Ortho Outline
Ortho Outline
Ortho Outline
Outline Anterior relationship and Angle classification Development of primary dentition Ideal occlusion in primary dentition Deviations from normal Maturation of oral function
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Anterior relationship Overbite: o vertical overlap of the incisors o Max always overlaps in normal occlusion, primary and perm. Overjet: o horizontal overlap of the incisors Anterior crossbite o or reverse overjet o when Man are in front of Max incisors Open bite o No overlap of the anterior teeth Angle classification Normal occlusion Class I molar relationship: o Mesiobuccal cusp of Mx 1st M occludes buccal groove of Mn 1st M Class I malocclusion o Molar relationship is correct, but there is Crowding or Space Crossbite Open bite Class II molar relationship: o Buccal groove of Mn 1st M is distally positioned relative to mesiobuccal cusp of Mx 1st M o Convex profile Class III molar relationship: o Buccal groove of Mn 1st M is Mesially positioned relative to mesiobuccal cusp of Mx 1st M
o Concave profile Development of Primary Dentition Mineralization or calcification of primary teeth occurs in utero Ground section of enamel has lines (similar to circles in wood) o Reflect appositional growth of the enamel layers Striae of Retzius & Neonatal line A line forms if any disturbance or insult occurs. o The darker the line, the more severe the disturbance; like birthing. (neonatal line) More obvious in perm. dentition o b/c the child is more susceptible to things outside the womb Location of neonatal line Neonatal lines are not in the same position o Primary incisors have a line closer to gingival 3rd o Primary 2nd molars are closer to occlusal surface Calcification: All primary teeth start calcification before birth Sequence of calcification (2nd trimester): o centrals (14wks iu), o 1st M, laterals, canines, and 2nd molars (18-19wks iu) o Primary Crowns are complete 1.5-11 mos. Pp (postpartum) o Permanent calcification begins (3-28 mos) ; 4yrs = crown finished on M1 Age Terminology: Perinatal Period There are two ways to determine perinatal age o LMP last menstrual period o Conception / Fertilization This is usually 2 weeks after LMP What orthos use to determine starting points Problems with tooth development 2nd trimester = all primary 3rd trimester = all primary + 1st Molars o Other growth disturbance examples
Just after birth prior to 1 month = All primarys + M1 Disturbance ~ 3yrs No primarys, ALL Permanents
Development of primary dentition Prim. in boys are generally larger than those in girls, gender difference is not as marked as in the perm. o Did you get that, he said Perm have a greater difference male to female than in Primarys Anomalies less frequently in prim. than in perm. Less than 1% have congenitally missing prim. Most frequently missing: o Mx laterals > Mx centrals > 1st prim M. Eruption: The precise time of each tooth eruption is not too important unless it deviates greatly from the average. Boys start earlier than girls on average. Which is opposite of the permanent dentition Teething In infant, tooth eruption may be accompanied by a slight temperature increase, mild irritation of gums, and general malaise. Holy crap, thats putting it mildly. Severe symptoms should not be associated. How about severe crying, staying up all night letting the poor kid chew on a cold washcloth or carrot til they finally fall asleep around 2am? Precocious erupted primary teeth familial tendencies Mn incisors (enamel hypoplasia) Natal: present at birth Neonatal: erupt during 1st Mo o So this could be a problem for nursingum yeah ya think? pre-erupted: 2nd to 3rd Mo KEEP if normal, not supernumeraries REMOVE if loose and aspirate
o Which begs the question: What definition of aspirate do we have here? Think about it, its been used in a lot of classes all meaning different things: swallowing something, pulling back on the syringe etc. Primary tooth resorption Eruption of perm. is not the only factor to cause prim. tooth resorption. o Can resorbed w/out permanent successors Primary tooth resorption can be expedited by inflammation and occlusal trauma, delayed by splinting and absence of a permanent successor Ideal occlusion in primary dentition 20 Primary Teeth Ovoid arch form Midline coincide All Mx teeth overlapping Mn Spacing (spaced anterior teeth & primate space) o Generalized o Primate Space alleviates later crowding Mesial to canine Distal to canine Near vertical relationship of anter. (0-2mm overbite/overjet) Straight/mesial step terminal plane o If the 2nd molar is positioned distally to the = can lead to Class II relationship o Straight plane exists b/c the 2M is larger MD than 2M Deviations from normal Crossbite o Anterior or Posterior Bilateral True (narrow compared to ) True - This means there is no jaw shift when in centric occlusion Unilateral True
