Please enable JavaScript.
Coggle requires JavaScript to display documents.
Management of Common Malocclusions (Spacing (Treatment (Retention…
Management of Common Malocclusions
Midline Diastema
Presence of space in mindline between 2 maxillary central incisors
Etiology
Iatrogenic
RME
Pathological
Trauma from occlusion
Midline pathology
Abnormal pressure habits
Abnormal frenal attachments
Physiological
Genetic and racial predisposition
Arch length/tooth material excess
Generalized spacing
Transient malocclusion
Diagnosis
Medical history
Dental age
Abnormal habits
Clinical examination
Absence of permanent teeth
Evaluation of overjet
Blanch test - thick labial frenum
Radiographic examination
Notching in interdental alveolar bone
Supernumerary tooth
soft tissue/intrabony lesion
Missing permanent lateral incisors
Model analysis - tooth material arch length discrepancies
Treatment
Primary Dentition Stage
NO active treatment
Mixed Dentition Stage
Ugly Duckling Stage - self correcting
Habit breaking appliance - abnormal habits
Permanent Dentition Stage
Etiotropic phase
(removal of etiology)
Elimination of abnormal habits
Eliminate midline pathology conditions
Frenectomy - excise thick fleshy frenum
Corrective phase
Removable appliance (2mm or <)
Clasps, finger springs
Split labial bow
Fixed appliance (>2mm)
Elastics
Modules
Chain
Springs
Closed coil spring
Inverted 'M' shaped spring
Retentive phase
(long-term retention)
Fixed lingual bonded retainers :check:
Banded retainers
Hawley's retainer
Esthetic Restorative Considerations :question:
Cosmetic restoration (composites and laminates)
Prosthesis/crown - anomalies of shape and size
Spacing
Primary Dentition
Localized
primate spaces
Generalized
developmental spaces
Mixed Dentition
Excess space with incisor protrusion
Permanent Dentition
MALOCCLUSION (localized/generalized)
Etiology
Generalized
Tooth material-arch length disproportion
Localized
Abnormal tooth form (peg laterals)
Rotation
Abnormal pressure habits
Macroglossia
Unerupted supernumerary teeth
Pathological conditions
Premature loss of permanent teeth
Diagnosis
Case history
Clinical examination - abnormal muscular habits
Model analysis - arch length-tooth material disproportioiin
Radiographic examination - unerupted teeth, pathological conditions
Treatment
Removal of etiology - discontinued habit
Removable appliances - active removable appliance incorporating labial bows :red_flag: mixed dentition
Fixed appliances - elastic, springs, space-closing loops :red_flag: permanent dentition
Crowns & prosthesis
Retention
Permanent retention - lingual bonded retainer :check:
Crowding
Etiology
Mixed Dentition
Lack of adequate space - erupting tooth deflected
Interference with eruption - teeth drift to improper positions
Permanent Dentition
Tooth size-arch length discrepancy
Decreased arch length
Premature loss of deciduous tooth
Decrease in arch length
Increased tooth material
Supernumerary teeth
Over-retained deciduous teeth
Abnormalities in tooth size and shape
Imbrication = lower incisors crowding
Late teens and early 20s
3 Major Theories
Lack of normal interproximal attrition
Later mandibular growth & rotation of jaw bases
Pressure from 3rd molars
Manifestations
Early loss of primary canines
Midline shift
Ectopic eruption of teeth
buccally blocked out canines
Abnormal labiolingual inclination
Mesiodistal rotation
Diagnosis
Clinical examination
Radiographic examination
Eruption schedule & shedding
Model analysis - amount of tooth material-arch length discrepancy
Treatment
Mixed Dentition Stage (prevention & interception)
Irregular incisors, no space discrepancy
2mm or < - transient crowding - NO treatment
3-4mm - disking interproximal enamel surfaces of primary lateral incisors/canines as permanent anterior teeth erupt
Moderate incisor crowding (4mm or <)
Arch expansion
Primary canines extracted
Lingual arch - prevent lingual tipping of incisors & decrease in arch length
Fixed appliance (TWO by FOUR appliance)
Severe crowding (>10mm)
Serial extraction in mixed dentition stage, followed by corrective fixed appliance
Permanent Dentition Stage
Methods of gaining space
Proximal stripping
Expansion
Molar distalization
Proclination of anteriors
Derotation & uprighting of posteior teeth
Extraction
Mechanotherapy
Removable appliance
Labial bows, canine retraction
Fixed appliance :check:
Retention
Fixed/removable retainers - Essix & Hawley
Rotation
Tooth movements occur around the long axes
Types
Distolingual/mesiobuccal
Mesiolingual/distobuccal
Treatment
Space management
Provision made for gaining the space - age, type of rotation, concurrent malocclusion
Removable appliances
(mild rotation)
Z spring with labial bow
Fixed appliances
(multiple teeth rotation)
Anterior teeth
Elastic rotation wedges
offset multilooped arch wires
Elastic thread
Posterior teeth
Couple force - elastic threads (pair of equal and opposite non-collinear forces)
Transpalatal arch
Autorotation
Retention
(difficult to retain)
Long-term retention
Adjunctive surgical procedures - Circumferential supracrestal fiberotomy (CSF) / pericision / vertical papillary fibrotomy (VPF)
Bimaxillary Dentoalveolar Protrusion
Facial Appearance (Profitt)
Lip incompetence (4mm or <)
Lip strain
Prominence of both upper & lower lips & dentoalveolar area
Etiology
Hereditary & familial
Tongue thrusting
Diagnosis
Case history
Clinical examination
Cephalometric analysis
Features
Extraoral
Convex profile
Decreased nasolabial angle
Incompetent lip
Lip strain
Everted lower lips
Deepened mentolabial sulcus
Hyperactive mentalis
Skeletal
Increased SNA & SNB
Increased ANB angle
mild divergent facial planes, slightly increased FMA angle, vertical growth pattern
Increased Y axis
Dental
Normal overjet & overbite, sometimes edge-to-edge
Decreased interincisal angle
Mild crowding/spacing
Normal class I molar & canine relationship
Treatment
Premolar extraction & retraction
FR-IV (mild cases, mixed dentition stage)
Surgical correction (sub-apical osteotomy) true skeletal proagnathism