2. 1. Ankylosis
2. Ectopic eruption
3. Premature loss of deciduous teeth
4. Delayed eruption
5. Primary failure of eruption
6. Single tooth in crossbite
7. Gingival recession
8. Midline diastema
9. Molar Incisor hypomineralization
10. Late lower incisor crowding
3.
4.
5. Anatomical fusion of alveolar bone with
tooth cementum
It can occur at any time during eruption
either before or after the tooth emerges into
the oral cavity
6. Mild The entire occlusal surface is located at least 1 mm below the
occlusal plane and above the contact point of the adjacent non-
ankylosed teeth.
Moderate The entire occlusal surface is located below the contact point level
but above the CEJ of adjacent tooth.
Severe The entire occlusal surface is level with or below the CEJ of the
adjacent tooth
7. 1. Syndromic
2. Non-Syndromic
a. Genetic
b. Trauma
c. Infection
d. Radiation and chemicals
e. Congenital absence of the second premolar.
f. Idiopathic
g. Iatrogenic
8. Any tooth that reached the occlusal plane
and subsequently dropped out of occlusion
should be considered ankylosed
Mobility test
Percussion sound
10. Computerized tomography (CT)
Failure of the tooth to move following the
application of orthodontic forces is believed to
be the definitive diagnostic test
11. In the presence of permanent successor
1. Exfoliate naturally
2. Restore the vertical dimension or extract the
affected tooth with lingual or palatal arch to
maintain the space if the infraocclusion
becomes greater
12. In the absence of a permanent successor or if the
permanent tooth is severely displaced
1. Retention of the second deciduous molar
2. Early extraction to facilitate spontaneous space
closure
3. Premolaizing the E
4. Extraction and prosthetic replacement
13. It depends on whether the patient is growing
or not
If he is a growing patient then extract
ankylosed tooth to prevent bone deficiency in
the area of ankylosis
If he is a non growing patient, maintain the
tooth as previously mentioned
14. If they survive to twenty years of age, continued
long-term function can be anticipated
15. 1. Extraction of the ankylosed tooth followed by prosthetic replacement.
2. Surgical luxation followed by periodontal ligament distraction
3. Osteotomy of the dentoalveolar segment with immediate repositioning of the
dentoalveolar structures.
4. Osteotomy followed by intraoral distraction.
16. 5. Osteotomy followed by heavy orthodontic forces.
6. Osteotomy followed by a combination of dentoalveolar distraction and light
orthodontic forces.
7. Osteotomy followed by conventional orthodontic forces.
8. Osteotomy with partial repositioning followed by heavy orthodontic forces
9. Lingual corticotomy of the dentoalveolar segment, followed by a labial
corticotomy three weeks later and a conventional orthodontic force.
17.
18.
19. A condition in which the permanent teeth,
because of deficiency of growth in the jaw or
segment of jaw, assume a path of eruption
that intercepts a primary tooth, causes its
premature loss and produces a consequent
malposition of the permanent tooth.
20. Grade I Mild – limited resorption to cementum or with minimum dentin
penetration
Grade II Moderate – resorption of the dentin without pulp exposition
Grade III Severe – resorption of the distal root leading to pulp exposure
Grade IV Very severe – resorption that affects the mesial root of the primary
second molar
21. If angle is from 15-30˚ of ectopic molar then
good prognosis of eruption
22. 1. Genetic
2. Associated with developmental disorders (ectopic
canines)
3. Increased mesial-distal width of 6
4. Increased mesial eruption angle of 6
5. Delayed calcification of the effected molars
6. Small maxilla
23. Eruption path where distal cusps emerge before
mesial cusps
Unilateral or bilateral delay in emergence of 6
Bulbos E and small jaw
Mobility of E
Neuralgia at area of 6
Diagnosis confirmed by dental radiographs
(superimposition and impaction against
distobuccal root of deciduous tooth)
25. If resorption of E <1.5mm
observe 3-6months (to establish if reversible)
if no resorption and vertical position
improved
monitor eruption
if no resorption and vertical position not
improved
expose unerupted 6 and wait for 3 months
if still not improving treatment to move the impacted tooth
distally
26. If resorption of E >1.5mm
• If E symptomatic or mobility >1mm consider extraction and management of
space problem once 6 erupts
If E asymptomatic and mobility <1mm and
6 partially erupted
treatment to move the impacted tooth
distally
If E asymptomatic and mobility <1mm and
6 unerupted
expose 6 and commence treatment to
move the impacted tooth distally
27. 6 is partially erupted
Brass wire ligature
Elastomeric
Halterman appliance
Humphrey appliance
Steel spring clip separators
Orthodontic band on the E and a bonded bracket on the exposed cusp of
6, with an open coil spring
6 is unerupted
Surgically expose and try above techniques or distal extension attached
to SS crown
28.
