preventive orthodontics applications .pptx

preventive orthodontics applications .pptx

1. PREVENTIVE ORTHODONTICS

2. action taken to preserve the integrity of what appears to be the normal occlusion at a specific time (Graber ). Prevention of potential interference with occlusal development(Profit and ackerman )

3. Procedures undertaken in preventive orthodontics Preventive procedures are are undertaken in anticipation of development of a problem Interceptive procedures are undertaken when the problem has already manifested Done in deciduous and mixed dentitions in growing patients. Most procedures are carried out on patients who are 3-12 years of age

4. benefits Intervening in deciduous dentition simplifies the treatment in permanent dentition Better compliance is possible at younger age Better stability of the treatment Better use of growth to aid treatment Pathologies such as root resorption,may be avoided Possible to avoid orthognathic surgery at later age Improved aesthetics due to intervention at an early age Possible to avoid psychological problems associated with malocclusion

5. Disadvantages Lengthy treatment plans can result in cooperation burnout ,caries ,increased cost of treatment and root resorption Growth prediction is unreliable at early age Chance of relapse

6. PREVENTIVE ORTHODONTIC PROCEDURES Parent education Caries control Care of deciduous dentition Management of ankylosed tooth Maintanace of quadrant wise tooth shedding time table Checkup for oral habit breaking appliance if necessary Occlusal equilibration if there are any occlusal prematurities Prevention of damage to occlusion eg:Milwaukee braces

7. Extraction of supernumerary teeth Space maintenance Management of deeply locked first permanent molar Management of abnormal frenal attachment

8. PARENT EDUCATION PRENATAL COUNCELLING the importance of oral hygiene maintenance by mother Possible co relationship between the mothers poor oral hygiene and premature births Transmitting the strings of caries inducing bacteria to the baby To have natural foods containing calcium and phosphorus ,as they would allow adequate formation of deciduous tooth crowns

9. POSTNATAL COUNCELLING SIX MONTHS TO ONE YEAR OF AGE Teething and associated irritation No sugar addition to bottle milk Brushing with the help of finger brush

10. Two years of age Bottle feeding should never be given during the passage to sleep Clinical examination to assess any incipient decay and eruption status of teeth

11. Three years of age Clinical examination-generally the full compliment of deciduous dentition should have erupted

12. CARIES CONTROL Effect of restoration : If the restoration is under contoured, it results in loss of contact with reduction in arch length. If over contoured, it consumes more space resulting in irregularity. Pulpal involvement causes extraction, leads to premature loss of tooth, and derangement of occlusion. • Proximal caries causes reduction in arch length

13. All possible caries prevention methods are to be used. Proper brushing will reduce chances of caries attack. Fluoride prophylaxis—Knutson’s technique, at ages 3, 7, 9, and 11, 4 sittings at weekly intervals is advised .

14. METHODS OF CARIES PREVENTION Tooth brushing Flossing Interdental brushes Chlorhexidine Dentifrices fluorides Pit and fissure sealants Caries vaccines

15. MANAGEMENT OF ANKYLOSED TEETH Ankylosis is a condition in which the cementum of a tooth’s root fuses directly to the surrounding bone and is characterized by absence of the periodontal membrane in a small area or the whole of the root surface ankylosis renders the tooth immobile to eruptive change Common in deciduous molars

16. Reasons for ankylosis Congenital absence of permanent successor Failure of resorption of deciduous teeth Trauma to the tooth infection

17. Ankylosed teeth do not get resorbed and therefor either prevent the permanent teeth from erupting or deflect them to erupt in abnormal position deeply submerged tooth can also cause tipping of adjacent tooth and possibly supraeruption of opposing teeth

18. management Surgical removal to permit permanent teeth to erupt In case of absence of underlying permanent tooth a decision should be made as to extract the tooth or build up the vertical dimension of the tooth and retain it

19. Management of abnormal frenal attachment The presence of thick and fleshy maxillary labial frenum that is attached relatively low prevents the maxillary central incisor from approximating each other producing midline diastema Heriditary factors

20. diagnosis BLANCH TEST Notching of interdental bone in a periapical rediograph confirms a thick frenal attachment

21. Ankyloglossia Fusion of the tongue and floor of mouth is called ankyloglossia This limits forward and upward mobility of the tongue The short frenum may restrict the tongue so that the infant is not able to extend it beyond the lower gum margins leading to breast feeding problems

22. Prevents normal functional development due to lowered position of the tongue and abnormalities in speech and swallowing Problems with articulation of sounds such as ‘t’,’d’,’ th’and ‘s’ because it restrict the ability to elevate the tongue This condition should be surgically treated to prevent full fledged malocclusion

23. ORAL HABITS CHECK UP AND EDUCATING PATIENTS AND PARENTS Habits such as finger and thumb sucking ,nail biting tongue thrusting and lip biting should be identified and stopped at an early age Prevention starts with proper nursing and use of a physiologically designed nursing nipple and pacifier to enhance normal functional and deglutational activity

24. DEEPLY LOCKED PERMANENT FIRST MOLARS The deciduous second molars occasionally have a prominent distal bulge that prevents the eruption of the first permanent molars. Slicing the distal surface of the second deciduous molar helps in guiding the eruption of the first permanent molars

