Join me for Sarah’s lecture looking at her management of trauma, hypodontia and molar incisor hypomineralisation
Expansion
o UK evidence base – usually for crossbites only
o US – encourage expansion in ‘phase 1’
o Difference = cultural clinical practice
Deciduous trauma
o Dilacerated and horizontal upper incisor
o Guidelines on impacted central incisors RCS
o Exposure and bonding
o Aligned
§ URA followed by sectional fixed
§ If patient is willing, can consider attempt
o Canines are more likely to be impacted
o May require second course of orthodontics
Avulsion on adult teeth
o Teenager with avulsed upper incisor, out of the mouth for 2 hours
o Dental trauma guidelines – up to date guidance
o Re-implant, but expect ankylosis
o RCT and plan for decoronation
Luxation injury
o Surgical repositioning
o Orthodontic alignment
Supernumerary
o Removal of supernumerary and wait prior to orthodontic treatment
Molar incisor hypo mineralisation
o Guidelines for extraction of first permanent molars in children RCS
o Not an orthodontic decision, team approach to prognosis
o Sarah delivers an orthodontic plan, and discusses prognosis of MIH separately
o Extraction of 6s
o May have impacted 8s, and require future orthodontics
Hypodontia patients
Dentally anxious patient with impacted canine
o Address patients concerns of gaps, then extraction of C to allow 3 to come through
Impacted canine
o 50% resorption centrals, 60% lateral resorption
o Leave 2s in situ
o Exposure of canines
o 2s left in place until 3s vertically erupted
o 2s extraction and same day 3s built up – minimise aesthetic consequences
Patients not wanting lower arch treatment – patient taking control of enforced decision
