The third and final lecture about interceptive orthodontic, guiding the developing occlusion

1. Sudan International University
Faculty of Dentistry
Department of Orthodontics
Management of the developing
dentition (preventive and
interceptive procedures)
Mohanad Elsherif
BDS (U of K), MFD RCSI, MFDS RCPS(Glasg), MSc (Orthodontics), M.Orth. RCSEd

2. Orthodontic Triage
Step 4: Space Problems:
 Crowding
 Spacing.
 Large midline diastema (3 mm or more).
 Space analysis is essential for planning treatment.

3. Orthodontic Triage
Management of space deficiency
 For space shortage of 4 mm or less, The lost space
can be regained during the mixed dentition stage.
 Space discrepancies of 5 mm or more, with or
without incisor protrusion, constitute complex
treatment problems and require special
management by specialist.

4. Orthodontic Triage
The leeway space

5. Orthodontic Triage
Distema during mixed dentition:
 Generally, minor midline diastemas
will close and cause little esthetic or
developmental problems.
 Large diastemas, over 2 mm, can be
esthetic concerns and inhibit adjacent
teeth from erupting properly.
 Either removable or fixed appliance
can be used depending on the
movement required

7. Serial extraction
Definition
Planned extraction of certain deciduous teeth and later specific
permanent teeth in an orderly sequence and pre-determined pattern to
guide the erupting permanent teeth into a more favorable position
when one can recognize and anticipate potential irregularities in the
dento-facial complex.
Rationale:
Based on 2 basic principles:
 Arch-length tooth material discrepancy.
 Physiologic tooth movement

8. Serial Extraction how?
CD4

9. Serial extraction

10. Serial extraction
Indications
 Class I malocclusion showing harmony between skeletal
and muscular systems
 Sever crowding (10 mm or more)
 Patients with straight profile and pleasing appearance

11. Serial extraction
Contraindications:
 Class I malocclusion with minimal space deficiency
 Class II & III malocclusion with skeletal abnormalities
 Spaced dentition
 Anodontia/Oligodontia
 Open bite and deep bite
 Midline diastema
 Unerupted malformed teeth. E.g.dilaceration
 Extensive caries or heavily filled first permanent molars

12. Orthodontic Triage
Step 5: Other Occlusal Discrepancies
Dental crossbite.
Dental scissor bite.
Dental open bite
Dental deep bite.

13. Anterior crossbite
 affect around 3% of US population.
 Can affect one or more anterior teeth
 The more the teeth in crossbite, the greater the chance of
skeletal discrepancy.

14. Consequence of cross bite
 TMJ problem, specially if
associated with displacement
 Periodontal breakdown
(e.g. to lower incisor).
 Esthetic concern (in case of
anterior crossbite)

15. Treatment
 The success of correction depend on
 Adequate space within the arch.
 Adequate overbite.

16. Treatment options
 Single tooth crossbite:
 Tongue blade
 Removable appliance with Z spring
 Inclined bite plate
 Fixed appliance

17. 1. Tongue blade

18. 2. Removable appliance with Z spring

19. Treatment options
 Removable appliance with Z spring

20. Treatment options
 Fixed appliance

21. Segmental cross bite

22. Segmental cross bite
 Treatment options:
 Removable appliances
 Fixed appliances

23. Fixed appliances

24. Posterior crossbite
 Can be unilateral or bilateral
 Can affect one or more
buccal segment teeth
 Often associated with
mandibular displacement
 treatment indicated in the
mixed dentition only if there
was mandibular shift

25. Treatment options in mixed
dentition
 Selective grinding to remove occlusal prematurity
 Dental expansion using removable plates or a
quad helix

26. Removable appliance

27. Orthodontic Triage
Vertical problems
 Open bite related to an oral habit like finger sucking in a young
child with good facial proportions usually needs no treatment -
other than habit cessation - because there is a good chance of
spontaneous correction with additional incisor eruption.
 Deep overbite can develop in several ways but often is caused by
or made worse by short anterior face height.
 Complex open bite and deep bite are rarely treated in the mixed
dentition.

28. Oral habits
 Common oral habit:
 Thumb sucking habit.
 Tongue thrust habit.
 Mouth breathing habit.
 lip biting habit.
 Nail biting habit.

29. Effect of oral habits
 The effect of any habit depend on:
 Frequency (how many times/day?)
 Duration (how long/day?)
 Intensity (how hard?)

30. Thumbsucking habit
 Effects of thumb sucking habit:
 Proclinaiton of upper incisors.
 Retroclinaiton of lower incisors.
 Increased overjet.
 Anterior open bite.
 Unilateral posterior crossbite.
 High arch palate and V shaped Arch

31. Thumb sucking habit
Management
 The patient must want to stop the
habit
 There are two approaches:
1. Non dental intervention:
 Discussion followed by reward.
 Reminder therapy: adhesive bandage
with waterproof tape on the finger that
is sucked

32. Thumb sucking habit
Foul odor or bitter taste
 Elastic bandage loosely wrapped around the elbow
prevents the arm from flexing and the fingers from
being sucked. If this is used, wearing it only at night
and 6 to 8 weeks of intervention should be sufficient.
The child should understand that this is not
punishment.
2. Appliance therapy
 If the previous methods have not succeeded in
eliminating the habit, the child who wants to stop can
be fitted with a cemented palatal crib to aid in habit
cessation.
 Its must be left in place for 6-9 month following the
cessation of the habit

33. In conclusion
Whenever in doubt Refer

34. Declaration
 The author wish to declare that; these presentations are his original work, all
materials and pictures collection, typing and slide design has been done by the
author.
 Most of these materials has been done for undergraduate students, although
postgraduate students may find some useful basic and advanced information.
 The universities title at the front page indicate where the lecture was first
presented. The author was working as a lecturer of orthodontics at Ibn Sina
University, Sudan International University, and as a Master student in Orthodontics at
University of Khartoum.
 The author declare that all materials and photos in these presentations has been
collected from different textbooks, papers and online websites. These pictures are
presented here for education and demonstration purposes only. The author are not
attempting to plagiarize or reproduced unauthorized material, and the intellectual
properties of these photos belong to their original authors.

35. Declaration
 As the authors reviews several textbooks, papers and other references during
preparation of these materials, it was impossible to cite every textbook and journal
article, the main textbooks that has been reviewed during preparation of these
presentations were:
Contemporary Orthodontics 5th edition; Proffit, William R, Henry W. Fields, and
David M. Sarver.
Handbook of Orthodontics. 1st edition; Cobourne, Martyn T, and Andrew T. DiBiase.
Clinical cases in orthodontics. Martyn T. Cobourne, Padhraig S. Fleming, Andrew T.
DiBiase, Sofia Ahmad
Essentials of orthodontics: Diagnosis and Treatment; Robert N. Staley, Neil T. Reske
Orthodontics: Current Principles & Techniques 5th edition; Graber, Lee W, Robert L.
Vanarsdall, and Katherine W. L. Vig
Orthodontics: The Art and Science. 3rd Edition. Bhalajhi, S.I.

36. Declaration
 For the purposes of dissemination and sharing of knowledge, these
lectures were given to several colleagues and students. It were also
uploaded to SlideShare website by the author. Colleagues and students
may download, use, and modify these materials as they see fit for non-
profit purposes. The author retain the copyright of the original work.
 The author wish to thank his family, teachers, colleagues and students
for their love and support throughout his career. I also wish to express
my sincere gratitude to all orthodontic pillars for their tremendous
contribution to our specialty.
 Finally, the author welcome any advices and enquires through his
email address: Mohanad-07@hotmail.com

37. Thank You