Mostrando entradas con la etiqueta Orthodontic. Mostrar todas las entradas
Mostrando entradas con la etiqueta Orthodontic. Mostrar todas las entradas


ORTHODONTIC : Guiding Unerupted Teeth into Occlusion: Case Report


Tooth eruption is considered to be delayed if emergence of a tooth into the oral cavity occurs at a time deviating significantly from norms established for the person’s sex and ethnic background.

Generally, a permanent tooth should erupt no later than 6 months after natural exfoliation of its predecessor, but a delay of up to 12 months may be of little or no importance in an otherwise healthy child.

Therefore, most practitioners consider eruption delayed only if the interval extends to more than 1 year.

Eruption of a tooth is considered to be delayed (i.e., the tooth is impacted) when all of the following conditions exist:

a. The normal time for eruption has been exceeded.
b. The tooth is not present in the dental arch and shows no potential for eruption.
c. The root of the unerupted tooth is completely formed.
d. The homologous tooth has been erupted for at least 6 months.

Read Also: DENTAL TRAUMA : A story of dental injury and orthodontics

Case Report . Diagnosis
A preadolescent girl (9 years, 2 months of age) and her mother presented to a private practice. The patient was “missing a front permanent tooth,” a situation that was esthetically displeasing to both the child and the mother.

A supernumerary tooth had been extracted when the patient was 7 years of age, and she had been advised to await eruption of the permanent successor tooth.

Clinical examination at the time of the current presentation revealed good oral health and mixed dentition.

Seema B. Shah, BDS, MFDS RCS (Eng); Gajanan Kulkarni, BDS, LLB, MSc, D Ped Dent, PhD, FRCD(C)


Early Premolar Extraction: An Uncommon but Very Effective Treatment Option


The terminology “serial extraction” in Orthodontics was first described in the late 1920’s when Kjellgren decided to plan the extraction of certain deciduous and permanent teeth at early stages of the dentition development.

Since the extractions are under taken at the transitional dentition. This type of treatment is defined as “Early Treatment” in Orthodontics.

The main indication for this treatment approach is for patients with severe crowding caused by tooth size arch discrepancies. In other words, when maxillary and/or mandibular arches cannot accommodate teeth, extraction becomes an interesting option.

Although this treatment option has been used for almost a century in the contemporary orthodontics it’s indication is very specific.

Since it’s an irreversible approach (permanent teeth are early extracted) the clinician should carefully diagnosis the case before selecting this option.

Read Also: ORTHODONTICS : Serial extraction of primary teeth

In addition, as time passed by, orthodontics specialty has dramatically evolved and developed several options to gain space instead of extracting teeth.

On the other hand, the idea to early extract permanent teeth continues to be an interesting treatment option in clinical orthodontics mainly in severely crowded patients.

The aim of this paper is to present a case report of a ten-year-old male patient who presented severe crowding and treatment option was to extract four first premolars at early stages of the dentition development.


° Adeniyi M J, A O Soladoye. Plasma Lipid Profile and Uric Acid in High Fat Fed Female Rats Treated with Oral Contraceptive. Biomed J Sci & Tech Res 1(3)-2017. BJSTR. MS.ID.000256. DOI: 10.26717/BJSTR.2017.01.000256


ORTHODONTIC : Tongue thrusting habit: A review


Deleterious oral habits are the common problem of pediatricians, which aff ects the quality of life.

Oral habits are repetitive behavior in the oral cavity that result in loss of tooth structure and they include digit sucking, pacifi er sucking, lip sucking and biting, nailbiting, bruxism, self-injurious habits, mouth breathing and tongue thrusting.

Para functional habits are recognized as a major etiological factor for the development of dental malocclusion. Thumb sucking and tongue thrusting is the common ones.

Abnormal tongue function and posture have been long debated as a cause of malocclusion. Lefoulon, in 1839 quoted “prevention is better than cure.”