25. REQUIREMENTS It should maintain the entire mesio distal space created by a lost tooth It must restore the function as far as possible and prevent over eruption of of opposing tooth It should be strong enough to withstand the functional forces It should not exert excessive stress on adjoining teeth It must permit maintenance of oral hygiene It must not restrict normal growth and development and natural adjustment that take place during the transition from deciduous to permanent dentition

26. The spcace maintainer should not come in the way of other functions

27. Advantages They are easy to clean and permit maintanance of proper oral hygiene They maintain or restore the vertical dimesion They can be worn part time allowing circulation of the blood to the soft tissues They serve other important functions like mastication,aesthetics and phonetics Dental check up for caries detection can be undertaken easily Stimulate eruption of permanent teeth Help in preventing tongue thrust habit into the extraction space

28. Disadvantages They may be lost or broken by the patient Uncooperative patient maynot wear the appliance Lateral jaw growth may be restricted ,if clasps are incoperated They may cause irritation of the underlying soft tissues

29. SPACE MAINTENANCE CLASSIFICATION According to Hitchcock Removable or fixed or semifixed With bands or without bands Functional or non functional Active or passive Certain combinations of the above

30. According to Raymond c.Thurow Removable Complete arch lingual arch extra oral anchorage 3. Individual tooth

31. According to Hinrichsen Fixed space maintainers Class 1 a)non functional types 1.bar type 2.loop type b)functional types 1.pontic type 2.lingual arch type

32. Class II cantilever type (distal shoe ,band and loop) 2.Removable space maintainers acrylic partial denture

33. REMOVABLE SPACE MAINTAINERS It can be functional or non functional Functional :- Teeth provided to aid in mastication ,speech and esthetics Non functional:- only an acrylic extension over edentulous area to prevent space closure

34. INDICATIONS When aesthetics is of importance When abutment teeth cannot support fixed appliance Cleft palate patient ;for obturation of palatal defect If radiograph reveal that the unerupted permanent teeth is going to erupt in less than 5 months CONTRAINDICATIONS Lack of patient coperation Allergy to acrylic Epileptic patients having uncontrolled seizures

35. If permanent teeth are not fully erupted so a band cannot be adapted Multiple loss of deciduous teeth requiring functional replacement

36. Acrylic partial dentures The inclusion of artificial teeth in the denture restores masticatory function Clasp on deciduous canines amd molars

37. Full or complete denture Restore masticatory function and aesthetics Guide first permanent molar into correct position The denture will have to be adjusted and a portion of it cut away as the permanent incisors erupt , and the posterior border contoured to guide the first permanent molars into position. When the permanent incisors and first molars erupted ,a partial denture space maintainer can be used until the remaining permanent teeth erupt

38. Removable distal shoe space maintainer

39. FIXED SPACE MAINTAINERS

40. ADVANTAGES Bands require no tooth preparation Donot interfere with eruption of abutment teeth Jaw growth is not hampered Succedaneous teeth is free to erupt Can be used in uncooperative patients

41. Disadvantages Elaborate instrumentation and skills required Banded tooth is more prone to caries and decalcification Supraeruption of opposing tooth

42. Band and loop Crown and loop Lingual arch Palatal arch Transpalatal arch Distal shoe space maintainer Esthetic anterior space maintainer Band and bar type space maintainer Preformed bonded space maintainer

43. Band and loop Most commonly used Unilateral fixed appliance Used in posterior segments

44. CROWN AND LOOP Stainless steel crown is used as an abutment Stronger than band and loop Cementaion failure or loss are less likely Crown is used in preference to bands when the abutment teeth is highly carious exhibit marked hypoplasia or is pulpotomized

45. LINGUAL ARCH INDICATIONS Bilateral loss of the mandibular primary molars after eruption of the permanent incisors Unilateral loss of more than one tooth in the mandibular arch It helps in maintaining the arch perimeter by preventing both mesial drifting of molars and also lingual collapse of anterior teeth

46. NANCE PALATAL ARCH Prevent mesial migration of maxillary molars It’s a simple maxillary lingual arch but does not contact anterior teeth It has an acrylic button in the anterior region that contacts the palatal tissue

47. TRANSPALATAL ARCH Indicated when one side of the arch is intact and several primary teeth on the other side are missing

48. DISTAL SHOE SPACE MAINTAINER Also known as intra-alveolar appliance Used when second primary molar requires extraction and first permanent molar has not erupted

49. ESTHETIC ANTERIOR SPACE MAINTAINER Describes by steffen,miller and johnson It consist of a plastic tooth fixed onto a lingual arch that inturn is attached to molar bands

50. Band and bar Abutment teeth on either side of the extraction space are banded and connected to each other by bar

51. Preformed bonded space maintainer This is direct bonded space maintainer consist of two bondable mesh pads that are bonded to the teeth on either side of the lost tooth One of the base has a metal rod and the other base has a metal tube The rod is inserted into the tube and is crimped so as to have the required length of the space maintainer It is now bonded to the teeth on either side of the extraction space

52. CONCLUSION As the word goes , PREVENTION IS ALWAYS BETTER THAN CURE , preventing orthodontic malocclusion at a very early age can do so much good for the children than interceptive and corrective procedures at a later age.Hence it is the need of the age ,for children and parent to be well informed,educate and motivated to take preventive measure against dental malocclusion

53. Thank you