Lecture 1 managment of the developing dentition

‫الرحيم‬‫الرحمن‬‫هللا‬‫بسم‬
Sudan International University
Faculty of Dentistry
Department of Orthodontics
Management of the developing
dentition (preventive and
interceptive procedures)
Mohanad Elsherif
BDS (U of K), MFD RCSI, MFDS RCPS(Glasg), MSc (Orthodontics), M.Orth. RCSEd
Lecture
one

Introduction
What do we mean by
preventive and
interceptive procedures?

Orthodontic treatment
Preventive
Orthodontic
Interceptive
Orthodontic
Corrective
Orthodontic

Preventive Orthodontic
Def: “These are the action taken to preserve the
integrity of what appears to be normal occlusion at
specific time”.
The preventive procedures are:
1. Caries control.
2. Parent counseling.
3. Monitoring of shedding of the teeth.

Contd Preventive Orthodontic
4. Correction of abnormal frenal attachment.
5. Treatment of ectopic permanent first
molar.
6. Correction of abnormal oral musculature
and related habit.
7. Space maintenance.

interceptive Orthodontic
Def: “Early recognition and elimination of potential
irregularities in the developing dentition before it
became more sever”.
The interceptive procedures are:
1. Space regaining.
2. Correction of anterior and posterior crossbites.

Contd interceptive Orthodontic
3. Elimination of oral habits.
4. Removal of hard or soft tissue or bony barrier that prevent
eruption of a tooth.
5. Resolution of crowding.
6. Serial extraction.

Corrective Orthodontic
Def: “These are procedures undertaken to
correct a well-established malocclusion”.
1. Non Surgical ( i.e. appliance treatment).
2. Combined orthodontic/surgical
treatment.

What should I do?
 For a dentist seeing a young patient with a
malocclusion, the first question is whether
orthodontic treatment is needed?
 If so, the next question is: when should it
be done?
 Finally, who should do it? i.e. can I treat
this patient or Does he/she need referral to a
specialist?

Orthodontic Triage
Step 1: Syndromes, Developmental Abnormalities
and complex medical problems:
 The first step in the triage process is to separate
out patients with facial syndromes and similarly
complex problems so they can be treated by
specialist or team of specialists.
 From physical appearance, the medical and dental
histories, and an evaluation of developmental
status, nearly all such patients are easily recognized.

Orthodontic Triage
Step 2: Facial Profile Analysis
a. Anteroposterior and Vertical skeletal Problems:
 Skeletal Class II and Class III problems and vertical
deformities of the long-face and short-face types,
regardless of their cause, require thorough cephalometric
evaluation to plan appropriate treatment and its timing
and must be considered complex problems.
 So Refer

Orthodontic Triage
But as a general rule:
 Class II treatment can be deferred until near adolescence and be equally
effective as earlier treatment.
 Class III treatment for maxillary deficiencies should be addressed earlier (less
than 10 years).
 Class III treatment for protrusive mandibles appears equally ineffective
whenever it is attempted.
 Treatment of both long- and short-face problems probably can be deferred.
 In Asymmetry, early evaluation is indicated even if treatment is deferred, so
early referral is appropriate.

Orthodontic Triage
B. Excessive Dental Protrusion or Retrusion
 Severe dental protrusion or retrusion, are also complex
treatment problems.
 The urgency for treating these problems usually depends
on the esthetic impact or in the case of protrusion, the
potential for traumatic injury.
 So, depend on the case, Refer.

Orthodontic Triage
Step 3: Dental Development
 Problems involving dental development often need treatment as soon as they
are discovered, typically during the early mixed dentition.
 Many of these problems can be done in general practice.
 Asymmetric Dental Development.
Premature loss of deciduous or retained deciduous tooth.
 unerupted permanent tooth.
 Hypodontia or supernumerary tooth.
 Ankylosed primary or permanent tooth.
 Abnormality in the size, shape and structure of teeth.
 Other Eruption Problems (ectopic eruption, transposition).

Orthodontic Triage
1. Asymmetric Dental Development
 Asymmetric eruption (one side ahead of the other by 6 months or more) is
significant.
 Treatment should start only after a careful determination of the underlying
cause.
 It requires careful monitoring of the situation, and in the absence of outright
pathology, often requires early treatment such as selective extraction of
primary or permanent teeth.
 A few patients with asymmetric dental development have a history of
childhood radiation therapy to the head and neck or traumatic injury. Surgical
and orthodontic treatment may be indicated so this category should be
referred.

Orthodontic Triage
2. Missing Permanent Teeth (hypodontia):
 Prevalence: 3.5-6.5%
 Most congenitally missing tooth are third molars (25-35%), mandibular
second premolar (3%) followed by maxillary lateral incisor (2%).
 More common in females.
 Maxillary central and lateral incisors are the teeth most likely to be lost
to trauma.
 The treatment possibilities differ slightly for anterior and posterior
teeth.

