jules e. lemay iii d .d.s., cert. ortho., f.r.c.d. (c)
DESCRIPTION
ETIOLOGY of MALOCCLUSIONS PREVENTIVE and INTERCEPTIVE ORTHODONTICS Nov. 2007. Jules E. Lemay III d .d.s., cert. ortho., F.R.C.D. (C) Diplomate, American Board of Orthodontics. EPIDEMIOLOGY OF MALOCCLUSIONS. USA (various studies): 35 - 95% USPHS (1960’s): - PowerPoint PPT PresentationTRANSCRIPT
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Jules E. Lemay IIId.d.s., cert. ortho., F.R.C.D. (C)
Diplomate, American Board of Orthodontics
ETIOLOGY of MALOCCLUSIONS
PREVENTIVE and INTERCEPTIVE
ORTHODONTICSNov. 2007
ETIOLOGY of MALOCCLUSIONS
PREVENTIVE and INTERCEPTIVE
ORTHODONTICSNov. 2007
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USA (various studies):USA (various studies): 35 - 95%35 - 95%
USPHS (1960’s):USPHS (1960’s): most thorough epid. study ever donemost thorough epid. study ever done statistically representing 26M (6-statistically representing 26M (6-17y)17y)
Grainger’s TPI (severity)Grainger’s TPI (severity)
75%75% Occlusal DisharmonyOcclusal Disharmony
25%25% Near-ideal OcclusionNear-ideal Occlusion
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EPIDEMIOLOGY OF MALOCCLUSIONS
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NORMALNORMAL 25%25% CL-ICL-I 50-55%50-55% CL-IICL-II 15-20%15-20% CL-IIICL-III 1%1%
USPHS 1960’s, age 6-17USPHS 1960’s, age 6-17 3
ANGLE CALSSIFICATION(Molar Relationship)
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6’s erupted = Post. Occl. established6’s erupted = Post. Occl. established
Detection of:Detection of: Fct. habits, crowding, deep/open bitesFct. habits, crowding, deep/open bites AP & transverse discrepancies AP & transverse discrepancies
Benefits:Benefits: ««influence» influence» jaw growthjaw growth, harmonize width of arches, harmonize width of arches improve improve eruptioneruption patterns, patterns, lower risk of lower risk of traumatrauma to protruding U inc. to protruding U inc. correct harmful correct harmful O. habitsO. habits improve improve estheticsesthetics & self-esteem & self-esteem simplify / shorten simplify / shorten Tx timeTx time for later corrective for later corrective
phasephase reduce likelyhood of reduce likelyhood of impactionsimpactions improve some improve some speechspeech problems problems preserve / gain preserve / gain spacespace for erupting perm. teeth for erupting perm. teeth
Why early orthodontic screening?
Why early orthodontic screening?
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AAO AAO RecommendationsRecommendations
19981998
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INCIDENCE OF PROBLEMSINCIDENCE OF PROBLEMS
CROWDINGCROWDING 40% (age 6-11)40% (age 6-11)85%85% (age 12-17) (age 12-17)
OVERJET OVERJET (> 6mm)(> 6mm) 16% 16% (CL-II & (CL-II & skeletal)skeletal)
CL-III MOLARSCL-III MOLARS 1%1% ANT. OPB ANT. OPB (> 2mm)(> 2mm) 1% whites1% whites 10% blacks10% blacks DEEP BITEDEEP BITE 10% whites10% whites 1% blacks1% blacks POST XB POST XB (>2 teeth)(>2 teeth) 6%6%
USPHS 1960’s / age 6-USPHS 1960’s / age 6-1717USPHS 1960’s / age 6-USPHS 1960’s / age 6-1717
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Inherited & AcquiredInherited & Acquired Predisposing Predisposing (direct) (direct) & & Determining Determining (indirect) (indirect)
(Mc Coy 1956)(Mc Coy 1956)
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ETIOLOGIC FACTORSClassification
7 Causes & Clinical Entities7 Causes & Clinical Entities (Moyers, 1958)(Moyers, 1958) HeredityHeredity Developmental defects of unknown Developmental defects of unknown originorigin
Trauma (pre & post-natal)Trauma (pre & post-natal) Physical agents (pre & post-natal)Physical agents (pre & post-natal) Habits (thumb , fingers, tongue, etc...)Habits (thumb , fingers, tongue, etc...) Diseases (systemic, endocrine)Diseases (systemic, endocrine) MalnutritionMalnutrition
Extrinsic (general) & Intrinsic Extrinsic (general) & Intrinsic
(local)(local)
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ETIOLOGY OF MALOCCLUSIONSETIOLOGY OF MALOCCLUSIONSETIOLOGY OF MALOCCLUSIONSETIOLOGY OF MALOCCLUSIONS
ENVIRONMENTmalocclusio
ns
HEREDITY
..7..
