Interceptive Orthodontics E-Book

Joseph Noar

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 133

Veröffentlichungsjahr: 2014

Beschreibung

Identify problems and introduce solutions early for an ideal aesthetic result

Interceptive Orthodontics: A Practical Guide to Occlusal Management aims to guide the practitioner in the art of interceptive management of the developing dentition. The goal is to guide the permanent dentition into the line of the dental arches, avoiding complex orthodontic treatment for teeth displaced far from their ideal position, and thereby reducing orthodontic treatment time. This book covers growth of the jaws and tooth development, and explains the correct timing of interceptive management. It also discusses orthodontic assessment, special investigations and comprehensive management of the mixed dentition, taking in the issues of early crowding, impaction, supernumerary and supplemental teeth, dental arch expansion, space maintenance and space management. In line with best available evidence, it provides clear treatment objectives and detailed treatment planning advice.

Practical, accessible and illustrated with a wealth of colour images, this is an ideal clinical companion for general dental practitioners, oral surgeons, paediatric dentists and orthodontists. It is also a valuable reference for all training grades.

Leseprobe

Table of Contents

Dedication

Title page

Copyright page

Preface

CHAPTER 1: Introduction

What Do We Know about Growth?

References

CHAPTER 2: Recognising the Problem

Is an Attractive Smile Important?

CHAPTER 3: Investigations

Radiographs

Cone-Beam Computed Tomography

Study Models

Photographs

What Is the Scope of Orthodontic Change?

References

CHAPTER 4: Managing the Developing Occlusion

Thumb/Finger Sucking

Crowding of the Permanent Lateral Incisors

Serial Extraction: a Modern Approach

The Unerupted Central Incisor

Submerging Deciduous Second Molars

Fusion, Gemination and Morphology Issues

Upper Labial Fraenum

Leeway Space and the Use of Intraoral Anchorage Arches

Sagittal Problems: Class II

Sagittal Problems: Class III ()

Ectopic and Impacted Teeth

Missing Teeth

References

Index

End User License Agreement

List of Illustrations

Figure 1.1  Directions of facial growth.

Figure 1.2  Growth is genetically controlled and largely not under our influence.

Figure 2.1  Essential clinical assessment tools.

Figure 2.2  Clinical assessment of the A–P skeletal relationship.

Figure 2.3  Clinical assessment of the maxillary mandibular angle.

Figure 2.4  Clinical assessment of the lower anterior face height.

Figure 2.5  Clinical assessment of facial symmetry.

Figure 2.6  Facial asymmetry can be caused by mandibular displacement due to crossbites with displacements. (a) Displaced position; (b) first contact with condyles in retruded axis position.

Figure 2.7  Clinical assessment of overjet.

Figure 2.8  Lip trap (upper right incisor resting on lower lip).

Figure 2.9  Lip apart posture at rest.

Figure 2.10  Forward tongue position causing an anterior open bite.

Figure 3.1  OPG radiograph: Simple assessment of the space requirements for the developing dentition.

Figure 3.2  (a) OPG radiograph to identify maxillary canine position using vertical parallax. (b) Standard occlusal radiograph.

Figure 3.3  Lateral cephalograph and analysis.

Figure 3.4  CBCT images in the X, Y and Z planes showing buccally placed ectopically positioned upper left and right canines overlying the roots of the upper lateral incisors. The images show significant resorption of the roots of these teeth and enlarged canine crown follicles. The reconstructed slices are also shown in 3D. Using these images it is possible to make a judgement in all planes as to the likely long-term prognosis for the lateral incisors. The difficulty at the present time is the lack of evidence for or understanding of what happens to the resorption once the canines have been moved away from the incisors. It is important within the treatment planning process to know if the resorption will continue or remain stable. These images demonstrate both the good visualisation of the area and our limitations in interpreting this information.

Figure 3.5  (a) Section from a DPT showing the presence of a supernumerary tooth associated with the upper left central incisor – the diagnostic information is limited, as accurate localisation is not possible. (b) CBCT images in the X, Y and Z planes showing the position in 3D of a supernumerary palatal to the ectopically positioned upper central incisor. These views provide excellent positional information for this tooth and the morphology of both its crown and root and the surrounding alveolar bone. This information is particularly important to the orthodontic surgeon as it allows removal with maximum accuracy and therefore minimal trauma. By assessing the orientation of the unerupted tooth, a view can be reached as to whether it will move away from the other teeth (and can therefore be left to be reviewed) or whether it is likely to be an obstruction that requires removal.

