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4. SPECIFIC OBJECTIVES:
1. Know how to approach the problem of lingually
erupting lower incisors.
2. Know when to assess a child patient’s tooth sizearch length relationship.
3. Identify when discing of lower cuspids is required.
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5. SPECIFIC OBJECTIVES (cont):
4. Explain leeway space control and the role of the
mandibular lingual arch in assisting lower incisor
alignment.
5. Be able to design an appliance to improve lower
incisor alignment.
_____________________________________
REQUIRED READING:
Preceding material in this Syllabus.
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6. REQUIRED READING:
(In manual)
Article: Early Mixed Dentition Developmental Module
Article:
Management of lower incisor crowding in the
early mixed dentition. T. Foley, G. Wright,
S. Weinberger, Journal of Dentistry for
Children, May-June, 1996, pp 169-174.
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8. Crowding and protrustion of the incisors
must be considered two aspects of the same
thing:
how crowded and irregular the
incisors are reflects both how much room is
available and where the incisors are
positioned relative to the supporting bone.
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9. Identify WHY incisor guidance is needed.
List WHAT is to be considered.
Indicate WHEN incisor guidance is appropriate.
Suggest HOW incisor guidance is performed.
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10. To help prevent orthodontic relapse.
Prevent unnecessary periodontic problems.
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11. Interdental spacing.
Intercanine distance.
Increase of the arch perimeter.
Size ratio between the primary and permanent
teeth.
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21. 1° - 4 YEARS
CROWDING
NO SPACE
0-3 MM SPACE
3-6 MM SPACE
> 6 MM SPACE
PERMANENT
-
10/10
7/10
5/10
2/10
0/10
B. C. LEIGHTON
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40. Most class I cases having more than 10 mm.
crowding should be referred to an
orthodontic
specialist by general dentists and (perhaps
paediatric dentists).
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41. 7 years old
9 years old
14 years old
Changes in the axial inclination due to the eruption of the maxillary anterior
teeth (Broadbent, 1957).
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44. Avoid unnecessary periodontal problems.
Enhance the long term stability of orthodontic
treatments.
Involve more clinicians in guiding the
developing dentition.
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47. GENERAL OBJECTIVE:
To discuss the problem of ectopic eruption
generally.
To discus the problem of ectopic eruption the
canine and first permanent molar and its
management.
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48. SPECIFIC OBJECTIVES:
1. Define ectopic eruption.
2. Know the frequency of ectopically
eruption first permanent molars.
3. Explain the reasons for ectopic eruption
occurring with first permanent molars.
4. Distinguish between a reversible and
non-reversible ectopic eruption.
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49. SPECIFIC OBJECTIVES (continued):
5. Know methods for correcting ectopic
molar eruption.
6. Explain why long term follow-up is needed
for corrected ectopic eruption cases.
REQUIRED READING
Article:
Weinberger, S., Wright, G., “The
Unpredictability of primary molar resorption
following ectopic eruption of permanent
molars”, Journal of Dentistry for Children,
Nov-Dec, 1987.
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50. REQUIRED READING (continued)
Article:
Weinberger, S., “Correction of bilateral
ectopic eruption of first permanent molars
using a fixed appliance”, Pediatric
Dentistry, Nov-Dec, 1992, Vol 14, No. 6
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67. Authors
Year of
study
Country
Number Of
Children With
Ectopic Eruption
CHILDREN
NUMBER
PERCENT
Cheyne & Wessels
1947
USA
500
9
2
Young
1957
USA
1,619
52
2
O'Meara
1962
USA
315
6
2
Pulver
1968
USA
831
26
3.1
Bjerklin & Kurol
1981
Sweden
2,903
126
4.3
Mackerle-Heporauto
1981
Switzerland
543
32
6
Kimmel et al
1982
USA
5,277
250
3.8
Kurol-1986
89. SPECIFIC OBJECTIVES:
1. Explain how space loss occurs in the
posterior region.
2. Describe indications for space regaining
in regards to the magnitude of space loss.
3. Describe the differences between
maxillary and mandibular arch space
regaining.
4. Describe indications for tipping and
bodily tooth movement to regain the
space.
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90. SPECIFIC OBJECTIVES (continued):
5. List the diagnostic aids required prior to
initiating space regaining.
6. Present the maximum amount of space
that can likely be regained with removable
appliances and the time for the treatment.
7. Describe the most commonly used
appliances for space regaining, such as:
(a)
removable applicant with finger
spring
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91. SPECIFIC OBJECTIVES (continued):
7. (b)
removable appliance with jackscrew
(c)
fixed appliance with coil spring
(d)
lip bumper
REFERENCE:
Proffit, Contemporary Orthodontics, 2nd
ed., 1993, Chapter 13, pp. 382-387
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Arch perimeter - Upper jaw about 6mm lower jaw 4mm gained between 2 and 8 (85% of boys finished, 100% of girls by this time)
Most of growth when central incisors erupting, then again when canines erupting
**EXAM QUES: Which spacing is shown here… General spacing
Primary & Freeway spacing? Leeway?
Canine is a little outside and distal… helps create 1-2mm for incisors
Primate(ry) spacing
Canine spacing… if its almost 28mm, can almost guarantee that there’ll be no probs with crowding….<26mm , very questionable about whether there’ll be crowding
Central incisors in nice pos’n
15%... Normal… two row teeth mouth pos’n of teeth - check if mobile… if so, then pretty much normal. If not, extract… two row teeth cannot be tolerated - called ‘guiding eruption’
Primary spacing at 4 years, gives the likelihood of permanent crowding
First arch preserv… is good restorative work
Disc if around 4mm
Extract primary canine if needed… do NOT do serial extractions!!!
Wedge to protect
***EXAM: Where do you use varnish? Discing, often get into dentin, have to use varnish
3. If maxilla distal to cranial base …congenital probs
And couple other reasons
no two row teeth, as soon as diagnosed, extract
Two row teeth, not ectopic eruption
1st perm M not supposed to resorb any tooth
Lateral incisor being resorbed slightly, not ectopic, somewhat normal
70% of ectopically erupting teeth can self correct
Lateral is blocked, not resorbing anything
Canine erupting ectopically commonly in a mesial direction towards lateral and central…(up to 70% will self-correct) 99(?)% of time will erupt normally
94% of extraction of primary canine will help… whenever you see a primary canine, extract… around 10-11
Can also put on a removable appliance to help guide 2&3 is lateral… etc..
Ectopic molar
Normal molar
ectopic
Self correction of previously ectopically erupting molar
Must monitor about 3months to give it a chance, then appliances if not erupting normally
SSC
Ligature wire
Tooth separators
Was only slightly ectopically erupting, but ended up becoming quite extensive by time film C was taken
Child came on time, but you screwed up, so it needs to be extracted
Removable appliances
Kids often play and break them