Understanding the etiology, eff ects and it management at early stages may be helpful to prevent future severe skeletal malocclusion. This review deals with these aspects of tongue thrusting habit.

Read Also: ORTHODONTIC : Serial Extractions in orthodontic – A Review


Tulley 1969 - states tongue thrust as the forward movement of the tongue tip between the teeth to meet the lower lip during deglutition and in sounds of speech, so that the tongue becomes interdental.

Tongue thrust is an oral habit pattern related to the persistence of an infantile swallow pattern during childhood and adolescence and thereby produces an open bite and protrusion of the anterior tooth segment.


°International Journal of Contemporary Dental and Medical Reviews
°Suchita Madhukar Tarvade, Sheetal Ramkrishna


How early can we intercept a malocclusion in children


Etiology of malocclusion can be the cause of deviation in the skeleton, dental, and soft tissue development in children.

Identifying etiology of malocclusion and dominant orthodontic problems as well as early detection could help in future effective treatment, management, and public health planning.

Malocclusions in children is an increasing problem, which in many cases is misdiagnosed.

A recent study reported that around 90 percent of the children in primary and early mixed dentition present signs of a developing malocclusion.

Read Also: ORAL MEDICINE : Clinical Management of Regional Odontodysplasia. Clinical Case

Youtube / Kidsmalocclusions 1
Image : Decisions in Dentistry

ORTHODONTIC : Diagnosing Early Interceptive Orthodontic Problems – Part 1

Emergency Pediatric Dentistry

It is important to have a clear picture of how a child is changing dentally and skeletally throughout his or her growth period.

In fact the American Association of Orthodontists recommends that every child have an orthodontic examination by the age of seven.

The early treatment examination in the mixed dentition enables the practitioner to identify problems at an early stage, and to determine when to commence treatment and/or refer patients to an orthodontist.

Things to look for during a mixed dentition examination include crowding of permanent teeth, excessive overjet or overbite, missing primary teeth needed for space maintenance, supernumerary teeth, skeletal discrepancies, habits, airway problems, and eruption path problems.

Read Also: ORTHODONTICS : Serial extraction of primary teeth


This continuing dental education article is being written to describe the need for early examination and diagnosis of malocclusions in growing children.


°Diagnosing Early Interceptive Orthodontic Problems – Part 1
°Written by: Michael Florman, DDS / Rob Veis, DDS / Mark M. Alarabi, DDS, CECSMO / Mahtab Partovi, DDS


When do kids need to go to the orthodontist?


Previously orthodontic treatment was carried out on children in their teenage years.

Today, however, many children start orthodontic treatment at a much younger age.

There are also large numbers of adults receiving orthodontic treatment.

At what age do you consider braces?

Traditional “train-track” braces are fitted to a child’s adult teeth and are used to move, realign and/or rotate a tooth or teeth into the correct position.

This is why you'll usually see children 10 years and older wearing these types of braces. However, crowded/crooked/skew adult teeth usually manifest because of a space shortage and/or a problem with jaw growth and/or jaw relationships.

Read Also: PERIODONTICS : Gingivitis in Children and Adolescents

This can usually be identified in young children, even before many of their adult teeth start coming through.

The big shift in orthodontics has been to check children at a much younger age, identify these issues earlier and intervene before the arrival of the adult teeth.

In many cases, early intervention can provide future adult teeth with all the space they need and the child may not have to wear conventional braces at all.

Dr Simon Reeves


ORTHODONTIC : Association between oral habits, mouth breathing and malocclusion


The ratio of bad habits, mouth breathing and malocclusion is an important issue in view of prevention and early treatment of disorders of the craniofacial growth.

While bad habits can interfere with the position of the teeth and normal pattern of skeletal growth, on the other hand obstruction of the upper airway, resulting in mouth breathing, changes the pattern of craniofacial growth causing malocclusion.

Our crosssectional study, carried out on 3017 children using the ROMA index, was developed to verify if there was a significant correlation between bad habits/mouth breathing and malocclusion.