Figure 3.6  CBCT imaging at different heights showing the talon cusp and clearly demonstrating the degree of extension of pulpal tissue into the cusp.

Figure 3.7  (a) Periapical radiograph (2D image) showing fusion of the incisor teeth. (b) CBCT image (3D) showing accurately the extent of root and crown contact.

Figure 3.8  CBCT images in the X, Y and Z planes, allowing comprehensive analysis of the root fracture affecting the UR1. The level of the root fracture, any shelving and any microfractures can be visualised. This allows accurate treatment planning and assessment of any repair. Progressive resorption can also be monitored accurately.

Figure 3.9  (a,b) A simple space analysis on plaster study casts.

Figure 3.10  Extraoral photographs.

Figure 3.11  Intraoral photographs.

Figure 4.1  Effect of thumb sucking on the dentition.

Figure 4.2  Asymmetric open bite due to digit sucking.

Figure 4.3  Fixed thumb guard to prevent digit sucking.

Figure 4.4  Clinical effects of the thumb guard. (a) Start. (b) At 3 months. (c) At 6 months. (d) At 9 months.

Figure 4.5  (a) The Quadhelix appliance. (b) Using a Quadhelix appliance to expand the upper dental arch and correct the lateral arch dimensions, as well as acting as a thumb guard.

Figure 4.6  (a) Before extraction of the primary canines. (b) After extraction of the primary canines, space is created to allow the upper permanent lateral incisors to erupt, and the crowding is seen to shift distally in the arch.

Figure 4.7  Early expansion can be used to create an effective environment for the permanent teeth to develop into.

Figure 4.8  Using fixed appliances to close anterior incisor spacing early can be useful when guiding the developing dentition into the correct alignment.

Figure 4.9  Anterior crossbite of the upper right central incisor.

Figure 4.10  Anterior crossbite causing forward displacement of the lower central incisors and leading to reduced labial bone coverage.

Figure 4.11  Case showing potential damage involving tooth wear and periodontal involvement.

Figure 4.12  When correcting an anterior crossbite, posterior coverage is needed to open the bite beyond the depth of the crossbite.

Figure 4.13  Simple removable appliances can provide effective treatment for anterior crossbites.

Figure 4.14  Extraction of the lower canines eliminates the crossbite.

Figure 4.15  Upper arch expansion with a removable appliance to eliminate a unilateral crossbite.

Figure 4.16  A Quadhelix appliance can eliminate the need for patient compliance as it is not removable from the mouth.

Figure 4.17  Serial extraction. (a) Start. (b) 6 months after primary canine extraction. (c) First premolars erupted and ready for extraction. (d) Second premolars erupting, ready for alignment if required.

Figure 4.18  Series of OPG radiographs showing the management of severe crowding with interceptive extractions alone, thus avoiding the need for orthodontic treatment. (a) 2009; (b) 2011; (c) 2014.

Figure 4.19  Tuberculate supernumeraries preventing the eruption of the central incisors.

Figure 4.20  Mesiodens supernumeraries preventing the eruption of the central incisors.

Figure 4.21  Managing the impacted incisor: the treatment sequence.

Figure 4.22  Severely ectopic teeth can be effectively treated with complex orthodontic treatment. Bringing the teeth into the line of the dental arch preserves alveolar bone.

Figure 4.23  Lateral incisor moved into central incisor position and restored showing poor emergence profile.

Figure 4.24  Submerging lower right second deciduous molar and impacted second premolar.

Figure 4.25  Submerging lower left second deciduous molar causing a food trap.

Figure 4.26  A band and loop is rarely successful in preventing the medial tipping of the first molar after loss of primary molars. (a) Before extraction of the primary second molar. (b) Band and loop in place, but not controlling mesial movement of the adult molar. (c) Loss of space leading to impaction of the developing premolars.

Figure 4.27  A lingual arch is effective at stabilising the molar position and arch length after loss of a primary second molar.

Figure 4.28  A geminated central incisor.

Figure 4.29  Large upper central incisors (megadont teeth) cause occlusal issues and crowding due to their size, and benefit from early management.