True have a straight Frontal View; and a curved Lateral View o Functional Crossbite (Pseudo) Mn shifts laterally and anteriorly Needs early correction, asymmetry of jaw Have a stepped Frontal and Lateral View Ankylosis (of Primary Molars) o Fusion of bone to dentin and /or cementum o Clinically - tooth fails to erupt; bone fails to develop - almost impossible to move orthodontically - usually involve primary (Mn) molars - 20% related to congenitally missing teeth Occurs 2x more often with than o The earlier occurs, the more occlusion is affected Need to consider: 1) loss of arch perimeter or length 2) extrusion of opposing teeth 3) interference with the eruption of perm. 4) inhibition of alveolar bone development Problem with arch perimeter o arch perimeter or arch circumference (A) o arch length/depth (B) o arch width (C/D) distal of 2M across
o caries of primary teeth o loss of individual or multiple primary teeth Exfoliation problem o Exfoliation should be: - bilaterally within 6 mos of contralateral teeth - should occur before the perm. tooth erupts - in same order as eruption of permanent teeth Eruption problem o Asymmetric eruption Number - congenitally missing 0.1-0.4% prim (3.9-6.3% perm. Excluding 3rd M) - supernumeraries 0.5%-prim (1%-perm) Excessive Space o Potential causes - frenum attachment - supernumerary teeth yeah, I diagnosed a kid with a mesioden, this dude had a HUGE friggin gap b/t his incisors.
Maturation of oral function Physiologic functions of the oral cavity: o respiration, o swallowing, o mastication, and o speech Chewing patterns Adult: opens straight down Baby: opens laterally Transition occurs when perm. canine erupts Open bite cases retain infantile chewing pattern and they might still suck their thumbno joke Speech
Gradient from anterior to posterior First sounds are m, p and b t & d later s & z even later with some posterior tongue control r is the last and requires more tongue control o which reminds mecan you trill your rs?
Mixed Dentition
Outline Dev. of mixed dentition Ugly duckling stage o o
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Can have space in the incisors, and crowding in the incisors Deformities may improve or eliminate during eruption of the permanent teeth
Leeway Space o Differences between 1 and 2 molars that can lead to class I relationship in perm dentition.
Transition of molar relationship The eruption pattern is more important than the eruption sequence.
Mixed Dentition Prim. And Perm teeth in the mouth Early eruption of 1st M and/or permanent incisors o o 6-8yr erupt as a group ~ 8 no perm eruption for a couple of years then @ 11 you go to late Late eruption of at least one PM or Can o o ~ 11yr, eruption of PM and can one two phase ortho tx. Perm. teeth eruption Dental age vs. chronological age o o Weak correlation Ex. could reach dental age of 12, but could be chonologically 10F or 14M Eruption sequences more important than time o o Mx - M1, I1, I2, P1, P2, C, M2, M3 (6,1,2,4,5,3) 7,8* Mn - M1, I1, I2, C, P1, P2, M2, M3 (6,1,2,3) 4,5,7,8* One phase starts at late mixed Two Phase starts at early mixed; then monitor growth; then start second phase
Root formation at time of eruption Root completion 2-4yrs after eruption o How long do they take? ~ Inc & PM 3yr; C 2yr; M 4yr
At the time of eruption Inc & PM about formed C about 2/3 formed
Variation of eruption If Eruption of M2 before C or PM o o Decrease of available space Normal if < 6mos. Asymmetrical eruption
Ideal occlusion in primary dentition Midline conincide All teeth overlapping teeth Near vertical relationship of anteriors Spacing b/t teeth Straight/ mesial step terminal plane Ovoid arch form 20 primary teeth
Ugly duckling stage Mx incisors flare laterally o Normally a mesial inclination Diastema o o o Tend to close with eruption of laterals or canines 2 mm or less may close spontaneously Permanent Inc are much bigger Due to lateral Inc influence
Incisor Liability discrepancy in size b/t the primary and permanent incisor teeth May be overcome by: o o 1) Interdental spacing 2) Incisors & canines erupt labially, esp. Mx
Decrease of Arch length & perimeter Both Arches show perimeter & length decrease during the transition stage o o o o Especially Mandibular Decrease of 2-3 mm Maxillary, length remains close to same, Due to perm inc and canines increase of 5mm And about 2-3 mm
Changes in Arch Dimensions The dental arch perimeter are used to Leeway Space o o Difference b/t prim molars and perm premolars (mesial-distally) After loss of prim. 2nd molars there is a late mesial shift of perm 1st molars (larger in ) As the larger incisors erupt, they find space by increasing the arch width by pushing the primary canines distal o However length of arch does not change This is possible in the mandible because the space is distal of the primary canines (space meaning, primate space) In the maxilla, the primate spaces are mesial of the primary canines Align the permanent incisors which typically are crowded upon eruption