The results showed that an increase in the degree of the index increases the prevalence of bad habits and mouth breathing, meaning that these factors are associated with more severe malocclusions.

Moreover, we found a significant association of bad habits with increased overjet and openbite, while no association was found with crossbite.

Read Also: ORAL MEDICINE : How to treat oral thrush in newborns

Additionally, we found that mouth breathing is closely related to increased overjet, reduced overjet, anterior or posterior crossbite, openbite and displacement of contact points.

Therefore, it is necessary to intervene early on these aetiological factors of malocclusion to prevent its development or worsening and, if already developed, correct it by early orthodontic treatment to promote eugnatic skeletal growth.


C. Grippaudo, G. Antonini, R. Saulle, G. La Torre, and R. Deli


Space regainers in pediatric dentistry


Premature exfoliation or extraction of deciduous tooth or teeth can frequently lead to the development of malocclusion. Early orthodontic interventions are often in the beginning of developing dentition help to promote favorable developmental changes.

The term interceptive orthodontics includes timely management of hostile features of a developing occlusion.

Interceptive orthodontics is defi ned as a phase of science and art of orthodontics employed to recognize and eliminate the potential irregularities and malpositions in the developing dentofacial complex.

Guiding the erupting and developing deciduous and permanent teeth and developing occlusion forms an essential part of the preventive care of pediatric patients.

Such assistance will lead to the development of a permanent dentition in a harmonious, functional and esthetically acceptable occlusion.

Read Also: The Importance of Early Orthodontic Treatment for Your Health

In 1998, Hoff ding and Kisling reported that premature loss of primary teeth caused space loss. As a result of space loss, the permanent tooth may remain impacted, or it may erupt buccally or lingually.

In the case of premature loss of primary second molars, the space closure is much more than premature loss of primary fi rst molar. In such circumstances, where there is space loss, routinely we require space regainer.


° International Dental & Medical Journal of Advanced Research (2015), 1, 1–5
° Pratiksha Chandak, Sudhindra Baliga, Nilima Thosar


ORTHODONTIC : Guideline on Management of the Developing Dentition and Occlusion in Pediatric Dentistry


The American Academy of Pediatric Dentistry (AAPD) recognizes the importance of managing the developing dentition and occlusion and its effect on the well-being of infants, children, and adolescents.

Management includes the recognition, diagnosis, and appropriate treatment of dentofacial abnormalities.

This guideline is intended to set forth objectives for management of the developing dentition and occlusion in pediatric dentistry.

Guidance of eruption and development of the primary, mixed, and permanent dentitions is an integral component of comprehensive oral health care for all pediatric dental patients.

Such guidance should contribute to the development of a permanent dentition that is in a stable, functional, and esthetically acceptable occlusion and normal subsequent dentofacial development.

Read Also: ORTHODONTIC : Early interceptive treatment management

Early diagnosis and successful treatment of developing malocclusions can have both short-term and longterm benefits while achieving the goals of occlusal harmony and function and dentofacial esthetics.

Dentists have the responsibility to recognize, diagnose, and either appropriately manage or refer abnormalities in the developing dentition as dictated by the complexity of the problem and the individual clinician’s training, knowledge, and experience.


American Academy of Pediatric Dentistry

The Importance of Early Orthodontic Treatment for Your Health


Many general dentists have indicated during my orthodontic courses that they received little information on the diagnosis and treatment of patients with orthodontic problems as part of their education in dental school.

Many orthodontic clinicians are reluctant to treat patients prior to the eruption of the permanent teeth.

There are many reasons why early orthodontic treatment is good for a child’s self-esteem and is also important for the child’s overall health.

There are basically two different treatment philosophies within orthodontics: the retractive philosophy and the functional philosophy.

Read Also: ORTHODONTIC : Diagnosing Early Interceptive Orthodontic Problems – Part 1

The more traditional approach favors the retractive philosophy. The current school of thought favors early treatment with the functional philosophy.


