Management of the Management of the Developing Dentition, Developing Dentition, Missing, Extra and Ectopic Missing, Extra and Ectopic teethteeth

Aims:Aims:

lOverview of changes from deciduous to permanent dentition

lCommon problems and their managementlPrinciples of treatment for missing, extra

and ectopic teeth

Changes from deciduous to Changes from deciduous to permanent dentitionspermanent dentitions

Ages of dentitionsAges of dentitions

lPrimary Dentition: 6mths - 6yrs

lMixed Dentition: 6yrs - 10/12yrs

lPermanent Dentition: 10/12yrs +

‘‘IdealIdeal’’ Deciduous dentitionDeciduous dentition

lSpaced incisorslAnthropoid spaceslNormal incisor

relationshiplDistal surfaces of E’s

aligned

Variations in Deciduous Variations in Deciduous occlusionocclusion

lSpaced Incisors: 33% spaced 3% crowded

lAnthropoid spaces: Absent -13% upper 22% lower

lIncisor relationship: lOB:

19% ideal 20% increased 37% reduced 24% AOB

lOJ 72% increased

Variations in Deciduous Variations in Deciduous occlusionocclusion

lDistal surfaces of E’s 55% Class I 26% Class II 4% Class III

Variations in Deciduous Variations in Deciduous occlusionocclusion

Changes in Deciduous Changes in Deciduous dentitiondentition

lSpaces change:lD-E spaces closelapparent increase in

incisor spacing

lIncisor relationship: OB - reduces (attrition) OJ - reduces (growth)

lAntero-Posterior: 50% molars/canine relationships change

lArch Dimension: slight increase in width and length

Changes in Deciduous Changes in Deciduous dentitiondentition

Changes to accommodate Changes to accommodate Permanent dentitionPermanent dentition

lSpaced primary dentitionlIncrease in arch dimensions:

Width increase - molar and canines Length increase - to accommodate molars

Changes to accommodate Changes to accommodate Permanent dentitionPermanent dentition

‘Ugly duckling’ phase

Eruption sequenceEruption sequence

lmore important than age of eruptionlcontra-lateral expected within 6mths

1. 66 1

(6yrs)

2. 12

(7-8yrs)

3. 2 (8yrs)

4. 3

(9-10yrs)

5. 5 4 34

(10-12yrs)

6. 77 5

(12yrs)

Eruption sequenceEruption sequence

Common ProblemsCommon Problemsin mixed dentition and in mixed dentition and

SolutionsSolutions

Deciduous extraction'sDeciduous extraction's

lRetain/restorelExtract and space maintainlExtract and ‘balance’

Avoid if possible

Options:

Deciduous extraction'sDeciduous extraction'sProblems

lSpace loss Caries/loss of DE - mesial drift

Deciduous extraction'sDeciduous extraction'sProblems

lCentre line loss esp. unilateral loss of C

Early loss

Deciduous extraction'sDeciduous extraction'sProblems

lOver eruption of opposing teeth minimal problem

Serial ExtractionPoor solution

lExtract C’s as 2’s erupt to allow incisors to align

lExtract D’s - 6mths before normal loss to hasten eruption of 4’s

lExtract 4’s

lClass I skeletal patternlClass I occlusionlMild - moderate crowdinglALL teeth present

Serial ExtractionPoor solution

Requirements:

lAdvantages:may avoid appliance treatment consolidation of crowding to premolar region

lDisadvantages:3 sets of extraction's Does NOT prevent need for appliances OB increases

Serial ExtractionPoor solution

Extraction of CExtraction of C’’ss

l2’s erupting lingual/palatalloss of C’s may allow spontaneous correction

lLower incisor crowding loss of C’s may allow spontaneous correction

lPalatally displaced 3 loss of C’s may allow spontaneous correction

Extraction of CExtraction of C’’sslLower incisor crowding

loss of C’s may allow spontaneous correctionl NB: loss of space for 3|

Management of problemsManagement of problems

lObservelDisimpactlExtract E - results in space loss

Impacted upper 6

lExtract if deflecting/impeding eruption

Management of problemsManagement of problemsRetained deciduous teeth/roots

lAnterior crossbitescorrect - ensure space is available

lPosterior crossbitescorrect - if deviation is associated

Management of problemsManagement of problemsCrossbites of permanent teeth

Management of problemsManagement of problemsCrossbites of permanent teeth

lRadiographs lDetermine cause for failurelRefer if appropriate

Management of problemsManagement of problemsNon eruption of teeth

Management of problemsManagement of problemsNon eruption of teeth

Management of problemsManagement of problemsNon eruption of teeth

lDetermine cause displacement on closure – correct crossbite? asymmetrical loss - balance?

lRefer as appropriate

Management of problemsManagement of problemsCentre line shift

Management of problemsManagement of problemsSubmerging teeth

lCause: anklylosis - ‘cracked cup’ percussion

lProblems: Space loss Delayed eruption Over eruption of opposing teeth Alveolar defects

lManagement wait and see extract - if submerging totally

Management of problemsManagement of problemsSubmerging teeth

HabitsHabitsDepends upon habit and duration

lProblems: AOB OJ increased Arch asymmetry Crossbites

lManagement :‘talk to stop’reminder plate

Habits Habits -- the cluesthe clues

Habits Habits -- the cluesthe clues

Habits Habits -- solutionssolutions

Management of problemsManagement of problemsWhen to Refer

lGross crowdinglTraumatic occlusionslGross skeletal/arch discrepancies

Management missing teethManagement missing teeth

Hypodontia – few missing

Oligodontia – many missing

Anodontia – all missing

Management missing teethManagement missing teeth

Treatment options:1. Accept2. Maintain the space3. Redistribute the space4. Close the space

Interdisciplinary planning required

Management missing teethManagement missing teeth

Redistribute the space

Management missing teethManagement missing teeth

Close the space

Management missing teethManagement missing teethRefer!!!

Management extra teethManagement extra teeth

Supernumary e.g. mesiodens

Supplemental

Management extra teethManagement extra teeth

Treatment options:

1. Removal (supplemental)

2. Use best placed (supernumary)

Management Ectopic teethManagement Ectopic teeth

Buccal or Palatal ?

Management Ectopic teethManagement Ectopic teethBuccal or Palatal ?

Open Exposure

TractionTraction

Closed Exposure(gold chain)

C retained, no root resorption

Extract C

Management Ectopic teethManagement Ectopic teethBuccal

Traction

Closed Exposure(gold chain)

Management Ectopic teethManagement Ectopic teethPalatal

Open Exposure

Traction

Management Ectopic teethManagement Ectopic teeth

SummarySummary

lMaintain deciduous dentitionlAvoid serial extractionlIf extraction's unavoidable - balancelEnsure all teeth present before extractinglCorrect simple problems

lIf in doubt - refer

Further readingFurther readinglMitchell L

orthodonticslFoster TD

A textbook of orthodontics Chp3 Development of the occlusion

lProffit WR Contemporary orthodontics Chps ‘Development of orthodontic problem ‘ and ‘Treatment of preadolescent children’

lMitchell & Mitchell Handbook of clinical dentistry Chp ‘Orthodontics’