A New Approach to the Analysis and Treatment

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A NEW APPROACHTO THE ANALYSIS

AND TREATMENT INMIXED DENTITION

SILAS J.KLOEHNAJODO MARCH 1953

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INTRODUCTION

The time to start orthodontic treatment is a basicproblem in which there should be considerableharmonious agreement and understanding

But unfortunately there is considerable confusionamong various groups within the profession

Some are of opinion that appliances should be placedas soon as any permanent teeth erupts in an abnormalposition,while some thinks that no treatment until allpermanent teeth have been erupted

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Some think that there is importance of balance of environmentforces to a good stable occlusion

Such people apply principles of growth and development andstarting treatment at various ages whenever a definite plan of treatment can be determined where by best stable results canbe obtained

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The literature of first twenty five years of twentieth centurycontained many advantages of early treatment

The conclusion was made from this work that earlytreatment influenced amount and direction of growth of facial bones particularly the mandible

Dr Brodie carried out study on facial pattern and observedthat

a. orthodontic appliances did not always obtained the resultthat were observed clinically

b. Maxillary teeth did not move distally as was concluded

from clinical observation but rather mandibular teethmoved forward in relation to maxillary teeth as well asbody of mandible

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The findings suggested thatthe treatment did notchange the pattern nor stimulate growth of facial

bone .the changesresulting from treatmentwere confined to alveolar bone

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Due to early treatmentThe teeth placed in normal functioningrelationshipBetter alveolar bone growthBetter balance of environmental forcesMore stable results

Tissue destruction and disturbanceminimal

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Tratment had beenpostponed

Maxillary arch remained locked within mandibular arch

The canines would have been erupted into labialposition and protruded into lip

The environmental forces,tongue,facial musculaturecould not have reached their well developedform,position and tonicity

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Reason for failure of some ofmixed dentition treatment

Definite rules for treatment : the orthodonticprofession has great tedency toward giving rule

for treatmentStandardization of treatment in various types of malocclusion does not seem possible inorthodontics

Principles should be there relating to treatmentand time of treatment which can readily be appliedto each individual case but not rules

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A good stable orthodontic result requiresa balance of forces of occlusion whichmeans good tongue position andfunction, good facial musculature andharmonious functional relationship ofteeth

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Case analysesin analysis of class II malocclusion prior to1930 etiology mainly wasunderdevelopment of mandibleTreatment plan:

a. Place appliances in maxillary andmandibular arch using intermaxillaryelastics,thereby stimulating mandibular growth

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But mandibular growth cannot beincreased beyond regular intendedgrowth rate nor could the pattern bechanged

In such cases mandibular teeth movedmesially en masse placing them inprotrusive position

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In such cases reinforce anchorage ofmandibular teeth by changing axialinclination

But it was seen that mandibular teeth stillmoved mesially

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Reason

growing alveolar bone is in continuousstate of flux and teeth in this type ofbone will not provide much anchorage

Change of axial inclination failed toreinforce anchorage as intended

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Two points to be consideredin use of occipital hedgear:

headcap must be comfortable

the direction of pull on arch isvery importantprinciple: move molarsdistally and pull of transseptal fibres of periodontal membrane willmove buccal deciduous teethin same direction .if molar istipped distally too severly,contact with deciduous molar will be lost and effect of transseptal fibre pull will belost

Hedcap and ill placed arch

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Alveolar process grows rapidly at

timeof eruption of teeth,which isfrom birth till 14 years of age

So responseof bone will begreater during most active growth period

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Considerations duringtreatment in mixed dentitionperiod

What part of face is in best balance toenvironmentl forces of face

Which teeth are in best relationship andposition to supporting facial bones

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objectivesTo guide the malpositioned teeth in correctposition,relationship and balance

Not to disturb teeth that are in goodrelationship and balance

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AdvantagesGood alignment of teeth,good arch form,goodrelationship to supporting bone,good balanceto their environmental forces

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Conclusion the time to start orthodontic treatment is basicproblem in treatment in which profession should

have more uniformity of thought and practiceShould have knowledge of fundamental sciencesDo not blindly follow rules of treatment which haveresults in mechanical concepts withoutconsideration of biological reaction

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Do not neglect treatment in mix dentitionperiodPosition and relationship of teeth can bechanged which can influence growth anddevelopment of facial musculature and

produce better functioningThe philosophy of mix dentition treatmentshould be guiding alveolar bone growth anderuption of teeth thereby producing more

stable results with less destruction and loss of tissue

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Early treatment will require a change inanalysis and treatment plan with specialconsideration of anchorage

As archlength and width cannotbeextendedbeyond their balance toenvironmental forces,if arch length and widthincreased then mandible cannot be use for anchorage

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If treatment was postponed until eruption of the

permanent dentition, there would have been onechance for correction of the problem rather than aPhase I and Phase II (if needed) approach.

the key to successful Phase I treatment is thiscomprehensive approach to early treatment.

The entire malocclusion is addressed at an early agerather than only addressing one or two problems andpostponing the majority of the orthodontic correctionuntil the permanent dentition.

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Occurrence of malocclusion and need oforthodontic treatment in early mixed dentitionKatri Keski-Nisula, Raija Lehto AJODO 2003 VOL6

A prediction of occlusal development can often bemade with a reasonable degree of accuracy, the

question of whether orthodontic treatment is warrantedin the deciduous or the early mixed dentition remains.

The problem is complex and cannot be answered onthe basis of the information presently available. Inaddition to early diagnostics, other factors such asorganizatio nof the orthodontic care, cooperation of thechildren, risks involved if treatment is postponed, risk of relapse,and direct and indirect costs are important andshould be considered along with the timing of treatment

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The rationale of early treatment is based on theassumption that occlusal development can effectively

be corrected by intervention in the early stages.So this assumption should be tested and follow up thechanges in the occlusion and the need of treatment asthe children mature.

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A New Approach to the Analysis and Treatment