° Written by Brock Rondeau


ORTHODONTICS : Childrens Crooked Teeth - Tongue Thrusting

A child's jaws and face naturally grow downwards and forwards.

The jaws are constantly reshaped and influenced by the surrounding muscles of the face.

If these muscles are functioning correctly and the tongue is in the correct position, with the mouth closed most of the time, then the growth will achieve full genetic potential.

Reverse swallowing and mouth breathing can restrict the forward growth of the jaws and face.

This results in insufficient space for the front and back teeth -- including the wisdom teeth.

Correction of these myofunctional habits allow the teeth, jaws and face to reach full genetic potential, and the teeth to move into their correct position naturally.

Read Also: ORTHODONTIC : Malocclusion in Down syndrome - a review

Youtube / Dan Hanson


Developing Class III malocclusions: challenges and solutions


Class III malocclusion represents a growth-related dentofacial deformity with mandibular prognathism in relation to the maxilla and/or cranial base.

Its prevalence varies greatly among and within different races, ethnic groups, and geographic regions studied.

Class III malocclusion has a multifactorial etiology, which is the expression of a moderate distortion of normal development as a result of interaction between innate factors or genetic hereditary with environmental factors.

Various skeletal topographies of underlying Class III malocclusion are due to discrepancy in the maxillary and mandibular growth along with vertical and/or transverse problems apart from sagittal malformations.

Read Also: PERIODONTICS : Guidelines for periodontal screening and management of children

The spectrum of complications for Class III malocclusion ranges in gravity from dentoalveolar problems with functional anterior shift of the mandible to true skeletal problems with serious maxillomandibular discrepancies, which makes its diagnosis highly challenging in growing children.


°Edlira Zere / Prabhat Kumar Chaudhari / Jitendra Sharan / Kunaal Dhingra / Nitesh Tiwari
°Foto: Clinica Dental Herrera

ORTHODONTIC : Diagnosing Early Interceptive Orthodontic Problems — Part 2


Early examination and treatment of the mixed dentition enables the practitioner to identify at an early stage the specific problems discussed in this article, and to determine when to commence treatment and/or refer patients to an orthodontist.

In addition to problems discussed in Part I, orthodontic problems discussed in this article (Part II) include crossbites, open bites, excess spacing, and Class II and Class III malocclusions.

Treatment options using appliances for early interceptive orthodontics are also addressed.


This continuing dental education article is Part II of “Diagnosing Early Interceptive Orthodontic Problems.”

After completing this course, the reader will have a clearer understanding of specific problems associated with children in the mixed dentition stage of development.

Read Also: The Importance of Early Orthodontic Treatment for Your Health

These problems include excess spacing, crowding, crossbites, open bites, and Class II and Class III malocclusions.

Appliances that can be used to treat these various orthodontic problems are also discussed.


°Diagnosing Early Interceptive Orthodontic Problems – Part 2
°Written by: Michael Florman, DDS / Rob Veis, DDS / Mark M. Alarabi, DDS, CECSMO / Mahtab Partovi, DDS


ORTHODONTIC : Space Maintenance


It is essential that children be evaluated for missing primary teeth in order to determine if any space maintenance is necessary.

As a general rule of thumb, it is recommended that all space created by a missing primary tooth should be maintained. When in doubt, maintain space.

If there is an early loss of a primary molar and the first permanent molar has erupted, space maintenance must be employed as soon as possible.

Doing so will prevent the first permanent molar from drifting mesially. If the first molar is allowed to drift mesially, it will not only eat up the Leeway space, but it can potentially interfere with the eruption of the premolars or canines.

Posterior Space Maintenance

Space maintainers are very important to keep this Leeway space intact until eruption of the permanent teeth occurs. There are two basic categories of space maintainers: fixed and removable.

As a rule, fixed appliances are generally used as space maintainers. The two types are unilateral and bilateral.

