PAEDODONTIC/ORTHODONTIC

INTERFACE
ABNORMALITIES OF PRIMARY AND MIXED
DENTITIONS

DR FAISAL SAEED
PRIMARY DENTITION
Primaryteeth formation begins after
4-5 months of intrauterine life

Firstprimary teeth erupt 6-7 months

after birth

All primary teeth have usually erupted

21/2 -3 years of age
Normal Primary Dentition have three
features
Straight(Flush terminal plane) or Mesial
Step molar relationship

Incisor Spacing

Anthropoid (primate) Space

Considerable variations occurs in overbite
and overjet of incisors

Attrition of teeth occurs

By the age of 5-6 years incisors may

occlude edge to edge
 ERUPTION OF PERMANENT
FIRST MOLARS

ClassI molar relationship of

permanent first molars can be
achieved by three ways

Primary molars which terminate in marked mesial

step

Spaced primary dentition with straight terminal

planes

Closed primary dentition with no inter dental

spaces
 ERUPTION OF PERMANENT INCISORS
Spaces between primary incisors
Labial proclination of permanent incisors
Eruption of each tooth pair is symmetrical
The Ugly Duckling Stage

ERUPTION OF PREMOLARS AND

CANINES
Leeway Space 1 mm in Maxilla 3 mm in Mandible
 MONITORING THE
DEVELOPING DENTITION
Interceptiveorthodontics
Age 3-6 years
Interdental spacing
Age 6-8 years
Crowding of erupting permanent incisors
Anterior Crossbite
Ectopic eruption of permanent first molars
Open bite and increased overjet
Age 8-10 years
Radiographic examination
Availability of space for unerupted canines and
premolars
Long term prognosis of permanent first molars
Position of maxillary canines
Age 10-12 years
Eruption of premolars and permanent canines
 ABNORMALITIES OF TOOTH
ERUPTION
NATAL AND NEONATAL TEETH
Natal Teeth are erupted at birth
Neonatal Teeth erupt during first month of life
Crown may be normal or shell like, with little or no root
Enamel is often hypo-mineralized and tends to break
away
Mostly are mandibular incisors, usually of normal
primary dentition, not supernumerary teeth
Treatment
Should be retained
Loose teeth should be extracted because it
causes discomfort during feeding or might
become dislodged and be swallowed or
inhaled
TEETHING

Eruption of primary dentition causes local irritation, which

may be severe enough to interfere with childs sleep

Teething problems are more commonly associated with

eruptions of relatively larger molars
Signs of Teething Treatment
Local Local
Redness or swelling of Teething Toys
gingiva Teething Foods
Patches of erythema on Topical Medicaments
cheeks
Systemic Systemic
General irritability and
crying Analgesics
Loss of appetite Hypnotics and
Sedatives: Chloral
Sleeplessness Elixir,
Increase salivation and Dichloralphenazone
drooling
Reduced appetite
Increased thirst
Circumoral rash
ERUPTION CYST
Smooth Bluish swelling of oral mucosa overlying erupting
teeth
Most frequently over primary molars, primary anterior
teeth, and occasionally permanent teeth
Should be differentiated from Dentigerous cyst and
Eruption hematoma

Treatment
Eruption cysts are transient and resolve by rupture
Incision of cyst with scalpel under local anesthesia
INFRAOCCLUSION (SUBMERGENCE)
Tooth that has failed to maintain its position
relative to adjacent teeth in the developing
dentition, and is therefore Submerged below
the occlusal level

Usually associated with primary molars but

permanent molars are occasionally affected

Mandibular primary molars more affected then

maxillary molars

Infraocclusion is most commonly related to

Ankylosis
Treatment
Many affected primary molars exfoliate normally

Treatment necessary if tooth interferes with premolar

eruptions, adjacent teeth tilting over submerged tooth, or
danger of tooth being submerged below gingival margin

