Self correcting anomalies

DENTAL Self correcting anomalies

1. SELF CORRECTING ANOMALIES MADE BY : DR. DHARATI PATEL

2. Content Introduction Classification Pre-dental period Primary dentition Mixed dentition Permanent dentition Summary References

3. ALSO CALLED TRANSIENT MALOCCLUSION Get corrected themselves As they pass through the developmental stages

4. ANOMALY: Is defined as marked deviation from normal. SELF CORRECTING ANOMALIES : Self-correcting anomalies are the anomalies which arise in the child’s developing dentition during the period of transition from that of gum pads stage to the onset of permanent period and get corrected on their own without any dental treatment.

5. Classified based on stages of development of dentition

6. PRE-DENTAL PERIOD ( F rom birth to the eruption of 1 st deciduous teeth) Retrognathic mandible : Mandibular lateral sulcus lies posterior to maxillary lateral sulcus Upper gum pad protrudes - about 5 mm

7. Causes : Growth magnitude and duration – greater for anterior maxilla then anterior mandible Upper anterior gum pad > lower anterior gum pad (intercuspid width ) (intercuspid width ) Mandible undergoes the largest amount of growth post-natally rather than prenatally .

8. Self corrected by : within 6-7 months By downward and forward growth of the mandible

9. Clinical consideration : Remain till 6 months after birth and helps in suckling Can not be used as a reliable diagnostic criteria for predicting subsequent arch relationship But if the antero-posterior dimension of gum pads is greater the possibility of the child developing a malocclusion is greater.

10. 2) Anterior open bite : When Upper and lower gum pads are approximated :- Contacts only at the molar region Space exist in the anterior region called anterior open bite

11. Self corrected by: At 6-7 months Eruption of primary incisors .

12. Clinical consideration This o pen bite is considered normal Helps in suckling

13. 3) Infantile swallowing : Different from mature swallowing Carried out by stomatognathic system

14. Features of infantile swallowing outlined by Moyer(1964) : The jaws are apart – tongue placed between upper and lower gum pads . The mandible stabilization – by contraction of muscles of seventh cranial nerve and interposed tongue Swallow is guided and controlled - Sensory interchange between lips and tongue

15. Self corrected by : Gradually disappears with eruption of teeth And As infant begins to eat solid food (approximately 1 st year) Tongue is contained within the dental arch and mandible is no longer protrude Indicate the onset of mature swallowing

16. Clinical consideration As above two conditions , the anterior region of the gum pads do not come in contact with each other Hence to swallow an infant has to close this space So tongue is used to close the space by placing it between the gum pads during swallowing. During transitional period both swallowing can be observed

17. PRIMARY DENTITION (6 months to 2.5 to 3 years ) Anterior deep bite : Excessive vertical overlapping The lower incisal edge come in contact with the cingulum of upper incisor

18. Causes : Primary teeth are more upright than their successors Have more vertical inclination - Inter-incisal angel of ( about 150 ) Infra-occlusion of partially erupted molars

19. Self corrected by: Complete Eruption of primary molars-Increase the vertical dimension Attrition of incisal edges Forward and downward growth of mandible

20. Clinical consideration Should not consider as – Malocclusion orthodontic treatment for deep bite – not required

21. 2) Spacing Delabarre (1918 ) – first described interdental spacing in primary dentition

22. Types of spaces in primary dentition Primate /anthropoid/simian spaces : Physiological/developmental spaces : 4 mm in maxilla 3 mm in mandible

23. Primate space Physiologic space Leeway space

24. Clinical consideration Spaced dentition is supposed to be good - important for normal development Spaces can be utilized for adjustment of permanent successors which are always larger Absence of spaces indicates that crowding may occur in permanent dentition

25. Self corrected by : Eruption of larger permanent successors Eruption of first permanent molar (Early mesial shift )

26. 3)Flush terminal plane : Primary molar relationship Flush terminal plane Distal-step terminal plane Mesial-step terminal plane

