Mixed Dentition Stage: Development And Orthodontic Interception
Describe in detail development of dentition in mixed dentition stage. Write role of dentist in interception of early signs of malocclusion in this stage.
Answer.
Role of Dentist in Interception of Early Signs of Malocclusion in Mixed Dentition Stage
Following are the procedures to be undertaken by the dentist in interception of early signs of malocclusion in mixed dentition stage:
- Serial extraction.
- Correction of developing crossbite.
- Control of abnormal oral habit.
- Proximal stripping.
- Correction of occlusal interferences.
- Interception of skeletal malrelation.
- Space regaining.
- Muscle exercises.
- Removal of soft tissue and bony barriers.
Serial Extraction
Eruption of permanent incisors in early mixed dentition may result in crowding in patients with severe tooth size-arch length discrepancy of 8-10 mm or more. Such patients would ultimately require extraction of four premolars to provide space for proper alignment of remaining permanent teeth. Rationale of serial extraction procedure is to intercept malocclusion at early mixed dentition period by extracting certain primary and permanent teeth and guiding the eruption of remaining permanent teeth in best possible occlusion.
Correction of Developing Crossbite
Anterior crossbite should be intercepted and treated at an early stage, if left untreated it can cause severe skeletal malocclusion. Dentoalveolar anterior crossbites are best treated by tongue blade therapy. Skeletal anterior crossbites are best treated by myofunctional appliances. Functional anterior crossbite is treated by eliminating occlusal prematurities.
Control of Abnormal Oral Habits
Oral habits such as thumb sucking, tongue thrusting, etc should be intercepted by the dentist at age of 3.5 years to 4.5 years. Oral habits are intercepted by removal orthodontic appliance such as oral screen or by fixed orthodontic appliance such as fixed crib.
Proximal Stripping
Proximal stripping of first and second deciduous molars is required to facilitate eruption of adjacent succedaneous permanent teeth into normal occlusion.
Correction of Occlusal Interferences
Occlusal interferences can deflect mandible anteriorly, laterally or posteriorly. So as soon as occlusal prematurities are ruled out by dentist, they should be intercepted by reduction of crown height by pear-shaped stone in center angled handpiece.
Interception of Skeletal Malocclusion
Space Regaining
This can be done by using following appliances, i.e.
- By using cantilever spring: Space lost due to mesial drifting of permanent molar as well as distal drifting of deciduous fist molar when deciduous molar get lost prematurely, this is regained by use of two finger springs.
- By using jack screw: Space is regained by use of removable orthodontic appliance which has jack screw in a way which increases the arch length which is obtained by distalization of molar.
- Gerber space regainer: It is an orthodontic molar band which is used for the tooth which has to be distalized. It consists of a U-shaped hollow tubing.
Removal of Soft Tissue and Bony Barrier to Enable Eruption of Teeth
It involves excision of soft tissue as well as removal of bone covering the crown of unerupted tooth for making the space so that tooth can erupt easily.
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