ORTHODONTICS SEMINAR Fatimah Che Rahimi Laila Azwa Hassan Ahmad Zulkhairi Resali Nurmarzura Abdul Latif Aishah Shahrir Nur Amalina Zulkepre Akmal Khalis Doreyat Masyitah Mustaffa Aimi Amalina Ahmad

Early loss of deciduous teeth It happened as a result of extraction due to caries or trauma The degree of space loss is influence by: Unilateral / bilateral Age of loss --> more effect if the tooth lost at earlier age Crowding/spacing the more inherent the crowding present, the more potential for space Tooth typeposition of the affected tooth in arch influence subsequent space distribution timevery early extraction can delay successional tooth eruption, later extraction have opposite effect Degree of intercuspation-less effect Skeletal factors-less effect

Balancing and compensating extraction Aim: to preserve arch symmetry and occlusal relationship Balance enforced extractions A balancing extraction is a tooth from the opposite side of the same arch, designed to minimise centreline shift. Compensate enforced extractions Compensation means extraction of a tooth from the opposing quadrant to the enforced extraction. It is designed to minimise occlusal interferance by allowing teeth to maintain occlusal relationships as they drift. It is more difficult to justify compensation than balance, especially when it would involve removal of a tooth from an intact arch.

Which deciduous teeth need balancing and compensating extraction? Tooth Influence Need balancing or compensating extraction Deciduous incisor - Deciduous canine Centreline shift Need balancing extraction 1st deciduous molar Lower 1st deciduous molar Need compensating extraction 2nd deciduous molar (if it contribute to significant alteration in molar relationship)

Digit sucking habit

Digit sucking habit Most prevalent of oral habits, 13% - 100% If the habit ceases before the permanent teeth begin to erupt, any effects on the dentition are unlikely to be long-term. If however the habit persists into the mixed and permanent dentition malocclusion Thumb sucking may develop early in life and continue from infancy through the primary dentition and into the mixed and permanent dentition. In many cases, if the thumb habit continues into the mixed dentition a malocclusion may develop (Kaplan 1950; Ruttle et al. 1953; Graber 1959).

Factors that Affecting the Degree of Damage to Teeth and Investing Tissue Frequency of habit The more frequency the more the damage Duration of habit The more duration the more the damage Intensity of habit Active vs passive *Prolonged digit sucking habit may affect occlusion and dentofacial structures.

Factors Not all habits will result in tooth movement. It is related to frequency, duration and intensity. Studies suggest that it only takes very light forces to move teeth, if the force is of long enough duration. The threshold is believed to be 6 hours.

Maxillary changes 1. Proclination of maxillary incisors 2. Increased maxillary arch length 3. Anterior placement of maxillary apical base 4. Increased sella-nasion point A angle 5. Decreased palatal arch width

Mandibular changes 1. Proclination of mandibular incisors 2. Decreased sella-nasion B point angle 3. Increased intermolar distance

Others: -arch assymmetry -increased overjet -anterior openbite -posterior crossbite

How to stop? Gentle discouragement Oral appliances/ habit breaker -palatal crib -acrylic appliance on finger

Approaches to treat chronic thumb sucking These can be split into three distinct categories: Behavioural – rewarding a child for not exercising the habit; Mechanical – preventing or interrupting the process of thumb sucking; Aversive – generating negative sensations when the habit is exercised, such as bad taste, pain or major discomfort

Fig 1: URA with acrylic ridge Fig 2: Blueglass roller Fig 3: The Rake appliance

Space Maintainer

Space Maintainer Definition Objectives: An intraoral appliance used to preserve arch length following premature loss of primary tooth/teeth in order to allow permanent teeth erupt into proper alignment and occlusion Objectives: Prevent drifting/tipping Prevent loss of arch length Prevent midline shift Prevent crowding of permanent teeth Prevent impactions As orthodontic intervention including extraction

Types of Space Maintainer Anterior VS Posterior Fixed Removable Unilateral Bilateral

Types of Space Maintainer Fixed Band and loop Crown and loop Lingual / Palatal arch Distal shoe Removable URA (Hawley retainer) Partial denture

Band and Loop Loss of D (unilateral/bilateral) Indication : Ease of fabrication for clinician Ease of maintenance for patient Advantage : Opposing tooth may be over-erupt Disadvantages :

Crown and Loop Loss of D with significant loss of tooth substance of abutment tooth (unilateral/bilateral) Indication : Ease of fabrication for clinician Ease of maintenance for patient Advantage : More difficult to fabricate than band & loop Disadvantages :

Palatal Arch/Lingual Arch Loss of bilateral E’s Indication : Maintains tooth space & Leeway space Prevents tipping of molars Advantage : Meticulous hygiene required 6 prone to decalcification Disadvantages :

Lower Lingual Arch Palatal Arch

Distal Shoe/Intra-alveolar Loss of E prior to eruption of 6 Indication : Maintain E’s space Advantage : Difficult to fabricate Contraindicated in medically compromised patient (Subacute bacterial endocarditis, chemotherapy, radiotherapy) Disadvantages :

Upper Removable Appliance Multiple teeth are lost and space maintenance and mastication are of concern Indication : Maintain space Aid in mastication Advantage : Susceptible to fracture / loss Disadvantages :

Infraoccluded 55 & Impacted 15 15 erupting rotated

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