29. Orthodontic band on E with attached distal
spring +/- transpalatal arch when maximal
anchorage required (Halterman appliance)
30. A bonded button is placed on
the first permanent molar at the
same time the appliance is
cemented on the second
primary molar. The free arm
engages on the mesial side of
the button using reciprocal
anchorage to distalize the
permanent molar
Activation at 3 to 4-week
intervals is made with three-
prong pliers until overcorrection
occurs
31.
32.
33. Extent of it depends upon the degree of
crowding, the patient’s age, and the site
34. Local factors
1. Trauma
2. Periapical pathology
3. Periodontal problem
4. Caries
General factors
1. Congenital disease, fibrous dysplasia
2. Nutritional, vitamin D deficiency
3. Endocrine, diabetes
4. Genetic disease, hypophosphatemia or Ehler Danlos
syndrome
5. Tumour
6. Iatrogenic
35. 1. Stage of eruption of successors
2. Which tooth: space loss greater for E`s than D`s
by mesial drift of permanent teeth
3. rate of space closure is greater in maxilla than
mandible
4. Amount of crowding: greater space loss in
crowded dentitions
5. Occlusal interlocks
37. Loss of primary incisors – Early loss of primary incisors has little
effect. It is not necessary to balance or compensate the loss of a
primary incisor
Loss of primary canines– In all but spaced dentitions is likely to
have most effect on centre lines.The more crowded the dentition,
the more the need for balance
Loss of primary first molars – Balancing extraction may be
needed in a crowded arch but compensation is not needed
Loss of primary second molars –There is no need to balance the
loss of a primary second molar because this will have no
appreciable effect on centreline coincidence. However, when a
primary second molar has to be extracted consideration should
be given to fitting a space maintainer
38.
39.
40. Eruption time is defined either by chronological age
(Expected tooth eruption time )or biological age
(indicated by progression of root development)
41. When teeth do not erupt at the expected age
(mean 2 SD)
A disruption in the normal sequence of eruption
An asymmetry in eruption pattern between
contra lateral teeth. If a tooth on one side of the
arch has erupted and 6 months later there is still
no sign of it’s equivalent on the other side
(radiographic examination is indicated)
42. Generalized Localized
Hereditary gingival fibromatosis Congenital absence
Down’s syndrome Crowding
Cleidocranial dysplasia Delayed exfoliation of primary
predecessor
Cleft lip and palate Supernumerary
Rickets Dilaceration
Abnormal position of cyst
Primary failure of eruption
43. if root formation is not complete in
permanent follow up of root development by
periodic radiographic examination.
If the tooth is lagging in its eruption status,
active treatment is recommended
Obstruction must be removed ( soft tissue or
dental)
44. If self-correction is not observed over time,
active treatment should begin. Exposure
accompanied by orthodontic traction has been
shown to be successful when more than 2/3 of
the root has developed
If ectopic teeth deviate more than 90° from
the normal eruptive path, autotransplantation
might be an effective alternative.
45.
46.
47. non syndromic eruption failure of permanent
teeth in the absence of mechanical obstruction
with no obvious local/systemic causative factor
Teeth distal to affected tooth also involved.
48. Complete failure of tooth eruption (primary retention)
Initial eruption prior to the eruption failure (secondary
retention).
