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Early treatment (phase 1): AAO meeting 2022. Episode 150. June 22nd 2022

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Hosted by
Farooq Ahmed

Early treatment AAO meeting 2022

 

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Join me for a summary of early treatment lectures from this years AAO meeting from May 2022. Topics will cover trauma, airway diagnosis and orthodontic treatment, and optimal timing of class 2 correction

Lectures:

  • Dental Trauma Eustaquio A. Araujo
  • Airway-centered Orthodontic Diagnosis & Treatment for Pediatric Patients Hong He
  • Predictors of Success for Early Mixed Dentition Treatment Heesoo Oh

 

Dental Trauma Eustaquio A. Araujo

Trauma protocol

  • Reposition with firm grip
  • 16x22NT 
  • Bite props to eliminate occlusal interference
  • Soft diet
  • Recall 2 weeks

Re-implantation of avulsion success

  • Less than 1hour 75% 
  • Up to 24 hours 25%

Ankylosis during upper incisor retraction 

  • Treatment options
    • Decoronate
      • Remove pulpal tissue
      • Fill with blood
      • Suture on top of the root
        • = new bone through replacement resorption
    • Regional corticotomy
      • Older patient
      • Buccal and palatal osteotomy
      • Bracket to fixate onto the archwire
  • Effect of trauma with finite element analysis Vilela 2019
    • Simulate trauma on 1 tooth, investigate adjacent teeth
    • Blunting of adjacent teeth
  • Conclusion – look at the neighbours

Airway-centered Orthodontic Diagnosis & Treatment for Pediatric Patients Hong He

Nasal breathing Vs mouth breathing 

  • NB = Tongue rests on the palate.  MB = Tongue floor of the mouth
  • NB = Pressure of the cheeks is balanced with the tongue. MB Pressure of the cheeks is unopposed by tongue
  • NB = U shape upper arch (normal). MB = V shaped arch

Tonsillar hypertrophy

  • Oropharynx obstruction
  • Ventilation impaired
  • Occlusal effects
    • Tongue and mandible forwards Iwasaki 2017
    • Mandibular protrusion
      • Class 3 malocclusion
  • He’s study n=1776
  • Greater tonsillar hypertrophy in children with class 3 

Adenoid hypertrophy

  • Upper airway restriction
  • Occlusal effects
    • Transverse construction occurs
    • Mandibular clockwise and retrusion
    • Upper airway is unfavourable for vertical control during orthodontic treatment. Zhao 2018

2012 Paediatric American Academy of Pediatrics Guidelines

  • Adenotonsillectomy recommended first line treatment for patients with adenotonsillar hypertrophy

Adenotonsillectomy effects

  • AP: Nil
  • Vertical
    • Counter clockwise rotation of 3.8 degrees S/R Sun 2018
  • Transverse
    • Increased intercanine width (no difference molar) Viera 2012
    • Increase intercanine and intermolar width (1mm from study) Caixeta 2014

If not correct hypertrophy

Appearance

  • Adverse growth, height, weight increased, and increased growth factor (pre and post data) S/R Bonock 2009

Cognitive impairment

  • SR Song 2016
    • Improved 
      • Neuropsychological Developmental Assessment Increase in 7 points 
      • Stanford-Binet Intelligence Scales (IQ) Increase 3.6 p <0.0001

Caution as limited studies pre-pubertal and controls also improved in scores

Predictors of Success for Early Mixed Dentition Treatment Heesoo Oh

When is it best to treat class 2 cases

Study: optimal timing of the effectiveness and efficiency 

 

  • Early class 2 equally effective not as efficient
  • BUT
  • Mean changes = mask individual response
      • Philosophy – correct some / all features of malocclusion
        • Reduce / eliminate need for phase 2
  • Angle orthodontist Oh 2017 

Treatment protocol

  • 7-9 years
  • Headgear night wear 11 hours
  • RME
  • 2 x 4 fixed appliances
  • Lingual arch
  • Greater 33 months = unsuccessful (time only marker of success, as occlusal and skeletal the same at the end)

Results

  • 15/54 (28%) phase 1 only
  • Comparison
    • No differences in occlusal and skeletal outcomes
  • Time 
    • Total treatment times (phase 1 + phase 2):
      •  67% less than 18 months in treatment active treatment
      • 20% 4-5 years of total treatment time

Predict patients with unsuccessful outcomes

  • Expansion requirements intercanine width
  • 36 degrees mandibular plane angle SnMPA, 4 degrees more than successful

Greatest predictor:

  • Hyper divergence and narrow intercanine width – unsuccessful prediction72%

Management of hyperdivergent class 2

  • Using MARPE
    • Expansion
    • Intrusion to plan for future likely adverse growth

Conclusions

  • 67% of patients with phase 1 treatment completed in 18 months
  • Class 2 hyperdivergent 
    • Better treated in late mixed dentition with MARPE and TAD intrusion
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