Orthodontic Triage
2. Missing Permanent Teeth (hypodontia):
 Treatment options:
1. Maintain the primary tooth or teeth (for posterior teeth only).
2. Extract the overlying primary teeth and then allow the adjacent
permanent teeth to drift (for posterior teeth only).
3. Extract the primary teeth followed by immediate orthodontic
treatment.
4. Extract and replace the missing teeth prosthetically or perhaps by
transplantation or an implant later.

Orthodontic Triage
3. SupernumeraryTeeth:
 Presence of extra tooth or teeth.
 Also called hyperdontia.
Prevalence:
 0.1-0.9% in primary dentition
 2% in permanent dentition.
 More common in males.
 90% of all supernumerary teeth are found in the anterior
part of the maxilla.

Orthodontic Triage
Types of supernumerary:
1. According to the position:
A. Mesiodense:
 Most common type of
supernumerary teeth.
 Conical in shape and Found
in the midline.

Orthodontic Triage
B. Paramolar:
 Buccal and palatal to premolar and molar.

Orthodontic Triage
C. Distomolar:
Found distal to the last molar tooth

Orthodontic Triage
2. According to the shape
A. Conical

Orthodontic Triage
2. According to the shape
B. Tuberculate:
 These are barrels in shape.
 They usually have no roots
thus most of them do not
erupt.
 The most common cause of
maxillary incisors impaction is
tuberculate supernumerary.

Orthodontic Triage
1. according to the shape
C. Supplemental
Resemble the normal teeth
shape and usually occurs at
the end of the series.

Orthodontic Triage
1. according to the shape
D. Odontomas:
 They are the most common odontogenic tumors and they usually interfere
with eruption of permanent teeth.
 They are usually asymptomatic and are discovered during routine radiographic
examination when there is delayed eruption of permanent tooth.
 Usually are two types:
 Compound odontoma.
 Complex odontoma.

Orthodontic Triage
D. Odontomas:
a. Compound odontoma:
 It is a collection of small
radiopaque masses, some or
all may be tooth-like
structures “denticles”.
 62% in the anterior region
of the maxilla and usually
associated with the crown of
an unerupted canine.

Orthodontic Triage
D. Odontomas:
b. Complex odontoma:
 It is composed of
haphazardly arranged dental
hard and soft tissue.
 It has no resemblance to a
normal tooth.
 It tends to occur in 70% in
the posterior region of the
mandible.

Orthodontic Triage
 Effects of supernumeraries:
 No effect.
 Midline diastema.
 Crowding.
 Labial or palatal deflection of teeth.
 Impaction of permanent teeth.
 Unerupted supernumeraries can
cause root resorption or undergo
cystic transformation

Orthodontic Triage
Treatment of supernumeraries:
 Regular follow-up.
 Extraction with or without
orthodontic treatment.
 For supplemental,
extraction of the most
displaced tooth.

Declaration
 The author wish to declare that; these presentations are his original work, all
materials and pictures collection, typing and slide design has been done by the
author.
 Most of these materials has been done for undergraduate students, although
postgraduate students may find some useful basic and advanced information.
 The universities title at the front page indicate where the lecture was first
presented. The author was working as a lecturer of orthodontics at Ibn Sina
University, Sudan International University, and as a Master student in Orthodontics at
University of Khartoum.
 The author declare that all materials and photos in these presentations has been
collected from different textbooks, papers and online websites. These pictures are
presented here for education and demonstration purposes only. The author are not
attempting to plagiarize or reproduced unauthorized material, and the intellectual
properties of these photos belong to their original authors.

Declaration
 As the authors reviews several textbooks, papers and other references during
preparation of these materials, it was impossible to cite every textbook and journal
article, the main textbooks that has been reviewed during preparation of these
presentations were:
Contemporary Orthodontics 5th edition; Proffit, William R, Henry W. Fields, and
David M. Sarver.
Handbook of Orthodontics. 1st edition; Cobourne, Martyn T, and Andrew T. DiBiase.
 Clinical cases in orthodontics. Martyn T. Cobourne, Padhraig S. Fleming, Andrew T.
DiBiase, Sofia Ahmad
Essentials of orthodontics: Diagnosis and Treatment; Robert N. Staley, Neil T. Reske
Orthodontics: Current Principles & Techniques 5th edition; Graber, Lee W, Robert L.
Vanarsdall, and Katherine W. L. Vig
Orthodontics: The Art and Science. 3rd Edition. Bhalajhi, S.I.

Declaration
 For the purposes of dissemination and sharing of knowledge, these
lectures were given to several colleagues and students. It were also
uploaded to SlideShare website by the author. Colleagues and students
may download, use, and modify these materials as they see fit for non-
profit purposes. The author retain the copyright of the original work.
 The author wish to thank his family, teachers, colleagues and students
for their love and support throughout his career. I also wish to express
my sincere gratitude to all orthodontic pillars for their tremendous
contribution to our specialty.
 Finally, the author welcome any advices and enquires through his
email address: Mohanad-07@hotmail.com

Lecture 1 managment of the developing dentition

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