Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 48

Presentation Summary

Doctors

Revisiting Developing Malocclusions:
When "Early" Is the Right Time
Dr. Bruce Hawley
PCSO Bulletin Columnist

Dr. Eustáquio Araüjo
Associate Director
for the Center for Advanced
Dental Education (CADE)
and Graduate Orthodontics
Clinic Director,
St. Louis University

Presented by Dr. Eustáquio Araüjo at the PCSO
Annual Session, Oct. 15, 2017
Impactions
Orthodontists are sometimes faced with
impactions in the developing malocclusion.
These include single incisor impactions, dilacerations, ectopically oriented developing teeth, and
canine ankylosis. Trauma-related impactions of
maxillary permanent central incisors in the
mixed dentition may lead to extraction when
considered hopeless. Sometimes it is possible to
move the adjacent permanent lateral incisor into
the position of the missing central incisor, and
eventually place the adjacent permanent canine
in the lateral incisor position, finishing to a Class
II molar on that side of the mouth. Autogenic
tooth transplant in such a situation warrants a
careful surgical technique, including preserving
the periodontal ligament and the Hertwig
epithelial root sheath. The procedure also requires
adequate bone to be present. In relation to
impactions, Dr. Araüjo states: "Teeth talk to you-
listen to the teeth!"
A dilacerated superiorly oriented impacted upper
central incisor can sometimes be rotated orthodontically in a clockwise fashion to bring the
crown of the tooth down, even if the root may
originally be dilacerated or bent. In these cases,
the tooth traction should be done with light
forces, and gently, as moving the tooth too fast
can result in less favorable root formation.
Impacted and displaced mandibular second premolars with crowns oriented distally (below the
primary second molars) can also be favorably
addressed. These teeth at the appropriate time
can be bonded (with surgical assistance) and the
crowns uprighted orthodontically. For impacted
ankylosed maxillary canines that are unresponsive to orthodontic forces with or without dilacerated roots, an apicotomy can be rendered
rather than resorting to extraction. The procedure involves severing the apical 3 to 5 mm of
root end but without removing the root, which

48

is left in place, followed by orthodontic traction.
The younger the patient, the greater the possibility of success.
Orthodontic Management in the Developing
Malocclusion
When is orthodontic treatment indicated, and
should it be rendered in one or two phases? It
has been known for over 100 years that the best
time to treat is during the time of growth. The
objectives of Phase 1 orthodontic treatment
include taking advantage of arch development,
correcting transverse deviations, implementing
evidence-based theories of growth and development, and enhancing the self-confidence of the
young child. Treatment is indicated when it is
possible to produce a beneficial result for the
patient in an efficient and effective manner. A
quantitative study utilizing the American Board
of Orthodontics (ABO) discrepancy index demonstrated that Class III malocclusions benefit the
most from Phase 1 intervention, followed by Class
I, and finally by Class II. The wise utilization of
leeway space provides good opportunities for
successful treatment. The loss of leeway space
decreases arch perimeter, and there is continuous
mesial drifting of teeth throughout life.
Tooth Size Arch Length Discrepancy (TSALD)
For zero to 4 mm of discrepancy, it may be best
to let nature take its course, but utilization of the
leeway space may be necessary. With a -4 to
-9 mm discrepancy, a Schwarz expander or lip
bumper can be considered. There is an average
of 2 mm of gain for the lower incisors for lip
bumpers, and an average of 3 mm of crowding
reduced with a lip bumper. Lip bumpers can
provide excellent results transversely, as well as
in posterior-anterior control. With greater than
10 mm of crowding, serial extraction of four premolars may need to be rendered. This is a treatment choice that needs to be fully discussed with
the patient's family, because it may seem more
aggressive than waiting for future treatment and
then doing the necessary extractions.

PCSO Bulletin  Spring 2018



Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Spring 2018

Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 1
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 2
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 3
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 4
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 5
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 6
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 7
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 8
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 9
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 10
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 11
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 12
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 13
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 14
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 15
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 16
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 17
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 18
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 19
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 20
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 21
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 22
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Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 36
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 37
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Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 40
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 41
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 42
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 43
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 44
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 45
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 46
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 47
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 48
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 49
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 50
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Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 60
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 61
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 62
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