The unilateral space maintainer can be used in very young children who have lost a single primary posterior tooth but only when you are sure that the successor tooth will not erupt for many years. Otherwise when using a space maintainer consider using a bilateral space maintainer because:

Read Also: ORTHODONTIC : Diagnosing Early Interceptive Orthodontic Problems – Part 1

1. If a permanent tooth is erupting a properly designed bilateral space maintainer will not cause you to have to remove the new appliance you just placed.

2. If there is need for other space maintenance on the other side of the arch, a bilateral appliance would be a better choice.

This is where the mixed dentition analysis and the panoramic radiograph become useful.

Analyses such as the Tanaka and Johnston method measure one half of the mesiodistal width of the four lower incisors. Then by adding 10.5 mm to this number the space needed for the mandibular canine and premolars in one quadrant can be estimated.

Add 11 mm to estimate the space required for the maxillary canine and premolars in a maxillary quadrant. This method has good accuracy for children of European descent.

This method will overestimate the required space for Caucasian females in both arches and underestimate the space required in the lower arch for African-American males.

The lower lingual holding arch (LLHA) in the mixed dentition is readily used to maintain the Leeway space in children with minor to moderate crowding. Note the Leeway space maintained on the lower right segment between the first premolar and the cuspid.

The transpalatal arch appliance is used in the maxillary arch as a bilateral space maintainer.

If maximum anchorage is needed, a Nance button can be added to a maxillary appliance which touches the palate, preventing mesial movement of the maxillary molars.

The following case demonstrates a maxillary arch with no crowding and with a normal eruption pattern. In the mandibular arch, there is minor crowding that will be resolved by using the Leeway space that is maintained by using a fixed lingual holding arch.

When a patient receives a fixed lower lingual holding arch, it maintains the space that the primary cuspids and primary molars are occupying. Once exfoliation occurs, the anterior crowding can be distalized into the Leeway space. From the mixed dentition analysis, the following were labeled:

A. Corrected lateral position, which corrects for excess space or crowding in the anteriors, demonstrating the space the laterals will occupy when uncrowded and properly aligned.

B. True available space, which is measured from the mesial of the first molar to the the corrected later position.

Anterior Space Maintenance

There are three categories of anterior space maintainers: fixed, removable-functional, and removable-static. Anterior space needs to be maintained for esthetics, normal speech and phonetic development, and to allow normal oral maxillofacial development.

The best fixed appliance for anterior space maintenance in arches that do not need arch development is the Groper appliance.

When arch development is needed, removable-functional appliances like the Schwarz can be used, delivering esthetics during arch development.

The next category, removable-static, is represented by Hawley-type appliances that have an artificial tooth placed.

As permanent teeth erupt, adjust the acrylic to accommodate the needed space. Its main use is in trauma cases and cases that have congenitally missing teeth (for example, lateral incisors). A labial bow can be used to add retention if desired.

°Diagnosis Early Interceptive Orthodontic Problems - Part 1
°Michael Florman


Interceptive orthodontics: The need for early diagnosis and treatment of posterior crossbites

Crossbites are the result of a malocclusion on the transverse plane of the maxilla and are defined as alterations of the correct alignment of the palatal cusps of the upper molars and premolars with the pits of the lower molars and premolars.

Transverse alterations are frequently seen in general dental practices and it is necessary to establish a good differential diagnosis in order to adopt the treatment that will achieve the greatest efficiency and the most stable results possible.

Skeletal constriction, dentoalveolar constriction and dental constriction must therefore be differentiated, as each requires different treatment with different orthodontic appliances.

Read Also : ORTHODONTIC : The Mixed Dentition Orthodontic Examination

This article aims to provide a simple guide to the correct diagnosis of transverse anomalies and to choosing the most suitable orthodontic appliance for each case.

Crossbites are defined as the occlusion between the buccal cusps of the upper molars and premolars and the pits of the lower molars and premolars.

The frequency of crossbites seen in dental clinics varies between 1% and 23%, according to different studies.