Figure 4.30  Orthodontic tooth movement and restorative management of one megadont tooth to allow space for normal occlusal development of the remaining incisors.

Figure 4.31  A large labial fraenum.

Figure 4.32  Lip trap causing proclination of incisors.

Figure 4.33  Lip trap causing proclination of the upper central incisors and retroclination of the lower incisors.

Figure 4.34  Using palatal and lingual arches to preserve the leeway space.

Figure 4.35  Proclination of the upper incisors increases the risk of trauma.

Figure 4.36  Result of a fall, fracture and luxation of the anterior teeth.

Figure 4.37  A treatment sequences for the management of an increased overjet. (a) Start. (b) With the appliance in place. (c) Post treatment with the overjet reduced.

Figure 4.38  Functional appliances come in many designs but generally effect the same outcome. (a) Clark Twin Block; (b) functional regulator II; and (c) median opening activator.

Figure 4.39  A treatment sequence for the management of an increased overjet. (a) Start. (b) A usual regimen is for an active phase of 9–12 months, followed by a passive phase of night-time wear only. Once in, the appliance is unobtrusive and there is an instant ‘Class II’ correction, which many children find very helpful. (c) The end result can be very rewarding for the patient, their parents and the practitioner.

Figure 4.40  Using dental wax to provide a postured position for a functional appliance.

Figure 4.41  Class III malocclusion.

Figure 4.42  The treatment of Class III malocclusion with protraction headgear and fixed appliances.

Figure 4.43  Early extraction of teeth whether they are deciduous or permanent can influence the path of eruption of the permanent canines if carried out early enough. These three OPG radiographs were taken in (a) August 2009, (b) October 2010, and (c) October 2012; the improvement in the angulation of the developing teeth can be clearly seen. This intervention has avoided lengthy orthodontic treatment to bring the canines into the dental arch.

Figure 4.44  Palatally impacted upper left canine; surgical access.

Figure 4.45  Attaching the gold chain to a fixed appliance.

Figure 4.46  A modern approach to provide vertical traction and avoid the long-term use of fixed appliances using a temporary anchorage device (TAD).

Figure 4.47  Final occlusion following extraction of the upper left maxillary canine. This can be considered to reduce the orthodontic treatment time.

Figure 4.48  Missing upper right lateral incisor.

Figure 4.49  Early extraction of the deciduous anterior teeth to guide the permanent canines more easily.

Figure 4.50  (a,b) Early extraction of primary teeth guides the second dentition, but may leave unaesthetic spaces during the teenage years. This can be traumatic for the patient.

Figure 4.51  The aesthetics of having the upper maxillary canine in the upper lateral incisor space depends on the height of the smile line.

Figure 4.52  (a) Preparing space for the replacement of one missing lateral incisor. (b) Using a composite crown form bonded onto an adjacent tooth to keep ideal aesthetics during tooth movement.

Figure 4.53  Preparing patients for the provision of a replacement lateral incisor.

Figure 4.54  (a) Pre- and (b) post-extraction of the first permanent molars showing good replacement by second molars.

Guide

Cover

Table of Contents

Start Reading

Preface

CHAPTER 1

Index

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To my family for their patience and support while I prepared this book, to the many postgraduate students I have had the pleasure of training and supervising for providing the inspiration for this book and to the patients who I hope have benefitted from the concepts behind this book.

This edition first published 2014

© 2014 by John Wiley & Sons, Ltd

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Library of Congress Cataloging-in-Publication Data

Noar, Joseph, author.

    Interceptive orthodontics : a practical guide to occlusal management / Joseph Noar.

        1 online resource.

    Includes bibliographical references and index.

    Description based on print version record and CIP data provided by publisher; resource not viewed.

    ISBN 978-1-118-88027-2 (Adobe PDF) – ISBN 978-1-118-88028-9 (ePub) – ISBN 978-0-470-65621-1 (pbk.)

    I.  Title.

    [DNLM: 1.  Malocclusion–therapy.    2.  Maxillofacial Development.    3.  Orthodontics, Corrective–methods.    4.  Tooth–growth & development.    WU 440]

    RK527.5

    617.6'43–dc23

                                                                      2014021386

A catalogue record for this book is available from the British Library.

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Cover images: courtesy of Joseph Noar

Preface