Prepared by
Eman Abd elraouf
Mohamed
❑Levels of Prevention of malocclusion:
➢ Primary prevention — Preventive orthodontics; Control of
harmful oral habits, and preservation and restoration of primary
and permanent dentition.
➢ Secondary prevention — Interceptive orthodontics; Habit-
breaking appliances should be used. Serial extractions, space
maintainers/regainers, and functional appliances to correct jaw
relations are other modalities. Frenectomies and simple
appliances can be used to correct anterior crossbites •
➢ Tertiary prevention — Corrective orthodontic; treatment by
removable and fixed appliances, and surgical orthodontics in
cases of severe malocclusion.
❑ Preventive orthodontics
It is division of the science and art of dentistry
which deals with the recognition, prevention,
treatment & elimination of factors involved in
production of oral & dentofacial abnormalities
➢ Dentist should be able to : Role
1. Understand normal dentofacial growth &
development.
2. Recognize early deviation from the normal.
3. Understand the various etiological factors in
malocclusion.
4. Recognize the cases in which early intervention
may be helpful.
5. Recognize ,when it is better to wait & delay
orthodontic ttt or to consult an orthodontist to
help in prevention of malocclusion.
Preventive measures:
1. Retained deciduous teeth
• Ankylosed tooth may → cause mal alignment of
permanent successor
→ cause lack of
development of alveolar
process
• Ankylosed primary tooth should be extracted
2.Poor restorative attention
• Loss of contact due to caries or inadequately
contoured filling may lead to →loss of space
posteriorly.
• While over contoured posterior contact areas
→ may cause anterior crowding .
3. Unerupted or erupted supernumerary
teeth → may cause malalignment
4. Loss of posterior deciduous tooth
• May lead to loss of space required for eruption
of permanent successors.
• So that it is necessary of construction of
space maintainer to preserve that space
until the time of eruption of permanent
teeth to prevent loss of arch length.
5. Cross bite in wholly deciduous arch
• Not required orthodontic interference → as
permanent arches are not usually corrected by
this early treatment.
6.Individual teeth which are in incorrect
labiolingual relationship.
• Can be corrected by simple bite-plane appliance ,
once it corrected → no retention will be required.
7. Ectopic eruption of 1st permanent
molars
▪ Definition
1st permanent molar may position too far
mesially causing premature resorption &
exfoliation of 2nd primary molar.
▪ Occurrence :
✓ Occurs in 3% of population ✓ Maxilla more than mandible
✓ Boys more than girls ✓ At age 5- 6 years
✓ May occur in more than one quadrant in the same
mouth
▪ Diagnosis:
Full mouth radiographs at 5 or 6 years of
age are essential for early diagnosis
▪ Etiology :
1. Large tooth
2. Inadequacy arch length
3. Abnormal path of eruption where affected
tooth inclined mesial against E inspite of being
distal inclined.
▪ Complication :
• Child may complain of neuralogic pain
at area of impaction due to resorption of
distal portion of E → break of epithelial
attachment → ingress of oral fluid &
causing pulpal inflammation.
• Early resorption will
lead to early
exfoliation & this lead
to loss of arch length.
▪ Treatment:
• Although the problem is self limiting in two
thirds of cases → one third requires correction.
• When 1st permanent molar is partially erupted,
several methods for correction have been
suggested such as:
1. Brass separating wire (0.5 - 0.6 mm)
tightened around the contact area & retightened
every 2- 3 days.
▪ Technique:
1. Anesthetize the gingiva buccal & palatal to The tooth.
2. A brass wire (0.5 t0 0.6 mm) is passed under the contact point
between the upper 1st permanent molar & 2nd primary molar from
buccal to palatal. Twist the ends together over contact point.
3. Cut off the ends leaving 5 mm & tuck to avoid cheek injury. Then
retighten wire every 2 to 3 days.
4. The wire will cause disto-occlusal movement of 6, if contact open
to degree that wire can not be retained → thicker wire should be
used
2. It is helpful to place gingivally over
extended band on E → to provide smooth
guiding surface for the permanent molars.
➢ These techniques may be unsatisfactory & 2nd
primary molars may be severely damaged.
➢ In this case → extraction of E & construction of
an active appliance to distalize 6 into its proper
position followed by construction of a passive
space maintainer.
3. There are two appliance used for correction of
ectopic eruption of first permanent molar:
Humphrey ' s appliance Helterman 's appliance
THANK YOU
For any questions feel free to
contact me by mail
eman.elbashir@ su.edu.eg
