Early orthodontic, non-appliance and appliance treatment: Ute Schneider part 1

orthodontics In summary

Join me as I summarise Ute Schneider’s lecture exploring early interceptive treatment. Part 1 explores signs of patients appropriate for interceptive treatment, the treatment options available with a focus on an adaptation of serial extractions which Ute is a proponent of.

Signs of hereditary tooth size jaw discrepancy in the younger patient

· Premature exfoliation of one or more deciduous lateral incisors

· Gingival recession on a prominent lower incisor

· Splaying of the maxillary or mandibular lateral incisors

· Ectopic eruption of U6, with premature exfoliation of E

· Impacted L7s

Treatment strategy for young patients

1. Wait for growth – natural skeletal discrepancy

2. Arch development: expansion , distalisation , proclination

3. Leeway space

4. Serial extractions

1/ Wait for growth

· Arch length and depth decreases with age, especially mandible decrease in arch length from age of 8 Bishara 1998

· Compare arch length 1930 Vs 1990s, smaller arch length and worse crowding in 1990s Bishara

2/ Arch development

· Rapid maxillary expansion

o Questionable stability

§ Meta analysis loss of RME 2.4mm Schiffman 2001

· Limited evidence of stability of RME

· Lip bumper, Quadhelix, 2 x 4, removable appliance

o 6 years severe relapse greater than other strategies

o 89% Significant relapse of mandibular anterior crowding Little et al

3/ Leeway space management

o Is crowding is equal or less than the leeway space Nance 1947

o Wide range of the leeway space available 0-8mm

o Lower premolars are larger now that 1930s – Evidence of reduced leeway space in 1930s Vs 1990s Allen 2017. Reduced 0.42mm per quadrant

· Lip bumper

o Impaction of 7s 10-20 x more prevalent than in the general population Sonis 2011

4/ Serial extractions

Advantages

· Immediate spontaneous improvement

· Reduces appliance time

· Reduces cost

· Reduces discomfort

Best candidates

· Severe hereditary tooth size discrepancy

· Orthognathic or bimax cases

· Minimal OJ and OB

· Class 1 malocclusion

Significant relief of crowding spontaneously?

· Extraction of Cs and 4s = Littles index improves from 11.8-2.74 Yoshihara 1999

Profile changes with serial extractions

· No evidence supporting adverse profile changes with serial extractions

· Non-extraction: consider possible negative aspects of non extraction Bowman 2000

Protocol for serial extraction

· Extraction of Cs

· Monitor every 6/12

· When 4s erupt, extract

Conclusions of serial extractions:

· Early non appliance orthodontic treatment

· Eruption guidance

· Limited to select group of patients

· Still has a place in orthodontic clinical practice