Join me as I summarise Ute Schneider’s lecture exploring early interceptive treatment. Part 1 explores signs of patients appropriate for interceptive treatment, the treatment options available with a focus on an adaptation of serial extractions which Ute is a proponent of.
Signs of hereditary tooth size jaw discrepancy in the younger patient
· Premature exfoliation of one or more deciduous lateral incisors
· Gingival recession on a prominent lower incisor
· Splaying of the maxillary or mandibular lateral incisors
· Ectopic eruption of U6, with premature exfoliation of E
· Impacted L7s
Treatment strategy for young patients
1. Wait for growth – natural skeletal discrepancy
2. Arch development: expansion , distalisation , proclination
3. Leeway space
4. Serial extractions
1/ Wait for growth
· Arch length and depth decreases with age, especially mandible decrease in arch length from age of 8 Bishara 1998
· Compare arch length 1930 Vs 1990s, smaller arch length and worse crowding in 1990s Bishara
2/ Arch development
· Rapid maxillary expansion
o Questionable stability
§ Meta analysis loss of RME 2.4mm Schiffman 2001
· Limited evidence of stability of RME
· Lip bumper, Quadhelix, 2 x 4, removable appliance
o 6 years severe relapse greater than other strategies
o 89% Significant relapse of mandibular anterior crowding Little et al
3/ Leeway space management
o Is crowding is equal or less than the leeway space Nance 1947
o Wide range of the leeway space available 0-8mm
o Lower premolars are larger now that 1930s – Evidence of reduced leeway space in 1930s Vs 1990s Allen 2017. Reduced 0.42mm per quadrant
· Lip bumper
o Impaction of 7s 10-20 x more prevalent than in the general population Sonis 2011
4/ Serial extractions
Advantages
· Immediate spontaneous improvement
· Reduces appliance time
· Reduces cost
· Reduces discomfort
Best candidates
· Severe hereditary tooth size discrepancy
· Orthognathic or bimax cases
· Minimal OJ and OB
· Class 1 malocclusion
Significant relief of crowding spontaneously?
· Extraction of Cs and 4s = Littles index improves from 11.8-2.74 Yoshihara 1999
Profile changes with serial extractions
· No evidence supporting adverse profile changes with serial extractions
· Non-extraction: consider possible negative aspects of non extraction Bowman 2000
Protocol for serial extraction
· Extraction of Cs
· Monitor every 6/12
· When 4s erupt, extract
Conclusions of serial extractions:
· Early non appliance orthodontic treatment
· Eruption guidance
· Limited to select group of patients
· Still has a place in orthodontic clinical practice
