ORTHODONTICS SEMINARFatimah Che RahimiLaila Azwa HassanAhmad Zulkhairi ResaliNurmarzura Abdul LatifAishah ShahrirNur Amalina ZulkepreAkmal Khalis DoreyatMasyitah MustaffaAimi Amalina Ahmad
Early loss of deciduous teeth
• It happened as a result of extraction due to caries or trauma
• The degree of space loss is influence by: Unilateral / bilateral Age of loss --> more effect if the tooth lost at earlier age Crowding/spacing the more inherent the crowding present, the
more potential for space Tooth typeposition of the affected tooth in arch influence
subsequent space distribution timevery early extraction can delay successional tooth eruption,
later extraction have opposite effect Degree of intercuspation-less effect Skeletal factors-less effect
Balancing and compensating extraction
Aim: to preserve arch symmetry and occlusal relationship
Balance enforced extractions • A balancing extraction is a tooth from the opposite side of the same
arch, designed to minimise centreline shift.
Compensate enforced extractions
• Compensation means extraction of a tooth from the opposing quadrant to the enforced extraction. It is designed to minimise occlusal interferance by allowing teeth to maintain occlusal relationships as they drift. It is more difficult to justify compensation than balance, especially when it would involve removal of a tooth from an intact arch.
Which deciduous teeth need balancing and compensating extraction?
Tooth Influence Need balancing or compensating extraction
Deciduous incisor - -
Deciduous canine Centreline shift Need balancing extraction
1st deciduous molar Centreline shift Need balancing extraction
Lower 1st deciduous molar - Need compensating extraction
2nd deciduous molar - Need compensating extraction (if it contribute to significant alteration in molar relationship)
Digit sucking habit
Digit sucking habit• Most prevalent of oral habits, 13% - 100%• If the habit ceases before the permanent teeth begin to
erupt, any effects on the dentition are unlikely to be long-term.
• If however the habit persists into the mixed and permanent dentition malocclusion
• Thumb sucking may develop early in life and continue from infancy through the primary dentition and into the mixed and permanent dentition. In many cases, if the thumb habit continues into the mixed dentition a malocclusion may develop
(Kaplan 1950; Ruttle et al. 1953; Graber 1959).
Factors that Affecting the Degree of Damage to Teeth and Investing Tissue
• Frequency of habit– The more frequency the more the damage
• Duration of habit– The more duration the more the damage
• Intensity of habit– Active vs passive
*Prolonged digit sucking habit may affect occlusion and dentofacial structures.
Factors
• Not all habits will result in tooth movement. It is related to frequency, duration and intensity.
• Studies suggest that it only takes very light forces to move teeth, if the force is of long enough duration.
• The threshold is believed to be 6 hours.
Maxillary changes1. Proclination of maxillary incisors
2. Increased maxillary arch length
3. Anterior placement of maxillary apical base
4. Increased sella-nasion point A angle
5. Decreased palatal arch width
Mandibular changes1. Proclination of mandibular
incisors
2. Decreased sella-nasion B point angle
3. Increased intermolar distance
Others:-arch assymmetry-increased overjet-anterior openbite-posterior crossbite
How to stop?
1. Gentle discouragement2. Oral appliances/ habit breaker
-palatal crib-acrylic appliance on finger
Approaches to treat chronic thumb sucking
These can be split intothree distinct categories: Behavioural – rewarding a child for notexercising the habit; Mechanical – preventing or interruptingthe process of thumb sucking; Aversive – generating negativesensations when the habit is exercised,such as bad taste, pain or major discomfort
Fig 1: URA with acrylic ridge Fig 2: Blueglass roller
Fig 3: The Rake appliance
Space Maintainer
Space Maintainer
• Definition– An intraoral appliance used to preserve arch length following
premature loss of primary tooth/teeth in order to allow permanent teeth erupt into proper alignment and occlusion
• Objectives:– Prevent drifting/tipping– Prevent loss of arch length– Prevent midline shift– Prevent crowding of permanent teeth– Prevent impactions– As orthodontic intervention including extraction
Types of Space Maintainer
Types of Space Maintainer
Anterior VS
Posterior
Fixed VS
Removable
Unilateral VS
Bilateral
Types of Space Maintainer
Fixed
Band and loop Crown and loop
Lingual / Palatal arch Distal shoe
Removable
URA (Hawley retainer)
Partial denture
Band and Loop
• Loss of D (unilateral/bilateral)
Indication :
• Ease of fabrication for clinician• Ease of maintenance for patient
Advantage :
• Opposing tooth may be over-erupt
Disadvantages :
Crown and Loop
• Loss of D with significant loss of tooth substance of abutment tooth (unilateral/bilateral)
Indication :
• Ease of fabrication for clinician• Ease of maintenance for patient
Advantage :
• More difficult to fabricate than band & loop
Disadvantages :
Palatal Arch/Lingual Arch
• Loss of bilateral E’s
Indication :
• Maintains tooth space & Leeway space• Prevents tipping of molars
Advantage :
• Meticulous hygiene required• 6 prone to decalcification
Disadvantages :
Palatal Arch
Lower Lingual Arch
Distal Shoe/Intra-alveolar
• Loss of E prior to eruption of 6
Indication :
• Maintain E’s space
Advantage :
• Difficult to fabricate• Contraindicated in medically compromised patient
(Subacute bacterial endocarditis, chemotherapy, radiotherapy)
Disadvantages :
Upper Removable Appliance
• Multiple teeth are lost and space maintenance and mastication are of concern
Indication :
• Maintain space• Aid in mastication
Advantage :
• Susceptible to fracture / loss
Disadvantages :
Infraoccluded 55 & Impacted 15 15 erupting rotated
Thank You