Eruption guidance of the developing dentition.pptx

Eruption guidance of the developing dentition

1. Eruption guidance of the developing dentition Dr. Mohamed F arrag BDS, MSc Assistant lecturer of Pediatric Dentistry 1 st Scientific Meeting of Pediatric Dentistry Department

2. Does the eruption guide the pedodontist ?! or the pedodontist can guide the eruption?!

3. Eruption guidance in lower incisor segment Eruption guidance in lower canine and premolar segment Eruption guidance in maxillary canine and premolar segment Content

4. Eruption guidance in lower incisor segment Double row of teeth Extract ?! or not !!

5. Please, doctor extract these deciduous teeth ! They ask if the child need ortho or not ?! If the teeth will be self corrected or not ?!

6. They recommend that Periodic evaluation without surgical approach 8y, 2m for central 8y, 4m for lateral Over retention Firm No root resorption Extract No need to subject the child to Extraction Especially in his first visit N.B parents shouldn't be ignored N o significant contraindications to early removal of the offending primary incisor even in spaced dentitions

7. How can I make the decision Eruption guidance in lower incisor segment During eruption After complete eruption If still crowding What about the crowding and self correction Not sever crowding (no 3 rows of teeth!) Molding action (tongue) Inter canine width 2-3 mm Crowding < 3-4 mm Disking of C L.A. + + Passive lingual arch (lee way space 3.4 mm) Crowding > 3-4 mm Extraction of C (early orthodontic treatment program ) (serial extraction program)

8. D isking of lower primary canines 4 mm of lower incisor crowding 6-month recall 1- year recall

9. Elective extraction of primary canines Note: lingual collapse Pt is under serial extraction program

10. Eruption guidance in lower canine and premolar segment Crowding up to 2-3 mm Crowding 3-4 mm Elective extraction of D, mesial disking of E 2-3 mm distal positioning some anterior crowding relief N.B. sometimes extraction of E if atypical pattern is noted + passive lingual arch Passive lingual arch (utilizing Leeway space)

11. Elective extraction of D Disking of the mesial of E Permanent canines and first premolars erupted in distal orientation Some reduction in anterior crowding

12. Mixed-dentition cases with lower anterior crowding 60 cases Untreated Lower canine, premolars (mesial displacement) Overlapping already crowded incisors 60 cases Treated with passive lingual arch Lower canine, premolars (1.5 mm distal positioning per side) Relief of anterior crowding 3-4 mm

13. U sing cephalograms , Study model stomograms of the mandibular body Incisor crowding 3-4 mm mixed dentition cases untreated Treated by passive lingual arch Arch length decreased 2.5 mm per side 6 move forward 1.7 mm Arch length doesn’t change 6 move forward 0.3 mm only

14. Lingual arch Mesial molar migration Late mesial shift Incisor lingual movement Maintain arch length 3-4 mm relief of incisor crowding

15. Eruption guidance in maxillary canine and premolar segment Tortuous and long journey of the canine 7- 8 y Canine distal root of the lateral incisor Canine more vertical Toward C root area 3) Resorption of C 4) Canine slight labial orientation that tends to lingualize into the arch form

16. Notes The labial canine bulge may appear at 8y It should be palpated at 10-11 y give indication of normal path of eruption Absence of it need screening (clinical and radiographic)

17. Mesiolabial displacement (arch length deficiency) Palatal impaction 85 % demonstrate Adequate arch length (peg shaped lateral, missed, excessive space) The ectopic eruption can cause resorption of lateral (difficult to diagnose) Eruption problems Eruption guidance in maxillary canine and premolar segment

18. The degree of overlap of the canine with the lateral incisor root and the resorption pattern key indicators for successful interceptive guidance If 3 isn’t beyond midline of lateral incisor root (Distal half) Extraction of C Help canine repositioning (60 % only) If 3 is beyond midline of lateral incisor root (Mesial half) Extraction of C Help canine repositioning (85 % - 90 %) then Follow up 1 y after Extraction If improvement Good If no improvement Indicate limited eruptive force Or canine is positioned palatally Surgical exposure and allow for Passive eruption Or active orthodontic traction Extraction and substitution by first molar

19. B ilateral impaction of the maxillary permanent canines corrected by bilateral extraction of the primary canines and first molars In cases of mesially displaced maxillary canines with overlap of lateral incisor roots beyond age 10 years Timely removal of the adjacent primary canines and simultaneously the first primary molars (two-thirds root of canine ) Enhances the more distal and vertical eruption (Three-fourths or more) the eruptive force is reduced and the tooth will more likely have to be actively moved into the mouth

20. Thank You! [email protected]