Minimal Infraocclusion marginal ridge of

Submerged tooth occlusal to adjacent contact area

Moderate Infraocclusion marginal ridge of

Submerged tooth just cervical to adjacent contact area

Severe Infraocclusion marginal ridge at

Gingival level
 ECTOPIC ERUPTION OF PERMANENT
FIRST MOLARS

Results in impaction against the crown or root of the

primary second molar
Impaction is temporary
Almost always it is maxillary molar
Affected teeth are mesially inclined, whereas in
crowded dentition it is distally inclined
Treatment
Tooth should be disimpacted if possible
If necessary should extract the primary second molar
Disimpact the tooth using soft brass ligature wire 0.5-0.7
mm diameter
Orthodontic appliance
DELAYED ERUPTION OF PERMANENT
TEETH
Local causes
Delayed resorption of primary
Delay for more Dilaceration
then a month or Supernumerary teeth
two of contra Abnormal eruption path
lateral teeth gives Impacted against other teeth
cause for concern Retarded resorption of primary teeth
Infraoccluded primary teeth
Localized eruption
delay is more Systemic conditions
common in Downs Syndrome
permanent then Cliedocranial Dysplasia
Gingival Fibromatosis
primary dentition Mucoplysaccharidosis
Congenital Hypothyroidism
Congenital Hypopituitarism
Maxillary Permanent Canines
Path of eruption of maxillary canine is longer then
of other teeth
Commonly they deviate from normal path
Radiographs at age of 10 years
Treatment
Extract maxillary primary canines
Extract maxillary primary canines and surgically
expose the crown of permanent canine
Retain maxillary primary canines and either leave
or extract permanent canine
Extract maxillary primary canines and transplant
permanent canine
 PREMATURE LOSS OF
PRIMARY TEETH
Extractionof primary incisors has little or no
effect on the development of permanent
dentition.

Extraction of primary canine or molar may

result in mesial or distal drift of adjacent
teeth into the resulting space and
subsequent crowding of permanent teeth.

This
results in central line shift and loss of
space for canines and premolars
FACTORS INFLUENCING MESIAL &
DISTAL DRIFT

Degree of Crowding
Type of Tooth Extracted
Age of Patient
ASSESSMENT OF CROWDING

Observation of Erupting Permanent Incisors

Radiographic Examination

Mixed Dentition Analysis

Mixed Dentition Space
Analysis
The primary reason for dental arch malocclusion is the discrepancy between
tooth size and alveolar arch size.

Mixed dentition analysis is carried out to asses crowding in the permanent

dentition.

In mixed dentition analysis, the amount of space available between distal

surface of lateral incisor and mesial surface of permanent first molar is
compared with the estimated sum of mesio-distal dimensions of unerupted
canine and premolars.

The difference between the estimated combined width of the three unerupted
permanent teeth (canine and premolars) and arch space available (between
distal surface of lateral incisor and mesial surface of permanent first molar) in
the same quadrant is called leeway space.
Methods of Mixed Dentition
Space Analysis
Many methods of mixed dentition space analysis are available.
Common to all of these methods is the attempt to determine the
combined mesio-distal size of the unerupted permanent canine and
first and second premolars. These methods are:

Nance analysis.

Hixon and Oldfather analysis and its modifications.

Tanaka and Johnston analysis.

Moyers mixed dentition analysis.

 SPACE MAINTAINERS
Regarding the placement of space maintainers, patients fall
into four categories:
1. Where the arches have more space or where teeth are congenitally
absent, there is no need to maintain the space because space closure
will be desirable.

2. When there is crowding of the anterior teeth amounting to less

than the breadth of a premolar in each quadrant, there is no need to
maintain the space because extraction of premolars will be part of the
treatment.

3. When there is just enough space to accommodate the permanent

teeth in the jaws in acceptable alignment, space maintenance will be
mandatory and it is a classical indication.

4. Where extraction of a permanent tooth from each quadrant will give

barely enough space to accommodate the other teeth in good alignment,
space maintenance is essential.
 SPACE MAINTAINERS

Removable Space Maintainers

Fixed Space Maintainers

Band & Loop
Crown & Loop
Lingual Arch
Distal Shoe
CROSSBITES
Crossbites in Primary Dentition

Primary Incisor Crossbite may be a reflection of

Class III arch relationship

May be Localized

Primary Molar crossbite may be unilateral or

bilateral
Permanent First Molar Crossbite

Crossbite of permanent first molar should not be

treated in isolation but as part of an overall orthodontic

treatment plan

Treatment usually delayed until the child is 10 or 11

years old
Permanent Incisor Crossbite
Incisor crossbite may be associated with a Skeletal Class III
arch relationship
Caused by local factors also
Treatment
Anterior crossbite caused by local factors may be prevented
by timely removal of the cause
Maxillary permanent incisor if erupts in crossbite, appliance
therapy should be started as soon as a small overbite is
erupted.
Removable appliance
PERMANENT FIRST MOLARS
WITH POOR LONG TERM
PROGNOSIS
Assessment of Long Term Prognosis
Large amalgam restorations already present
Recurrent caries in teeth already restored
Lingual demineralization or caries in mandibular
molars, and buccal demineralization or caries in
maxillary molars
Abnormal Enamel structure, e.g. Hypoplasia
Unfavorable attitudes of child and parent
Poor oral hygiene
Poor patient cooperation
 TREATMENT PLANNING

General Factors
Congenital absence of teeth
Hypoplasia of premolars
Occlusal relationship and degree of crowding
Stage of dental development
Ideal conditions for extraction
Unerupted canines, premolars and second
molars
The occlusal relationship is class I
Mild buccal segment crowding
Patient is between 81/2 and 10 years of age
Balancing and Compensating
Extractions
Two factors must be considered
Occlusal relationship of Teeth
Inadequacy of space in dental arches
Compensation

Balancing
Thank You