Med Oral Patol Oral Cir Bucal
Amparo Castañer Peiro


ORTHODONTIC : The Mixed Dentition Orthodontic Examination


When performing a mixed dentition examination, the main goal is to determine whether there is need for interceptive orthodontic measures that will allow for the eruption of all the permanent teeth.

The earlier in the mixed dentition stage a problem is diagnosed and corrected, the better off patients will be as they continue to grow.

When performing an interceptive orthodontic examination, the following records are needed.


1. Study Models

Study models are necessary because they allow you to evaluate the occlusion outside of the patient’s mouth. For example, abnormal wear patterns and crossbites can easily be seen.

Study models also allow the practitioner to perform a mixed dentition analysis. Many mixed dentition analyses exist, such as the Tanaka and Johnston and Moyer’s prediction values. An accurate bite registration must also be taken as part of this record.

2. Radiographs

2.1 Panoramic Radiograph

In the mixed dentition phase, the panoramic radiograph is useful for seeing permanent erupting teeth, crowding of teeth, space or lack of space between teeth, eruption paths, third molars, supernumerary teeth, and root apex formation (which is used to determine the patient’s dental age).

Using a panoramic radiograph is like seeing the world through a wide-angle lens, as compared to looking through a small looking glass, which could be considered analogous to full-mouth series of radiographs.

Read Also: ORTHODONTIC : Early interceptive treatment management

2.2 Lateral Head Film

(Cephalometric Radiograph)

Lateral head films are necessary when evaluating growing children to evaluate dentofacial proportions. As teeth erupt and growth occurs, the teeth relationships (within the jaws and skull) are part of a much bigger picture only visible with a cephalometric film and the appropriate cephalometric tracing.

In the mixed dentition, the following guidelines are designed to help in the decision process on when a cephalometric film is indicated.

Class II Patients:

Patients presenting with Class II dental relationships such as a distal step in primary second molars.
Patients with Class II relationships of permanent molars.
Patients who have a signi cant positive overjet and/or patients with mandibular retrusive profiles.

Class III Patients:

Patients with Class III relationships of permanent molars.
Patients who have a mesial step of primary second molars.
Patients who have a signi cant negative overjet (underbite).
Patients who have a protrusive profile of the mandible or retrusive profile of the maxilla.
Airway problems:

Airway problems diagnosed in children with open mouth breathing tendencies, such as turned up noses, allergic salute (wiping the nose with the hand in an upward swipe), or other medical history findings.

Vertical relationship problems:

Vertical relationship problems such as open bites associated with habits, airway problems, vertical skeletal growth problems, or patients with lip incompetency(lips do not touch or seal at mandibular rest).

Serial Lateral Head Films

Serial lateral head film radiographs are useful when monitoring growth in children with Class II or Class III tendencies, beginning at the first visit you diagnose them. They are also useful in comparing what orthodontically has really occurred after patients have been treated, by comparing pre- and posttreatment films.

3. Photographs

It is recommended that a full series of orthodontic photographs is taken for all patients. There is a proper way to take photographs, along with a way to retract soft tissues to capture vital anatomy, such as molar relationships.

The standard orthodontic photographs consist of eight pictures. Extraoral Photos: profile, frontal facial smiling, frontal facial at rest.

Intraoral Photos (teeth in occlusion): maxillary occlusal, mandibular occlusal, right and left buccal dental, and frontal dental.

There are other useful photos one can take when documenting an examination. For example, a patient with a tooth interference that causes a shift when intercuspation occurs can be documented by photographing the midlines at rest and with the teeth apart. When the patient occludes, the midlines will change, demonstrating the shift.

Close-up shots of individual teeth are also useful when documenting chips or decalcifications that you may be blamed for in the future after orthodontic treatment has been completed.

4. Other Records

Other records may also be needed, depending on the oral examination, such as anterior-posterior films (AP films) (for transverse analysis), conebeam 3-D imaging films (the new frontier in radiology), and/or occlusal films.

°Diagnosis Early Interceptive Orthodontic Problems - Part 1
°Michael Florman