Dental Problems

Interceptive Orthodontics – Space Regaining

tooth-5Interceptive orthodontics is the concept which revolves around the minor problems present during development of dentition, which if left untreated may increase in terms of complexity and be, consequently difficult to treat at a later date. Thus, the procedures are instituted once the problem is detected, albeit at an early stage. It may thus be considered at the secondary level or prevention. The common problems of which can be intercepted would be space regaining, crowding, cross bites, midline diastemas and orthopedic guidance. In this article, there is a brief discussion on the interceptive orthodontics -space regaining

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Interceptive orthodontics – Space regaining:

Space maintenance is necessary in early loss of posterior primary teeth because early loss contributes to the development of occlusal disharmonies, However, when the space is progressively lost, as we have discussed in space closures following early loss of primary teeth, the therapy should be considered to regain it so that additional disharmonies do not develop. Then the regained space is maintained.

Diagnosis:

For regaining space or any movement of teeth, the most important procedure is diagnosis. Attention, limited to the segment in which the tooth is missing, is a frequent cause of the failure in attempting to regain space. Considerations for the treatment should include the following:

  • The alignment and space needs of the other teeth in the arch.
  • The relationships of teeth to the denture base.
  • The transverse and sagittal dental relationships and
  • The profile of the soft tissue

The various diagnostic aid necessary are study models, radiographs of all the periapical structures, clinical assessment of facial symmetry and proportions, and possibly cephalometric analysis.

Dental and skeletal relation:

  • Clinically, we have to make quick assessments to determine unfavorable skeletal patterns r dental malocclusions. Thus, clinical assessment should rule out the presence of a dental or skeletal class II, class III, open bite or closed bite relationship.
  • Certain variations in class I malocclusion may also exist in which simple measures at regaining space should not be the only consideration. Dental alignment considerations that affect the regaining of space include estimation of rotation, slipped contacts and facial-lingual displacement of teeth from arch circumference.
  • Assessment of the soft tissue profile will help to identify cases in which a relative protrusion or retrusion of the cental alveolar structures does complicate evaluation of available space.

Radiographs and study models:

Radiographs and study models will aid significantly in assessing space needs and consideration of tooth alignment. It is important to recognize whether teeth have moved bodily into the space or have tipped axially, because forces applied to tip teeth back into a proper alignment are easier to manage than forces required to move the teeth bodily.

Visualizing the proximity of adjacent erupting teeth (especially second molars) and estimating their potential impact on the teeth that have crowded the space should also be done. Radiographs of the periapical structures are necessary.

Mixed dentition analysis:

Moyer’s mixed dentition analysis will give an estimate of the amount of the space to be regained. It is however safer to do at least another analysis (Tanaka and Johnson) to confirm the exact amount of space loss that has taken place. Sometimes even it there is a loss of space, one may need only to maintain the space if it sufficient for permanent successors to erupt into good alignment.

Anchorage considerations:

When appliances are used to reposition the first permanent molars, there will be reciprocal force exerted to the teeth and the supporting tissues anterior to the space, and the result may be an undesirable flaring of the anterior teeth. Thus, if favorable conditions exist, an attempt to regain space is certainly indicated. Several fixed and removable appliances for space regaining procedures have evolved for the tipping of the first molars. However, the distal movement other than minimal tipping can most satisfactorily be achieved by head gear appliance.

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interceptive orthodontics -space regaining

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