Space for cuspids and premolars Adjustment of the molar occlusion Transition of molar relationship o o Straight / mesial step / distal step = terminal plane Steps b/c the lower primary 2nd molar is larger than the upper
Shift of teeth b/c of leeway space helps to achieve Class I Growth of Mandible o Growth graph Growth spurts : height > mandible > maxilla @ age 14
Minimal Growth > Differential Growth Distal Step Class II > End to End relationship End to End > Class I Class I > Class II >Class III Flush Mesial Step
Body Changes
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Late Mixed / Early Permanent Dentition Occlusal development o Primary canines and molars are exfoliating o Perm canines and molars are erupting Secondary sexual chracteristics appear & adolescent growth spurt takes place o Accelertion in overall facial growth differential growth of jaws Growth Prediction Need to know when the growth spurt is taking place to maximize effect of ortho tx on skeletal malocclusion o Prognathic Cl III skeletal o Retrognathic Cl II skeletal Ortho Tx. Late Mixed Dentition Effect of puberty on ortho tx. o Prepubertal growth spurt physical changes affect the face and dentition Make retrognath pt easier to work on Make prognath pt harder to work on 64% chance of predicting developmental age from real age 50% chance of predicting dental development from real age Developmental Parameters Correlation b/t real age and developmental age Physical growth status correlates well w/ skeletal age o Varies from real age Dental age is a poor correlation w/ other dev. indicators & real age Must assess o Skeletal, behavioral, and other dev. ages in planning dental tx. Methods of Determining maturity
1. Secondary Sex charcteristics Adolescent Hormonal Changes Hypothalamus Releasing Factor to Ant Pituitary Gonadotropins to adrenal glands & sex organs Sex hormones (estrogen and testosterone) produced in varying quantities depending on gender Sex hormones stimulate 2nd sex characteristics o Acceleration of body growth Genital growth, Jaw growth Shrinkage of lymphoid tissue o Neural growth essentially done at age 6, not effected by growth hormones BoardPearls Growth of jaw is intermediate b/t neural and general body curves follows the general body curve more closely than acceleration in general body curve parallels an increase in sexual organ and involution of lymphoid tissue
Adolescence Velocity Curves Boys are two years later than girls Timing of Puberty o Puberty longer for boys than girls o 2nd sex charac provide physiologic calendar of adolescence that correlates w/ individuals growth status not all characteristics are readily visible, but most can be evaluated in a normal, fully clothed exam Secondary Sex Characteristics Females pubertal growth 3.5 years o Stage 1 start to year 1 breast buds and pubic hair Peak velocity of physical growth occurs about 1 year after stage 1 around beginning of stage 2 o Stage 2 year 1-2.5
Bigger boobs, darker hair down there, armpit hair growth Purchase of a personal razor o Stage 3 year 2.5-3.5 Onset of menstruation growth spurt almost done Broadening of hips, adult fat distribution, boobs done growing Male pubertal growth 5 years o Stage 1 start to 1st yr Fat spurt o Stage 2 year 1-2 Fat , pubic hair, growth of penis, growth spurt begins o Stage 3 year 2,3 year 4 Aux. hair, facial hair on upper lip, muscle growth, less fat, harder body form, peak velocity in height o Stage 4 years 3,4 year 5 Height growth ends, hair on chin, darker hair down there, and more muscle strength Impact of Puberty Growth in height endochondral bone growth at epiphyseal plates Sex hormones o Stimulate cartilage to grow faster o Increase rate of skeletal maturation Earlier sexual maturation relates to early cessation of growth Ortho needs to be earlier in girls to take advantage of the growth palate Growth in jaw usually correlates w/ growth in height o Cephalocaudal gradent of growth evident at puberty Differential jaw growth More growth in lower jaw than in upper o Height chart Growth in jaw similar ~ easier to track in office
