True benefits of early orthodontic treatment

1. True benefits of early orthodontic treatment Children’s Dental World Dr. Milos Lekic

2. Why treat early • Malocclusions may be diagnosed early • Up until 10 years ago there hasn’t been evidence to point clinicians towards early or late treatment • Our desire to help patients with concerns and self-esteem considerations • Commercial influence as manufacturing has been ahead of science • ‘Practice Efficiency’

3. Early treatments with proven benefits • Posterior and anterior crossbites • Crossbites associated with mandibular shifts may lead to a true skeletal discrepancy as the mandible develops asymmetrically in the direction in which it is shifting

4. Possible treatments: Removable expansion – slow expansion Fixed expansion – slow/fast expansion (Quad-Helix, W-arch) Fixed expansion – rapid expansion (RPE)

5. Early treatments with proven benefits • Ankylosed teeth • Orthodontic treatment is usually warranted as the contralateral successor tooth is erupting • The successor permanent tooth may need guided eruption • Ankylosed teeth may be used for anchorage purposes • It was shown that prolonged retention of ankylosed teeth may lead to a decreased development of the associated alveolar bone

6. Early treatments with proven benefits • Excessive protrusions and diastemas • These may lead to injury or avulsions • They are often reasons why kids get teased • Thus, they affect the child’s self-esteem • As the condition persists, the mandibular lip may become entrapped behind the maxillary incisors, further perpetuating the problem

8. A 2x4 appliance may be used to correct the protrusion or to close the diastema space Maxillary fixed appliance may be combined with a headgear However, the three randomized randomized control trial studies showed that there may be no true benefit with an early two-phase treatment involving headgears or functional appliances

9. Early treatments with proven benefits • Severe anterior or lateral open bites • These conditions need to be addressed early • If there is a habit associated with the condition, the habit itself must be dealt with • The most common cause is a prolonged thumb sucking habit • If the habit is treated before the permanent anterior dentition erupts, the open bite may resolve spontaneously • If open bites are of true skeletal nature, they will require comprehensive treatment later on

10. Early treatments with proven benefits • Ectopic molars • These are best treated when they are discovered • They are most commonly found as the maxillary first molars erupt • If left untreated, ectopic molar eruption may lead to early primary molar loss as well as arch length loss

12. Early treatments with proven benefits • Severe arch length discrepancies • >10mm space required • Shallow to normal overbite • Fuller lips/profile • Class I malocclusion • Serial extraction, if successful, would still necessitate comprehensive orthodontic treatment

13. Early treatments with proven benefits • Pseudo Class III patients • Class III patients which have a discrepancy between centric relation and maximum intercuspation may have a pseudo Class III • This condition should be treated before it develops into a true Class III malocclusion

14. Early treatments with proven benefits • True Class III malocclusions due to a maxillary retrusion • This condition is best treated early between the ages of 8-10 • This is a time when the maxilla is undergoing active growth which can be modified to the patient’s advantage

16. Early treatments with proven benefits • Space maintenance • There were two major studies performed with the aim of assessing treatment of crowding in the mixed dentition • Both studies evaluated the mandibular dentition as it generally dictates the strategy for future maxillary arch treatment

17. Early treatments with proven benefits • Space maintenance • In the mixed dentition, crowding was expected in 85% of patients • However, when the leeway space was accounted for and preserved with a lower lingual holding arch, 68% of patients exhibited no crowding in the permanent dentition and 87% exhibited crowding of less than 2mm in the permanent dentition

18. Thus, a large proportion of young patients may be well managed simply by preserving the mandibular arch space There is a philosophy of treatment which dictates that early maxillary expansion treatment will remove the constraining influences on the mandibular arch and allow it to develop laterally However, studies have shown that with such treatment, the mandibular intercanine width changes by less than 1mm

19. Early treatments with proven benefits • Space maintenance • Treatment time for lingual arch space maintenance can be in the late mixed dentition • One major exception is the early loss of a primary canine in which case the opposite canine should be removed and a lingual holding arch inserted • The treatment with only a simple lingual holding arch has been found to be stable in 76% of cases 9 years into retention

20. Early treatments with proven benefits • Space regaining • If moderate space regaining is needed in the mandibular arch, up to 1mm, it may be accomplished with a lip bumper • It was shown that if more than 1mm of arch length needs to be gained, the final outcome will be unstable • In addition, lateral expansion as a way of gaining space will be unstable as it was shown that mandibular intercanine width tends to relapse to its pre-treatment values

22. References • White L. Early Orthodontic Intervention. American Journal of Orthodontics and Dentofacial Orthopedics 1998;113(1):24-28. • www.asoorg.au • www.alpersdental.co.nz • www.umnedudent.al • www.azur-orthodontics.com • www.cypressbraces.com • www.kiferdentalspecialist.com • Gianelly AA. Treatment of Crowding in the Mixed Dentition. American Journal of Orthodontics and Dentofacial Orthopedics 2002;121(6):569-571. • Gianelly AA. Crowding, Timing of Treatment. Angle Orthodontist 1994;64:415-8. • Brennan M, Gianelly AA. The use of the Lingual Arch in the Mixed Dentition to Resolve Crowding. American Journal of Orthodontics and Dentofacial Orthopedics 2000;117:81-5.

23. Thank you.