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Early Orthodontic Treatments what are the imperativesJADA vol.131,May 2000

Dr Prathibha Rani S

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 College of Diplomates of American board of Orthodonticsin Quebec city,Canada on July 13, 1997

Various questions asked

What is early treatment? Do you perform early tretment?how often Type of treatment Benefits Treatment time? Quality of treatment?

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 What is preventive orthodontic treatment?

 What is interceptive orthodontic treatment?

 What is comprehensive orthodontic treatment?

 How can a child's growth affect orthodontic treatment?

What is two-phase treatment?

Two-phase treatment - two stages. The first is the interceptive orthodontic phase and the second is the comprehensive orthodontic phase

Phase I-Precedes conventional treatment protocol Primary/Transitional dentition

Two-phase treatment
The goal

Time and complexity of fixed-appliance therapy

Early treatment -beneficial in terms of the long-term care of orthodontic patients is controversial

Does early treatment work better than a later?

greater ability to modify skeletal growth; improved patient self-esteem and parental satisfaction; better and more stable result; less-extensive therapy is required later; reduced potential for iatrogenic tooth damage such as trauma, root resorption and decalcification.

 Orthodontists - phase I less complex malocclusions with a lower treatment priority than subjects in an untreated control group

Early Treatment Of Class II Malocclusion

Evidence -improvement, if not complete correction, of the Class II malocclusion

Early Treatment Of Class II Malocclusion

Is facial growth altered -dentoalveolar changes? If facial growth is altered, permanent effect or simply a short-term response that will be negated by subsequent growth? Is the mechanism of change acting on the maxilla, the mandible or both?

Early Treatment Of Class II Malocclusion

Headgear

Early Treatment Of Class II Malocclusion

Randomized clinical trial is generally considered to be the gold standard for clinical research.

Early Treatment Of Class II Malocclusion

Tulloch and colleaguesextractions-bionator group>headgear or control groups

 Ghafari and colleagues -63 pts with class II 713 yrs Headgear- maxilla FR-II - mandibular position

RCT

As a result of treatment, the sagittal discrepancy was reduced in both groups.

Early Treatment Of Class II Malocclusion

Dentition-Molar and canine - headgear overjet correction - FRII, Treatment timing Class II similar in both phases

Early Treatment Of Class II Malocclusion

Keeling and collegues-Headgear and Bionator-short term skeletal changes.

Enhanced mandibular growth compared to control

Early Treatment Of Class II Malocclusion

Both the single-and two-phase approaches are effective in correcting the Class II malocclusion.

PRE

POST

Early Treatment Of Class II Malocclusion

They do view early Class II treatment as an effective means of reducing the difficulty of and priority for phase 2.

In class II div 1 and Class II div 2 Over jet >9mm and deep overbite with gingival trauma

Early Class III Treatment

Use of protraction headgear

skeletal crossbite

Early Class III Treatment

Protocol in facemask-12 ounces of force on the maxilla for 14 hours a day Orthodontic responses Contraindicatedexcessive vertical

Early Class III Treatment

Facemask therapy primary/ early transitional dentition,

Patency of the circummaxillary sutures

Early Class III Treatment

Ideal time-Early maturational stage1-4

Depends on developing dentition

Early Class III Treatment

Kapust and colleagues determined the effects of facemask therapy -63 pts of 4-13years

Improvement in the soft-tissue profile.

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Pre and post treatment of class III occlusion

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Early treatment of Transverse Discrepancies

Unilateral/bilateral crossbite-dental/skeletal dicrepancies

Spillane and Mc Namara-Expansion in transitional dentition is stable.

 Child with lateral functional shift-Early orthopedic correction

Early treatment of Transverse Discrepancies

Compensagtory/habitual movement

Early treatment of Transverse Discrepancies

Palatal constriction Premature contact occurs

Mandibular shift

Condyles-asymmetrical in their fossae

Transverse discrepancy
Facial asymmetry

Maxillary expansion

Early treament

Early treatment of arch-length discrepancy

Normal arch development

Transitional-mild incisor crowding

Continued growth and development

Early treatment of arch-length discrepancy

Proffit and Fields, 1.Normal growth

2.As the succedaneous incisors replace their primary counterparts they flare forward,gaining 1 to 2 mm of arch length.

Early treatment of arch-length discrepancy

3. Mandibular archprimate space

Early treatment of arch-length discrepancy

Early treatment of arch-length discrepancy

Transitional diastemaconcern for the parents Self correcting

If larger

Early treatment of arch-length discrepancy

Anterior crowdingposterior space

Leeway space

Lingual holding arch/lip bumper-lower arch Trans palatal/head gearupper

Early treatment of arch-length discrepancy

Gianelly- 80% Optimal timing-Late transitional dentition Late transitional is ideal

Early treatment of arch-length discrepancy

Early interventionSevere crowding. Malpositioningunfavorable wear patterns. Serial extraction-Early transitional dentition, aplliance phase-early permanent.

Summary
Early orthodontic treatment-Effective and desirable. ClassII-early/late equally beneficial ClassIII-early orthopedic treatment Palatal expansion-midpalatal suture Timing-specific needs of the pts Arch-length

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