2. Hand Wrist Films bones o ossification of bones ~ standard for skeletal development o 30 small bones w/ a predictable sequence of ossification yeah, so theyre all numbered, but I cant figure out a pattern to it, so I am not going to remember which is which. Information gathered from films o Maturity progress o Repeated films can graph development o Final stage = epiphyseal diaphysial fusion of the last bone in which it occurs o Distinguish nutritional status o Reveals imbalances in skeletal development o Discloses scars of interrupted growth record of past illness Correlations o Maturational stages and statural height o Facial growth and general skeletal growth Esp. mandibular growth Max rate of circumpubertal facial growth occurs slightly later than peak growth in statural heightwtf SMA Skeletal Maturation Assessment 1982 o Correlated skeletal growth of hand and wrist to facial, maxillary and mandibular growth peak velocities o 4 stages of bone maturation 6 anatomical sites thumb, third & fifth fingers and radius 11 discrete adolescent SMIs covering the entire period of adolescent development are found on these 6 sites o 4 Stages of SMA Width of Epiphysis Ossification Capping of Epiphysis Fusion o 6 anatomical sites
Width of epiphysis as wide as diaphysis Third finger Proximal phalanx Middle phalanx Fifth finger Middle phalanx Ossification Adductor of sesamoid of thumb Capping of epiphysis Third finger distal phalanx middle phalanx Fifth finger
Middle phalanx Fusion of Epiphysis and Diaphysis Third finger Distal phalanx Proximal phalanx Middle phalanx Radius Hand Wrist Observation Scheme o Ossification Y Fusion Y Fusion N Capping N Width Results o Maxilla and mandible growth tend to lag behind skeletal growth o Acceleration of growth velocity Mx and Mn Males b/t SMI levels 6 & 7 Females b/t SMI levels 5 & 6 o Maximum growth rate Males level 7 Females level 6 Current Literature o Flores 2004 says yep hand wrist does correlate o Verma 2008 says no it doesnt o Basically, why do you need to do hand wrist exams when the CVM measures it close enough
3. Cervical Maturation Measuring Maturity Skeletal Age based on cervical vertebrae Advantage o Separate radiograph not needed less radiation o As accurate as hand wrist films Cervical Vertebrae o Change from birth full maturity
o Vertebral growth Cartilaginous layer on the superior and inferior surfaces of each vertebrae 1928 Study on cervical vertebrae growth 1972 Skeletal age assessment utilizing cervical vertebrae o mapped maturation stages of cervical vertebrae 1995 skeletal maturation evaluation o developed index o Six stages of maturation Initiation, Acceleration, Transition, Deceleration, Maturation, Completion 2002 Baccetti improved version of CMV for Assessment of Mandibular growth o based on C-2,3,4 o analyzed at the six intervals T1-T6 (combined first stage) o Peak occurs b/t stage II and III
Growth Timing in Ortho Future o Molecular kits personalized medicine Dx. growth problems Personalized developmental status & growth factors and signaling molecules o Specific growth discrepancies presicesly targeted Orthopedic approaches alone Combination systemic and local interventions
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Growth Pattern in the dentofacial complex Nasomaxillary Complex o Passive displacement Primary dentition years Sutural growth b/t Cranial base and NMC pushes the NMC Forward Slows w/ completion of neural growth ~ age 7 o Active growth of maxillary structures and nose Surface remodeling resorption and apposition Grows downward and forward Bone added in posterior and superior Nasal Growth o Passive displacement Nose grows more rapidly than the rest of the face in size of nasal cartilaginous septum Proliferation of lateral cartilages alters the shape of the nose and adds to the overall increase in size o Nasal dimensions increase at a rate about 25% greater than growth of the maxilla Mandibular Growth o Relatively steady rate before puberty Ramus 1-2 mm/yr Body length increases 2-3 mm/yr o Juvenile and pubertal growth spurts demonstrate growth acceleration o Prominence of chin due to forward translation of mandible and resorption above the chin Timing of Growth o Sequence - growth is completed in maxilla and mandible Width before adolescent growth spurt Length during / after puberty Height during / after puberty Boys 20; girls 16
Dental Changes During Facial Develoment Path of eruption of maxillary teeth o Downward and forward Translocation o Teeth moving with jaw o of total maxillary growth during adolescent growth spurt Path of eruption of mandibular teeth o Upward and forward o Both jaws rotate upward in front Mandible > maxilla Mandible decreases in arch length more than maxilla Short face individuals - DEEP bite o Due to excessive (forward,upward) rotation of the mandible o Low mandibular plane angle Long Face individuals open bite o Mn backward rotation Perm pulp chamber size; eruption > older age Gingival attachment is above CEJ at eruption Downward migration of gingival attachment results from vertical growth of the jaws and eruption of the teeth as opposed to downward migration of the gingival attachment from perio dz.
