CATEGORY 62 AUSTRALASIAN DENTIST CLINICAL ful l their potential for each patient. e rate gradient of facial growth reduces with age. Any interferences or inhibiting factors would lead to malocclusion. erefore, it is apparent that any such factors should be removed as early as possible to start the orthodontic treatment. us, depending upon the inhibitory factors and their severity, some malocclusions may be treated in deciduous dentition, others in mixed dentition and the remaining in permanent dentition. erefore, the timing of orthodontic treatment should be focused depending on the degree of growth and maturation in an individual and family pattern. b) Tissue response: When the patient is young, one may be able to remove etiologic factors, enlist natural growth forces, provide di erential growth responses, and obtain a balanced pro le prior to the eruption of most permanent teeth. c) Preventive and Interceptive: e orthodontist should prevent or intercept the development of an existing malocclusion in its incipient stages. For example, based on studies, in those cases that are de nitely caused by sucking habits and in which the habit is corrected by early orthodontic treatment, about 50% require no further attention. In the remaining 50%, the progress of deformity is markedly arrested, and an extensive deformity is reduced to a simple proportion which may require a second period of treatment for nal tooth positional adjustment. Interceptive orthodontic therapies are performed in order to restore a normal occlusion once a malocclusion has developed. erefore, in cases where early treatment is indicated and instituted in good time, there is su cient reduction in the severity of secondary malocclusion. d) Psychological: Occasionally, dental malocclusion leads to skeletal malocclusion if left untreated. Also, from a psychological point of view, facial deformities often create a serious mental hazard in young children. Preventive therapies in orthodontics aim to promote a physiological development of a good occlusion and avoid the progress of a malocclusion. Summary According to Pro t (2006), early orthodontic treatments are carried out with the aim of reducing the length and severity of orthodontic treatments with conventional xed appliances. According to a study conducted by Grippaudo C. et al (2014), which was designed to determine the prevalence of malocclusions treatable at an early stage using the Baby-ROMA index (Risk of Malocclusion Assessment Index), there is the suggestion that early orthodontic treatment could be advisable in the following cases: u malformation syndromes u maxillofacial trauma (e.g., condylar fractures) u facial asymmetries u skeletal Class III malocclusion with anterior crossbite u severe crossbite (which could lead to asymmetric development of the jaw) u scissor bite u early loss of deciduous teeth due to caries. According to various studies: u Early treatments of Class III malocclusion due to maxillary hypoplasia have shown better clinical results in primary or early mixed dentition. u In Class II malocclusions the debate regarding the bene ts of a dual-phase treatment is still open. However, some patients with intra-arch toothsize/arch-size discrepancy problems also exhibit Class II malocclusion or a strong tendency toward a Class II malocclusion. Generally, these patients do not have severe skeletal imbalances but rather may be characterized clinically as having either slight mandibular skeletal retrusion or an orthognathic facial pro le with minimal neuromuscular imbalances. u Studies have found that “spontaneous” improvement of mild Class II and Class III malocclusions after using function jaw orthopaedic appliances in early phases of treatment. u An early treatment for the correction of posterior crossbites with jaw shifting is often advisable in order to prevent facial asymmetry. Although some studies found that 45% of posterior crossbites with lateral mandibular displacement resolve spontaneously with growth. u Space maintainers prevent the premature loss of deciduous teeth or crowded primary dentition loss of space, thereby allowing the eruption of permanent teeth in their natural position, and preserving the leeway space when the dental arches are crowded. u Early treatment of an open bite is very controversial. It is important to identify if the open bite is determined by a skeletal base or a dental base in order to choose the correct treatment option. In children with average vertical patterns, the open bite is determined just by environmental factors and can be treated more successfully during growth, while in subjects with malocclusion associated with increased skeletal vertical patterns, the prognosis is less favourable. According to a review by Gadgil (2012), possible milestone appointments for early orthodontic intervention are: Dealing with skeletal components in any malocclusions immediately should be considered, whereas the dental component can be handled at a later date. us, an ideal age to start orthodontic treatment would be the age at which treatment of malocclusion would create a more favourable occlusion, which in time would in uence dental and skeletal development in the direction of balance and harmony with the surrounding structures. Conclusion Prevention and early orthodontic intervention are generally successful in minimizing the detrimental dental and occlusal e ects of non-nutritive sucking habits and early loss of primary molars. Interception and early treatment of functional posterior crossbites and signs of ectopic canine eruption have been equally successful. On the surface, this concept seems reasonable because it appears more logical to prevent an abnormality from occurring than to wait until it has become fully developed. In general terms, an initial phase of treatment is provided that is approximately 1 year in duration followed by intermittent observation during the transition from the mixed to the permanent dentition. treatment. In many conditions, the advantages and limitations of early intervention must be considered individually for each patient, without omitting psychological factors such as patient cooperation and self-esteem in the decision-making. u For the full list of references, contact Australasian Dentist on: gapmagazines@gmail.com Dr Geoff Hall Specialist orthodontist and Director of the OrthoED Institute geoff@orthoed.com.au +61391080475
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