CATEGORY 60 AUSTRALASIAN DENTIST CLINICAL The process of proper di erential diagnosis and treatment planning determines whether interventions are best begun early (early mixed dentition) or late (late mixed or permanent dentition). Moyer (1988) suggests that early treatment can take advantage of normal growth to correct malocclusions before they become severe. It can eliminate or modify skeletal, muscular, and dentoalveolar abnormalities before the eruption of the full permanent dentition. Orthodontic therapies in primary dentition contribute to oral health and avoid more complicated patient treatment in permanent dentition. By initiating treatment in the mixed dentition, many of the skeletal and dentoalveolar problems associated with malocclusion are often eliminated or reduced substantially, thus lessening the need for prolonged xed appliance therapy in the adolescent years. Compliance is also believed to be greater because younger patients are considered to be more cooperative and attentive than adolescents. erefore, early treatment is de ned as the treatment started in either the primary or mixed dentition to enhance the dental and skeletal development before the establishment of the permanent dentition. Its purpose is to correct or intercept a malocclusion, thereby reducing the need for, or the complexity of, any treatment in the permanent dentition. Review of Literature Ricketts (JCO 1979) supported the theory that early treatment is easier and guides the physiological dental exfoliation. Functional/orthopaedic treatment is advisable in deciduous and/or early-mixed dentition to reduce the need for extractions of permanent teeth. Harvold et al (AJO 1981) suggested that some habits, such as persistent dummy or nger sucking, can cause alterations of the occlusion and oral breathing associated with respiratory obstructions, and may cause alterations to the physiological patterns of the craniofacial growth. Pietila et al (1992) found that the conditions most likely to be treated with Phase I orthodontics were Class II malocclusion, lateral crossbite, and crowding, which are not necessarily functional problems. Viazis (AJO 1995) recommends treatment of dental habits in primary dentition and crossbite in early mixed dentition. Dugoni and Lee (AJO 1995) discussed the advantages of initiating treatment in mixed dentition and suggested that the time required for treatment in the second phase can be reduced by initiating Phase I treatment between the ages of 7 and 9 years of age. Ghafari (AJO 1997) noted that crossbites and overjet that could cause trauma of the maxillary incisors should be treated in early or mid-childhood. Nelson (AJO 1997) concurs that crossbites, overjet greater than 8 mm in females, maxillary midface de ciency, moderate crowding, congenitally missing teeth, management of supernumerary teeth, as well as some midline discrepancies and habits would likely bene t from Phase I treatment. Long et al (2000) recommended Orthodontic treatment of cleft lip and palate patients during the deciduous and mixed dentition period to create more favourable conditions for midfacial growth, normalize the intermaxillary basal relationship and prevent or eliminate functional disturbances. Rationale for early treatment During the development of the dentition, the facial structures are passing through a period of rapid development with growth centres that are at the peak of their activity. Early orthodontic treatment should be allowed to take advantage of this developmental phase. If early treatment is not undertaken, then the structural imbalance will increase, as will muscular imbalance, leading to misdirected forces. Reasons to address at an early age Treatment in the primary dentition is undertaken for the following reasons: a. to remove obstacles to normal growth of the face and dentition, b. to maintain or restore normal function, c. to reduce all habits or malfunctions that may distort growth. e goal of such early treatment is to correct existing or developing skeletal, dentoalveolar, and muscular imbalances to improve the orofacial environment before the eruption of the permanent dentition is complete. By initiating orthodontic and orthopaedic treatment at a younger age, the overall need for complex orthodontic treatment involving permanent tooth extraction and orthognathic surgery is presumably reduced. Indications e basic principles of early intervention are to eliminate any primary etiological factors, manage arch length discrepancies, and correct skeletal dysplasia. Factors include: u non-nutritive sucking habits u premature loss of deciduous molars u anterior open bites u posterior functional crossbites and signs of ectopic erupting canines. Dr Geoff Hall By Dr Geoffrey Hall Benefits of early orthodontic treatment Ectopic eruption of upper canines Conditions that should be treated in the primary dentition: Early orthodontic treatment should be instituted in malocclusions in which there is no reasonable likelihood of selfimprovement or self-correction. Following are some of the conditions which make early orthodontic treatment imperative: u anterior and posterior crossbites, u threat of adverse occlusal and dental consequences, which are e ects of premature extraction, exfoliation or accidental loss of any deciduous teeth 6-8 months prior to the eruption of their predecessors, u the early loss of primary molars, which can lead to a loss of arch space, u unduly retained primary incisors which interfere with the normal eruption of
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