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

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