Active vs Passive Eruption Passive Eruption old theory o Gingival migration of the attachment w/o any eruption of the tooth o As long as gingival is healthy, this does not occur Active eruption current theory o Eruption of the dentition that is compensating for the simultaneous vertical jaw growth
Facial types: Class I, II, III Growth Patterns Classifying Facial Types o Common Systems Headform Type Facial Profile o Dolicephalics Long narrow facial pattern Nasomaxillary complex (NC) is in a more protrusive position relative to mandible NC is lowered relative to mandibular condyle which causes downward and backward rotation of mandible high angle Occlusal plane rotated in a downward-inclined alignment Tendency towards mandibular retrusion and a Class II molar o Brachycephalics Relative posterior position of maxilla Horizontal length of NC is relatively short Overall, tendency toward a prognathic (concave) profile and a CL III molar
5% of the population have a malocclusion of known cause Disharmon facial skel probs Environmental factors
Causes
Specific causes
Disturbances in embryonic development Skeletal growth disturbances Muscle dysfunction Any force on the teeth and bone will cause movement
Acromegaly & Hemimandibular Hypertrophy (Endocrine Problems) Disturbances of Dental Deveelopment Genetic Influences Teratogens Environmental Influences
Cleft lip and palate maternal use of Aspirin Cigarette smoke (hypoxia) Dilantin Valium
Central midface deficiency Fetal alcohol syndrome Disturbances of Dental Development Congenitally missing teeth Ethyl alcohol
Sometimes runs in families but there is no known gene that is the cause of this
Genetic Influences
Class III 1/3 of children with Class III had parent with same problem **Malocclusions
Familial tendencies
There are genetic links but not specific genes that can be associated with it.
There hasnt been a genetic link but you usually see it in more than one member of a family.
Relative discrepancy between size of teeth and size of jaws Disharmonous facial skeletal problems = maxilla and mandible dont grow at the same rate Tongue thrust results in an open bite Disproportion between teeth and jaws Biggest most common = discrepancy Results in crowding or spacing
Figure 1-4
Classified by the MB cusp of the maxillary first molar Class I MB cusp is in the B groove of the mandibular first molar, if this doesnt happen the other teeth wont fit together usually Class I Malocclusion molar Class I but other problems in the anterior Class II Malocclusion maxillary molar mesial to the mandibular molar, increase in overjet Class III Malocclusion maxillary molar distal to the mandibular molar
The cranium and cranial base is considered a stable point after the age of 7, it runs from sella in sella turcica to the junction of the nasal and frontal bone. Grows until age 6.
