Скачать или смотреть Early orthodontic, non appliance and appliance treatment Ute Schneider Part 1

Join me as I summarise Ute Schneider’s lecture exploring early interceptive treatment. Part 1 explores signs of patients appropriate for interceptive treatment, the treatment options available with a focus on an adaptation of serial extractions which Ute is a proponent of.

Signs of hereditary tooth size jaw discrepancy in the younger patient
• Premature exfoliation of one or more deciduous lateral incisors
• Gingival recession on a prominent lower incisor
• Splaying of the maxillary or mandibular lateral incisors
• Ectopic eruption of U6, with premature exfoliation of E
• Impacted L7s
Treatment strategy for young patients
1. Wait for growth – natural skeletal discrepancy
2. Arch development: expansion , distalisation , proclination
3. Leeway space
4. Serial extractions
1/ Wait for growth
• Arch length and depth decreases with age, especially mandible decrease in arch length from age of 8 Bishara 1998
• Compare arch length 1930 Vs 1990s, smaller arch length and worse crowding in 1990s Bishara
2/ Arch development
• Rapid maxillary expansion
o Questionable stability
 Meta analysis loss of RME 2.4mm Schiffman 2001
• Limited evidence of stability of RME
• Lip bumper, Quadhelix, 2 x 4, removable appliance
o 6 years severe relapse greater than other strategies
o 89% Significant relapse of mandibular anterior crowding Little et al
3/ Leeway space management
o Is crowding is equal or less than the leeway space Nance 1947
o Wide range of the leeway space available 0-8mm
o Lower premolars are larger now that 1930s – Evidence of reduced leeway space in 1930s Vs 1990s Allen 2017. Reduced 0.42mm per quadrant
• Lip bumper
o Impaction of 7s 10-20 x more prevalent than in the general population Sonis 2011

4/ Serial extractions
Advantages
• Immediate spontaneous improvement
• Reduces appliance time
• Reduces cost
• Reduces discomfort
Best candidates
• Severe hereditary tooth size discrepancy
• Orthognathic or bimax cases
• Minimal OJ and OB
• Class 1 malocclusion
Significant relief of crowding spontaneously?
• Extraction of Cs and 4s = Littles index improves from 11.8-2.74 Yoshihara 1999
Profile changes with serial extractions
• No evidence supporting adverse profile changes with serial extractions
• Non-extraction: consider possible negative aspects of non extraction Bowman 2000
Protocol for serial extraction
• Extraction of Cs
• Monitor every 6/12
• When 4s erupt, extract
Conclusions of serial extractions:
• Early non appliance orthodontic treatment
• Eruption guidance
• Limited to select group of patients
• Still has a place in orthodontic clinical practice