Mixed Dentition

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    21-Nov-2014
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Treatment

Definition: Is the treatment provided to a patient during the mixed dentition and occasionally late primary dentition (6-12 years). Preventive and interceptive orthodontics were terms used in the past to describe orthodontic treatment in children.

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Benefits of early treatment:1)Influence jaw growth in positive manner. 2)Harmonize width of dental arches. 3)Improve eruption patterns. 3)Lower risk of trauma. 4)Correct bad oral habits. 5)Improve esthetics. 6)Shorten and simplify treatment. 7)Reduce impaction. 8)Improve speech problems.Page 3

9)Preserve or gain space.

Clinical problems includeDento-alveolar problems(non-skeletal) -Space problems. -Eruption problems. -Occlusal RS. Skeletal problems: -Skeletal (cl.II & III). -Skeletal posterior crossbite. -Skeletal openbite.

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Treatment

Dento-alveolar problems: Space problems treatment include: A) Space maintenance. B) Space loss treatment. C) Spacing treatment.

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A- Space maintenanceSpace maintenance for missing primary teeth with adequate space. - Indicated in: 1- Adequate space. 2- All unerupted teeth present. 3- More than six-month delay before successor erupt.

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Appliances include:1) Band and loop space maintainers

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2) Distal shoe space maintainer:

- Indicated when E is lost before the eruption of 6. - The shoe will guide the eruption of the first molar preventing it from occupying the space of the second molar.

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3) Lingual arch space maintainerIndicated when multiple posterior teeth are missing.

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4) Partial dentureIndicated for bilateral posterior space maintenance with loss of 1ry incisors (esthetics).

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B) Space loss treatmentCrowding could be due to:- Space deficiency. or - Space loss.

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Management of space deficiency

Minimal (3mm:Extraction should be evaluated against space regaining. Consultation with orthodontist is necessary.

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Dental spacing

Localized Generalized No treatment

With protrusion Habit breaking appliancePage 35

Without protrusion No ttt in transitional stage

Antero-post.RS AP. Dentoalveolar crossbite Transverse RSOcclusal RS problems

Posterior Dentoalveolar crossbite Vertical RS Ant open bite Deep bite

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Anterior dentoalveolar crossbiteCaused by: - Over retention of upper 1ry incisor. - Lack of space. - Lingual development of permanent incisor tooth bud. Must be ttt as soon as diagnosed.

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Treatment of cross-bite

Removable appliance with finger spring

If space inadequate; Space regaining then crossbite correction

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Pre-treatment

Post-treatment

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Cross-bite appliance with double palatal spring (arrow)

Transverse RS problemsCauses: - Cheek sucking habit. - Mouth breathing habit. Treatment: - Removable appliance with acrylic plate with screw. - Fixed appliance (W- arch).

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Unilateral posterior cross-bite

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Removable appliance with screw

5 MONTHS

2 TURNS/WEEK

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TRANSVERSE DIMENSION

RIGHT UNILATERAL POST. CROSSBITE FUNCTIONAL SHIFT

INITIAL CONTACT POSITION MAXIMUM INTERCUSPATIONPage 43

DENTAL+?SKELETAL EXPANSION QUADHELIX EXPANDER

FIXED BANDS AND REMOVABLE WIREPage 44

DENTAL+?SKELETAL EXPANSION REMOVABLE EXPANDER

FULL COVERAGE ACRYLIC CLASPS MIDLINE EXPANSION SCREWPage 45

EXPANSION KEY

FIXED ACRYLIC EXPANDER

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Vertical RSAnterior Dentoalveolar Openbite Fixed Habit breaking appliance

Detoalveolar Deepbite Early treatment not indicated

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Anterior openbiteIs the failure of anterior teeth to overlap Caused by finger sucking habit

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Fixed habit breaking appliance

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