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Early orthodontic, non-appliance and appliance treatment: Ute Schneider Episode 84 June 16th 2021 Part 1

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Hosted by
Farooq Ahmed

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

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