,619 315 831 2,903 543 5,277

9 52 6 26 126 32 250 Kurol-1986

2 2 2 3.1 4.3 6 3.8

TWO TYPES OF ECTOPIC MOLARS ARE:

1. REVERSIBLE OR JUMP.

2. IRREVERSIBLE OR LOCK TYPE.

HOW MANY WAYS ARE THERE TO MANAGE ECTOPIC ERUPTION

A ligature wire is passed through beneath the contact and then twisted tightly.

REGAINING SPACE IN THE MIXED DENTION

REGAINING SPACE IN THE MIXED DENTITION

GENERAL OBJECTIVE:

Diagnose and regain the space loss.

SPECIFIC OBJECTIVES: 1. Explain how space loss occurs in the posterior region. 2. Describe indications for space regaining in regards to the magnitude of space loss. 3. Describe the differences between maxillary and mandibular arch space regaining. 4. Describe indications for tipping and bodily tooth movement to regain the space.

SPECIFIC OBJECTIVES (continued): 5. List the diagnostic aids required prior to initiating space regaining. 6. Present the maximum amount of space that can likely be regained with removable appliances and the time for the treatment. 7. Describe the most commonly used appliances for space regaining, such as: (a) removable applicant with finger spring

SPECIFIC OBJECTIVES (continued): 7. (b) (c) (d) removable appliance with jackscrew fixed appliance with coil spring lip bumper

REFERENCE: Proffit, Contemporary Orthodontics, 2nd ed., 1993, Chapter 13, pp. 382-387

Space regaining procedures should be limited to re-establishing 3 mm. Or less of space in a localized area.

Generally, space is easier to regain in the maxillary arch than in the mandibular arch.

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.

If the primary second molar has been lost prematurely in a single quadrant, up to 3 mm. of space may be regained by tipping the molar back distally.

If space loss is bilateral, the limit of space regaining is about 4 mm. for the total arch, or 2 mm. per quadrant.

Croll Kesling Halterman Weinberger

CLOSELY OBSERVE CORRECTED ECTOPIC ERUPTION CASES