Where the maxilla grows the teeth go with it, so if the maxilla grows forward the maxillary teeth will be forward occlusion. No teeth = no alveolar process (alveolar process and the teeth go hand in hand) All of these parts must fit together to have a good facial profile and for the teeth to be in the right Disharmonious Skeletal Relationships Class I Bimaxillary protrusion = both jaws are forward, molars in Class I relationship but everything else if forward o o o o Class II disharmony between the maxilla and the mandible Maxillary excess, normal mandible Normal maxilla, retruded mandible Combo (maxillary excess with retruded mandible) Normal maxilla, prognathic mandible Combo Retruded maxilla, normal mandible
Class III o o
Looking in the transverse direction: look at the maxilla ( you can change it, you cant change the Constricted = maxilla too narrow compared to the mandible Deep bite/Open bite
Class I
Bimaxillary Protrusion
Class I molar relationship but everything else forward resulting in convex facial profile relationship Both jaws too far forward
Whole anterior complex forward even though Class I molar relationship and Class I skeletal
Class I Crowding
Skeletal harmony but disharmony between size of the teeth and the size of the arch (tooth to jaw relationship) Tx: Ext of 4 PMs
Class II Division 1 Skeletal Problems maxilla and mandible not in harmony (maxillary excess or mandibular retrusion) o Division 1 = protruding incisiors and large overjet Class 1 Class 2 increase overjet Overjet = horizontal overlap of the teeth
Class II Division 2
Tx: corrected to Class I molar relationship and has better facial profile Disharmony between maxilla and mandible in the A-P direction o Difference between Division 1 and 2: Incisor position Division 1: teeth protruded, large overjet
Maxillary incisors define it as this the teeth are retruded (tucked in) Division 2: teeth retruded, associated with deep bite
Class III
Ortho alone cannot fix a retruded mandible, you would need surgery
Not just the teeth but everything changes usually have a long face with a cross-bite or edge-to-edge occlusion Will have a protruded chin Anterior crossbite = maxillary incisors behind the mandibular incisors cant change the bone, but you can correct the relationship of the teeth Jaw too big, there isnt enough tooth mass to fill the whole space too small to fill the jaws
Even when corrected these people have somewhat of the same appearance because you
Two problems: skeletal disharmony between the maxilla and mandible, and the teeth are cant increase tooth mass or make the jaws smaller
Esthetically close the space in the anterior but leave the space in the posterior because we
Esthetics with a class III in women is a big problem that is why some choose surgery
Posterior Crossbite and Anterior Openbite Upper arch inside the mandible in the posterior and no vertical overlap in the anterior Anterior openbite is usually associated with tongue thrust o o perpetuates the problem away They cant swallow properly so they put it between the teeth to create a seal, this You also have to do some tongue retraining to make sure the tongue thrust goes Overbite, 100% = dont see lower teeth at all; related to Cephalometrics
Deep Bite o
Cleft Lip Cleft lip failure of fusion of median and lateral nasal processes and maxillary prominence 6th week of development o
Usually notch in alveolar process of central and lateral Affects anterior development premaxilla
Cleft Palate
Once corrected scar tissue (not as bouncy) restricts the development of the
Closure of the secondary palate elevation of the palatal shelves Most minor = cleft uvula fusion
Palate closes from the anterior to the posterior so you can have various levels of failure of
Cleft Palate
Cleft Lip
Scar tissue resilience will affect the anterior tooth development Have all teeth because no cleft palate Cleft Lip and Palate See larger problems
The whole maxilla tends to be constricted which leads to anterior cross bite or rotation in the area between the central and lateral through The cleft affects the eruption of the canine because there is no bone there for it to come
Bilateral Cleft Lip and Palate The premaxilla is quite small but the mandible is fine There is an affect on the eruption of the teeth and the width of the maxilla Unrepaired cleft palate
He has a fairly good A-P relationship between the maxilla and the mandible There is a cross bite in the area of the cleft
They never treated the cleft palate so he will have eruption problems on that side Tx: tried to develop the arch form and move the teeth so that he could later have the cleft closed
The appliance has a screw in the middle that is turned to push the two sides apart maxilla you can widen it with an appliance as wide as you need until that age Skeletal A-P relationship is good
The midpalatal suture doesnt fuse until about age 15 or 16 so with a patient with a constricted
The lower teeth werent terribly out of alignment but there was some expansion due to a crossbite
Disturbance of Dental Development Congenitally missing teeth o Malformed teeth o o o o Anodontia (none), oligodontia (missing more than 6), hypodontia (less than 6) Rotated 180 degrees affects occlusion because wrong cusp is occluding
3rd molars, maxillary laterals incisors (peg lateral or malformed), 2nd premolars
