1. ORTHODONTICS SEMINAR Fatimah Che Rahimi Laila Azwa Hassan
Ahmad Zulkhairi Resali
Nurmarzura Abdul Latif
Aishah Shahrir
Nur Amalina Zulkepre
Akmal Khalis Doreyat
Masyitah Mustaffa
Aimi Amalina Ahmad

2. Early loss of deciduous teeth
It happened as a result of extraction due to caries or trauma
The degree of space loss is influence by:
Unilateral / bilateral
Age of loss --> more effect if the tooth lost at earlier age
Crowding/spacing the more inherent the crowding present, the more potential for space
Tooth typeposition of the affected tooth in arch influence subsequent space distribution
timevery early extraction can delay successional tooth eruption, later extraction have opposite effect
Degree of intercuspation-less effect
Skeletal factors-less effect

3. Balancing and compensating extraction
Aim: to preserve arch symmetry and occlusal relationship
Balance enforced extractions
A balancing extraction is a tooth from the opposite side of the same arch, designed to minimise centreline shift.
Compensate enforced extractions
Compensation means extraction of a tooth from the opposing quadrant to the enforced extraction. It is designed to minimise occlusal interferance by allowing teeth to maintain occlusal relationships as they drift. It is more difficult to justify compensation than balance, especially when it would involve removal of a tooth from an intact arch.

4. Which deciduous teeth need balancing and compensating extraction?
Tooth
Influence
Need balancing or compensating extraction
Deciduous incisor -
Deciduous canine
Centreline shift
Need balancing extraction
1st deciduous molar
Lower 1st deciduous molar
Need compensating extraction
2nd deciduous molar
(if it contribute to significant alteration in molar relationship)

5. Digit sucking habit

6. Digit sucking habit Most prevalent of oral habits, 13% - 100%
If the habit ceases before the permanent teeth begin to erupt, any effects on the dentition are unlikely to be long-term.
If however the habit persists into the mixed and permanent dentition malocclusion
Thumb sucking may develop early in life and continue from infancy through the primary dentition and into the mixed and permanent dentition. In many cases, if the thumb habit continues into the mixed dentition a malocclusion may develop
(Kaplan 1950; Ruttle et al. 1953; Graber 1959).

7. Factors that Affecting the Degree of Damage to Teeth and Investing Tissue
Frequency of habit
The more frequency the more the damage
Duration of habit
The more duration the more the damage
Intensity of habit
Active vs passive
*Prolonged digit sucking habit may affect occlusion and dentofacial structures.

8. Factors
Not all habits will result in tooth movement. It is related to frequency, duration and intensity.
Studies suggest that it only takes very light forces to move teeth, if the force is of long enough duration.
The threshold is believed to be 6 hours.

9. Maxillary changes 1. Proclination of maxillary incisors
2. Increased maxillary arch length
3. Anterior placement of maxillary apical base
4. Increased sella-nasion point A angle
5. Decreased palatal arch width

10. Mandibular changes 1. Proclination of mandibular incisors
2. Decreased sella-nasion B point angle
3. Increased intermolar distance

11. Others:
-arch assymmetry
-increased overjet
-anterior openbite
-posterior crossbite

12. How to stop? Gentle discouragement Oral appliances/ habit breaker
-palatal crib
-acrylic appliance on finger

13. Approaches to treat chronic thumb sucking
These can be split into
three distinct categories:
Behavioural – rewarding a child for not
exercising the habit;
Mechanical – preventing or interrupting
the process of thumb sucking;
Aversive – generating negative
sensations when the habit is exercised,
such as bad taste, pain or major discomfort

14. Fig 1: URA with acrylic ridge
Fig 2: Blueglass roller
Fig 3: The Rake appliance

15. Space Maintainer

16. Space Maintainer Definition Objectives:
An intraoral appliance used to preserve arch length following premature loss of primary tooth/teeth in order to allow permanent teeth erupt into proper alignment and occlusion
Objectives:
Prevent drifting/tipping
Prevent loss of arch length
Prevent midline shift
Prevent crowding of permanent teeth
Prevent impactions
As orthodontic intervention including extraction

17. Types of Space Maintainer
Anterior VS
Posterior
Fixed
Removable
Unilateral
Bilateral

18. Types of Space Maintainer
Fixed
Band and loop
Crown and loop
Lingual / Palatal arch
Distal shoe
Removable
URA (Hawley retainer)
Partial denture

19. Band and Loop Loss of D (unilateral/bilateral) Indication :
Ease of fabrication for clinician
Ease of maintenance for patient
Advantage :
Opposing tooth may be over-erupt
Disadvantages :

20. Crown and Loop
Loss of D with significant loss of tooth substance of abutment tooth (unilateral/bilateral)
Indication :
Ease of fabrication for clinician
Ease of maintenance for patient
Advantage :
More difficult to fabricate than band & loop
Disadvantages :

21. Palatal Arch/Lingual Arch
Loss of bilateral E’s
Indication :
Maintains tooth space & Leeway space
Prevents tipping of molars
Advantage :
Meticulous hygiene required
6 prone to decalcification
Disadvantages :

22. Lower Lingual Arch
Palatal Arch

23. Distal Shoe/Intra-alveolar
Loss of E prior to eruption of 6
Indication :
Maintain E’s space
Advantage :
Difficult to fabricate
Contraindicated in medically compromised patient (Subacute bacterial endocarditis, chemotherapy, radiotherapy)
Disadvantages :

24. Upper Removable Appliance
Multiple teeth are lost and space maintenance and mastication are of concern
Indication :
Maintain space
Aid in mastication
Advantage :
Susceptible to fracture / loss
Disadvantages :

25. Infraoccluded 55 & Impacted 15
15 erupting rotated

26. Thank You