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SERIAL EXTRACTIONS SERIAL EXTRACTIONS (Kjellgren, 1929)(Kjellgren, 1929)
GUIDANCE OF ERUPTION GUIDANCE OF ERUPTION (Hotz, 1970) (Hotz, 1970)
GUIDANCE OF OCCLUSIONGUIDANCE OF OCCLUSION
8.
...influence tooth eruption ...influence tooth eruption
into a favorable occlusion...into a favorable occlusion...
TERMINOLOGYTERMINOLOGY
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98%98% 98%98%
AGEAGE
99 85%85% 90%90% 1313 90%90% 95%95% 1515 1919
Wolford et Al., O. Surg., 1973 - 45:3Wolford et Al., O. Surg., 1973 - 45:3
9.
COMPLETION OF ANTERO-POST.
MANDIBULAR GROWTH
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NO SKELETAL DISHARMONYNO SKELETAL DISHARMONY(Good facial balance / harmony)(Good facial balance / harmony)
CL-I MOLAR RELATIONSHIPCL-I MOLAR RELATIONSHIP
MINIMAL OVERBITE & OVERJETMINIMAL OVERBITE & OVERJET
10.
SEVERE SEVERE SPACE DEFICIENCYSPACE DEFICIENCY( > 10mm / ARCH)( > 10mm / ARCH)
SERIAL EXTR. - CASE SERIAL EXTR. - CASE SELECTION SELECTION
(ideal conditions)(ideal conditions)
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1- PRIM. CUSPIDS 1- PRIM. CUSPIDS (C’s)(C’s)--relieves inc. crowdingrelieves inc. crowding
2- PRIM. 1st MOLARS2- PRIM. 1st MOLARS (D’s)(D’s)--accelerates 4’s eruptionaccelerates 4’s eruption
3- 1st PREMOLARS3- 1st PREMOLARS (4’s)(4’s)-provides room for 3’s -provides room for 3’s
eruptioneruption
4- 4- MECHANOTHERAPYMECHANOTHERAPY(fixed appliances (fixed appliances corrections)corrections)
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TYPICAL SERIAL EXTR. SEQUENCE
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SG 15.2
2. 5 years2. 5 years 1.5 years 1.5 years 1.75 years1.75 years 1.5 years 1.5 years
1/21/23/43/4
1/41/4
ROOT 1/4 1/2 ROOT 1/4 1/2 ROOT 1/2 3/4ROOT 1/2 3/4
3’s4’s
++ = = 4y4y ++ = = 3.25 y3.25 y
ROOT 1/2 ROOT 1/2 STANDS STILLSTANDS STILL ROOT 3/4ROOT 3/4 EMERGES into O.CEMERGES into O.C..
..12..
ROOT FORMATION vs ERUPTION(Longitudinal Studies, Moorrees et Al.,
1963)
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1- 1- D’s D’s (keep the cuspids)(keep the cuspids) Avoids Li tipping of incisorsAvoids Li tipping of incisors Prevents bite deepeningPrevents bite deepening Accelerates eruptionn of 4’sAccelerates eruptionn of 4’s
2- 2- 4’s 4’s & REMAINING & REMAINING PRIM. CUSPIDSPRIM. CUSPIDS makes room for 3’smakes room for 3’s
3- 3- MECHANOTHERAPYMECHANOTHERAPY (fixed appliances)(fixed appliances)
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ALTERNATE S. EXTR. SEQUENCE
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IndicationsIndications::IndicationsIndications::
xx
-Extr. D’s to accelerate 4’s-Keep the C’s
-Dentoalveolar protrusion-Minimal incisor crowding-3’s & 4’s at same level
Serial Extractions - Alternate Serial Extractions - Alternate SequenceSequence
14.
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No cookbook approaches...No cookbook approaches...
Not a licence for no Not a licence for no supervisionsupervision
Take pan-Xr, evaluate spaceTake pan-Xr, evaluate spaceHave specific Have specific Tx objectivesTx objectives
Explain them to parents & patientExplain them to parents & patient
(Phase-II & mechanotherapy usually (Phase-II & mechanotherapy usually indicated)indicated)
Short & Long term goalsShort & Long term goals Esp. when extracting permanent teethEsp. when extracting permanent teeth
When in doubt, DON'T take them out…When in doubt, DON'T take them out…
CONSULTCONSULT15
SERIAL EXTRACTIONS CONCLUSIONS
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U & L 8’s U & L 8’s 20-30%20-30%
U 2’s U 2’s 1.5%1.5%
L 5’s L 5’s 1%1%
U 5’s U 5’s 0.5% 0.5%
L 1+2+3+4’s L 1+2+3+4’s 0.5% 0.5%
AAO ORTHODONTIC DIALOGUE - Summer 1989: 4
AAO ORTHODONTIC DIALOGUE - Summer 1989: 4 16
CONGENITALLY MISSING TEETH(% POPULATION)