Ankylosis bone is no longer growing because the bone grew to the tooth Ankylosed teeth appear to submerge, why? Because as the child grows the ramus increases in height and the teeth and the alveolar bone grow with it (it grows 10.25 cm between bone adjacent to this area continue to grow and make it appear that the tooth has occlusion. the bone and everything stops. The bone can no longer grow in that area. The teeth and
eruption and age 18). When you have a tooth that is ankylosed the cementum is attached to submerged. It will be below the margin of the occlusal plane. The problem with this is that when there is not interproximal contact the tooth behind it tips over and screws with the Supernumerary Teeth There is a color difference between the permanent and primary teeth the primary teeth are whiter (milk teeth)
Ectopic Eruption tooth is not coming in the right place Malposition of a permanent tooth bud Can lead to eruption in the wrong position Can also be caused by retained primary tooth, crowding
Could also mean resorption of a tooth other than the primary that is supposed to be resorped o most) o Most common Maxillary first molar
Example: permanent lateral is causing the resorption of both the primary lateral and canine Other common tooth that erupts ectopically and/or impacts Maxillary canine (second If it doesnt have the right vertical area and crosses over the lateral it causes a problem, it wont come into the right path erupt a little bit Causes resorption of the primary second molar and it doesnt come into the mouth
The canine can move palatally where it will stay impacted or buccally where it may
The second primary molar is larger than the premolar that replaces it. If the premolar isnt lined up exactly under the primary molar it will fail to resorb the mesial root of the primary tooth and the deciduous tooth will not exfoliate on its own and will need to be extracted. Depending on the amount of root formation the tooth may have to be Ectopic eruption can result in an impacted second molar. Environmental Factors Loss of arch perimeter o o Caries brought in orthodontically.
Early Loss of Primary Teeth Maintain symmetry o Mesial drift of molars, distal of incisors and canines Avoid loss of arch perimeter lower ligual arch
Loss of primary teeth without space maintenance creates a huge problem orthodontically Ankylosis Loss of perimeter as anterior teeth tip in
The opposing teeth can supererupt and the adjacent teeth can drift into the space. It can prevent the eruption of the permanent tooth. Thumbsucking
Causes anterior open bite and constricted maxilla Retroclining of mandibular teeth Tx o Tongue cribs - reminders
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Eriksons - Emotional Development Stage Development of Trust Age Range Birth to 19 months Common Characteristics Basic trust develops Depends on caring mother/mother substitute Physical growth can be retarded if emotional needs are not met Development of Autonomy 18 months to 3 years Strong bond creates separation anxiety Uncooperative behavior Child developing autonomy Child struggling to exercise free choice Still dependent on patents in times of insecurity Development of Initiative 3-6 years Continued development of autonomy Physical activity and motion Extreme curiosity and questioning Aggressive talking Have child think whatever dentist wants is his/her choice Offer simple choices color of bib Allow parent to be present Complex dental treatment Sedation or General anesthesia Usually first visit Exploratory visit with mom present and little treatment After initial visit will tolerate separation from mother and usually behave better Mastery of Skills 7-11 years Acquiring academic, social skills Learning rules Competitionwithin a reward system Decrease parents Increase peer groups Reinforce independence over dependence Often orthodontic treatment is started, phase I or functional appliances Set attainable goals Positievely reinforce success Likely to faithfully wear headgear and/or removable appliances Development of Personality 12-17 years Intense physical development Psychological development Can exist outside family Belonging to a larger group Complex stage Time of stress and rewards Establishment of ones own identity Instructions explicit and concrete Most orthodontics is done at this time Behavior management a challenge Motivation is key External Internal Dental Considerations If dental work is necessary Parent present Parent holds child Children who havent developed basic trust will need special effort by dentist and staff
Development of Intimacy
Young adult
Development of relationships Factors of acceptance and success Appearance Personality Emotional qualities Intellect Others Successful parenting Supporting services for the next generation Opposite characteristics Stagnation Self-indulgence Self centered behavior Individual has adapted to the combination of gratification and disappointment that every adult experiences
Adult
Attainment of Integrity
Late Adult
Cognitive Assimilation
Accommodation
Birth to 2 years
Preoperational 2 to 7 years Period of concrete operations 7-11 years Period of formal ~11 years to
Concept of objects Communication limited Little ability to interpret sensory data Literal nature of language Understand the world through senses Abstract ideas hard to grasp Egocentrism Animism Improved ability to reason Ability to see another point of view Animism declines Instructions must be very clear and concrete Abstract concepts and reasoning
operations
adulthood