Proclined Upper Incisors

Copyright (c) Department of Orthodontics
University of Dental Medicine, Yangon

1. Proclined Upper Incisors Dr.Hla Hla Yee

2. Causes Skeletal cause Non-skeletal cause

3. due to habits Thumb sucking / Finger sucking Tongue thrusting Lip biting Dental causes Supernumerary teeth Retained deciduous teeth Function Adaptive swallowing behaviour caused by Skeletal discrepancy ( Sk II ) Short upper lip and Low lip line Non-skeletal cause

4. Differential Diagnosis Differentiate skeletal from non-skeletal

5. Treatment I .Treat / eliminate the causes For habits ( a ) Encourage to stop the habits Straight forward discussion between the child and the dentist ( b ) The reward system that provides a small tangible reward daily for not engaging in the habit. In some cases, a large reward must be negotiated for complete cessation of the habit.

6. ( C ) Reminder therapy For sucking habit Adhesive bandage with waterproof tape on the finger / thumb that is sucked Glove Mittens Solution with unpleasant ( bitter ) An elastic bandage loosely wrapped around the elbow prevent the arm from flexing and the fingers from being suck. It is usually only at night and 6 to 8 weekly of intervention should be sufficient.

7. For tongue thrusting habit Orthodontic elastic or sugarless candy lozenge at the tip of the tongue and asking the patient to place the tip of the tongue in correct position on the palate for certain length of time, several times each day. For lip biting habit Lip ballooning by holding air in the vestibule and making sure the lip are closed tight.

8. ( D ) Use of habit training device For sucking habit Removable appliance -oral screens -Hawley appliances

9. ( 1 ) The anterior portion of quad helix appliance Fixed appliance

10. ( 2 ) Cemented reminder appliance to actively impede sucking. ( Tongue Cribs ) The appliance consists of a maxillary lingual arch and a crib constructed of soldered wire so that it is difficult to insert the thumb / finger into the mouth when sucking apparently ceases, the appliance should be retained in place for approximately 6 months to ensure the habit has truly stopped.

11. ( 3 )for tongue thrusting habit Tongue cribs ( 4 )for lip biting habit Lip bumper appliances

12. II. Treat the condition In young individuals, spontaneous correction occur after stoppage of habits In adult If there is adequate vertical clearance and space within the arch the maxillary incisors can be tipped lingually with a removable appliance or fixed appliance.

13. If there is no space for retroclination of upper incisors and deep bite exists. space analysis choice of teeth for extraction Type of tooth movement Choice of appliance and mechanotherapy Correction of overbite before retroclination of upper incisors.

14. III. In adult, corrective treatment should be completed with habit training device to prevent relapse. ( For the causes of habits. )

15. For dental cause Extract retained / erupted supernumerary teeth Surgical removal of unerupted supernumerary teeth Treat the condition ( mention above )

16. But the corrective treatment should be completed with simple retention appliance For adaptive swallowing behaviours The lower lip should cover at least the incisal third of the labial surface of the retracted upper incisors when a lip seal is obtained If the lip seal is not obtained, relapse may occur.

17. Bimaxillary dentoalveolar protrusion

18. Causes Soft tissue pattern Full and everted lip, the tongue acts to mould the dental arches as they erupt Large tongue Habit Tongue thrusting habit

19. Treatment Bimaxillary dentoalveolar protrusion should be treated with caution because of its potential instability.

20. If it is due to habit Treat / eliminate the causes. Extraction of upper and lower teeth. ( usually 1st premolar ) , thus provide enough space for full retraction of the upper and lower incisors the lower lip should cover at least the incisal third of the labial surface of the extracted upper incisors when a lip seal is obtained. If the lip seal is not obtained, relapse may occur.