27. Self corrected by Mesial eruptive force of first permanent molar Early mesial shift : By using Primate spaces . Late mesial shift : By using leeway spaces 1.8 mm in maxilla 3.4 mm in mandible

28. Clinical consideration The most desirable permanent dentition - Class-I occlusion Relationship of primary terminal plane - key diagnostic feature regarding future occlusion status

29. Terminal plane prediction

30. Primary terminal plane (4-5 years ) Initial permanent first molar occlusion(6 -7 years ) Final occlusion (12 years ) 1% class-III (< 2mm) 3% class-III 49 % mesial step 27% class- I 59% class- I 17% flush terminal 49% End on 14% distal step 23% class-II 39% class-II Table: 1 Incidence of Terminal Molar Relationships at Three Stages of Occlusion Development

31. 4)EDGE TO EDGE BITE : Due to attrition of primary incisors By downward growth of mandible over jet decreased gradually

32. Self corrected by Eruption of permanent incisors Having more labial inclination- inter- i ncisal inclination 123

33. MIXED DENTITION (6 years to 12-13 years ) Anterior deep bite : D ue to large permanent successor incisors

34. Self corrected by Complete Eruption of primary molars-Increase the vertical dimension

35. 2)MANDIBULAR ANTERIOR CROWDING : Disproportion between tooth size and arch length Cause : E xchange of larger permanent mandibular incisors I n narrow lower arch

36. Self corrected by Increased inter-canine width - by jaw expansion Tongue pressure – cause forward migration of lower incisors

37. Clinical consideration Minor crowding - resolves spontaneously by development Moderate crowding – use of leeway space Preventing mesial movement of permanent molar

38. 3) Ugly-duckling stage: Seen at 8-11 years of age First described by – H Broadbent ( 1937) Also called B roadbent phenomenon Term Indicates Unaesthetic appearance of child

39. Self corrected by Complete eruption of permanent maxillary canine

40. Clinical consideration During this stage children tends to look ugly Parents are often apprehensive and do consult the dentist But this condition is corrected by itself - pressure is transferred from roots to coronal area So no need of any orthodontic treatment

41. 4) End on relationship: Buccal cusp tip of permanent maxillary 1 st molar coincide with buccal cusp of permanent mandibular 1 st molar. Obtained in mixed dentition period following the flush terminal relation in deciduous dentition.

42. Class -1 relationship in 1 st permanent molars End on relationship in 1 st permanent molars

43. Self corrected by : Eruptive force in mesial direction of permanent mandibular molars Late mesial shift in Non-spaced dentition

44. Clinical consideration :

45. PERMANENT DENTITION Increased overjet and overbite: Overbite : a vertical distance which the incisal edge of maxillary incisors overlaps the incisal edge of mandibular incisors. Overjet : a horizontal distance between the lingual aspect of the maxillary incisors and the labial aspect of the mandibular incisors.

46. Self corrected by : By eruption of all permanent molar Differential growth of mandible Overbite decreased up to - 0.5 mm by 18 years of age Overjet decreased up to - o.7 mm between 12 to 20 years of age

47. Summary : Therefore self correcting anomalies are part of developing dentition not to be considered as any developmental or pathological abnormality If there is any apprehension on part of the parents it should be removed promptly parents should be explained in brief the physiology behind these transitional changes

48. Reference : Avery D R, McDonald R E.Dentistry for the child and Adolescent. Mosby, 9 th Edition 2012 , 518-520. Marwah N. Text book of pediatric dentistry scientific foundation and clinical practice, Mosby, 3 rd Edition 2014, 166-178. Tandan S. Textbook of pediatric dentistry, P aras publication , 2 nd edition , 2009 ,107-117 Singh G. Text book of orthodontics ,Jaypee , 2 nd edition 2007,40-45. Bhalaji S I. Orthodontics - The Art and Science , Medi , 4 th Edition , 2009 , 44-50.

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