Preventive

Orthodontics


INDIAN DENTAL ACADEMY

Leader in continuing dental education
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Introduction:
Prevention is not only better than cure but more
stable and cheaper as well.
Preventive orthodontics is that part of orthodontics
which is concerned with
1.Patients & parents education.
2.Supervision of the growth & development
of the dentition & the craniofacial structures.
3.The diagnosis procedures undertaken to predict
the appearance of malocclusion.
4.The treatment procedures instituted to prevent
the onset of malocclusion.
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Preventive measures undertaken:
Parent counselling.

Caries control.

Exfoliation of deciduous teeth.

Abnormal frenal attachment.

Treatment of locked permanent first molars.

Abnormal oral musculature & related habits.

Space maintenance.


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Parent counselling
-prenatal counselling
-postnatal counselling

Caries control-
Especially proximal caries detection.
can be prevented by diet counselling, topical
fluoride application, pit & fissure sealants,
educating the parents about caries detection.

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Exfoliation of deciduous teeth includes
Extraction of over-retained deciduous/root
stumps.
Extraction of supernumerary teeth.

Abnormal frenal attachment
may cause the development of
diastemas/spacing between the teeth,which
in turn may not allow the eruption of
succedaneous teeth.
This should be surgically corrected.


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Treatment of locked permanent first molars.
Slight distal stripping of deciduous second
molars allows the permanent first molar to
erupt in their right place.

Abnormal oral musculature & habits.
-tongue thrusting.
-thumb/digit/lip sucking.
-mouth breathing.
-hypermentalis action.

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Space Maintainers:-
Definition :- Space maintainers are defined as
the appliances that prevent loss of arch length
and which in turn guide the permanent tooth into
a correct position, in the dental arch.
Factors to be considered for space
maintainance:-
1.Time elapsed since loss of tooth:-within 2weeks
to of extraction.
2.Dental age of the patient
3.Amount of bone covering the developing
permanent teeth
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4.Stage of root formation
5.Sequence of teeth eruption
6.Congenital missing teeth
7.Eruption of permanent teeth in opposite arch

Classification of space maintainers:-
According to Hitchcock:-
1.Removable or fixed or semifixed.
2.With bands or without bands.
3.Functional or Nonfunctional.
4.Active or Passive.
5.Certain combinations of the above.
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According to Raymond C.Thurow:-
1.Removable
2.Complete arch
Lingual arch
Extra-oral anchorage
3.Individual tooth
According to Hinrichsen:-
1.Fixed space maintainers
class I a} Non functional types- Bar type
-Loop type
b} Functional types- Pontic type
- Lingual arch type
class II cantilever type (distal shoe, band and loop)
2.Removable space maintainer:- Acrylic partial denture
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Requirements of space maintainers:-
-Maintain mesio-distal width.
-Must restore the Function.
-Simple in construction.
-Strong enough to withstand functional forces.
-Should not exert excessive stress on adjoining
teeth.
-Must permit maintenance of oral hygiene.
-Must not restrict normal growth & development.
-Should not come in way of other functions.



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Advantages of Removable space
maintainers:-
-easy to clean.
-serve important function like mastication,
esthetics & phonetics
-can be worn part time allowing circulation to soft
tissues.
-maintain or restore vertical dimension.
-dental check up can be done for caries
detection.
-stimulate eruption of teeth.
-help in preventing development of tongue thrust
in extraction space.

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Disadvantages of removable space
maintainer
- May be lost or broken by the patient.
- Uncooperative patient may not wear the
appliance.
- Lateral jaw growth may be restricted, if clasps
are incorporated.
- May cause irritation to the underlying soft
tissue.
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Advantages of fixed space maintainer
-Bands & crowns are used which require
minimum or no tooth preparation
-Do not interfere with passive eruption of
abutment teeth
-Jaw growth is not hampered
-The succedaneous permanent teeth are free
to erupt in the oral cavity
-They can be used in unco-operative patients.
-Masticatory function is restored if pontics are
placed.
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Disadvantages of fixed space maintainer
-Elaborate instrumentation with expert skill.
-May result in decalcification of tooth material
under the bands.
-Supra eruption of opposing teeth can take
place if pontics are not used.
-If pontics are used it can interfere with vertical
eruption of abutment of tooth.
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