49. Rare condition of unknown aetiology
Significant genetic influence suggested (PTH1
gene)
Commonly family history
50. Effect on vertical facial growth, the bite distal to
the first affected tooth is usually open
Permanent teeth may become ankylosed
Diagnosis often made retrospectively and
orthodontic extrusion is unsuccessful
May be associated with infra-occluded
deciduous teeth, in particular E's
51. No orthodontic solution, will tend to intrude
the rest of options dentition
Consider restorative options, e.g. Crown
build-ups
May consider segmental osteotomy
Extraction
52.
53.
54. Dental malocclusion resulting from the
abnormal axial inclination of one or more
maxillary teeth
55. Depends on:
1. Adequate space to reposition the tooth in the
arch
2. Sufficient overbite to hold the tooth in position
following correction
3. An apical position of the tooth in cross bite that
is the same as it would be if the tooth was in
normal occlusion
57. The “reverse” stainless
steel crown
Two disadvantages :
1. Unsightly silver
appearance of the crown
form
2. The limitations of working
with an inclined slope that
is already formed.
Both problems can be avoided
by using a bonded resin-
based composite custom
formed inclined slope.
61. 1. Plaque
2. Position of the tooth
3. Vigorous tooth brushing
4. Traumatic occlusion
5. Prominent frenum
6. Thin marginal gingiva
7. Alveolar plate is thin
8. Orthodontic movement (position the tooth labially)
62. 1. Maintain good oral hygiene throughout orthodontic
treatment
2. Eliminate potential causes of recession
3. Avoid uncontrolled dento-alveolar expansion and maintain
arch form by extraction or IDS
4. Modify tooth anatomy whenever indicated
5. in lower incisor crowding, consider segment arch mechanics
and create space before using it and use it wisely
6. Consider atypical extractions of severly involved tooth
7. Avoid jiggling because it may cause periodontal problems
8. Treat early
9. Gingival grafting before orthodontic treatment
63. 1. Thorough instructions on plaque control should be provided.
2. Free gingival graft before orthodontic treatment
3. Modified coronally advanced tunnel flap approach
4. envelope technique with connective tissue graft
5. The laterally positioned flap with or without connective
tissue graft.
6. A frenectomy can also be considered
7. The gingiva is attached to the supracrestal portion of the
root so that lingual movement of the incisor will result in a
labial increase in gingival height
64.
65.
66. 1. Normal development in the deciduous dentition
2. Ugly duckling stage before the eruption of the permanent canines
3. Abnormal frenal attachments
4. Microdontia (peg-lateral incisors)
5. Presence of a supernumerary
6. Abnormal shape or crown-root angulation of the centrals
7. Congenitally missing teeth
8. Abnormal pressure habits (tongue thrust, digit sucking,
9. Trauma, leading to tooth loss in the incisor region
10. Hereditary & Racial predisposition, Negros
11. Pathological migration of the anterior maxilla teeth (rarely)
12. during RME
13. Iatrogenic
67. Direct visualization
Blanching in the region of the frenum can occur
when tension is applied by lifting the upper lip
A spade-shaped or notched intermaxillary segment
can be visible on radiographic examination
68. Depends primarily upon the removal of the underlying cause
In the deciduous dentition: no treatment
In mixed dentition: reassurance
In permanent dentition: aesthetic build-up of the centrals
Active orthodontic treatment to close a diastema is usually
carried out in the permanent dentition using fixed appliance
72. Hypomineralization of systemic origin that
affects one to all of the first permanent
molars and is often associated with affected
permanent incisors
73. The etiology of MIH still remains unclear
Environmental conditions:
Respiratory tract infections
Perinatal complications
Oxygen starvation and low birth weight
Calcium and phosphate metabolic disorders
Childhood diseases
Antibiotics
Prolonged breast feeding
74. Primary teeth are not affected
The remaining permanent dentition is usually not affected
One, two, three or four permanent first molars affected
White/yellow/brown opacities well demarcated compared to normal
enamel
The lesions on the incisors are usually not as extensive as those in the
molars and present mainly a cosmetic problem
The risk of defects to the incisors appears to increase when more first
permanent molars have been affected
75. Behavioural avoidance of erosive diet
Preventive
Applying desensitizing agent in combination with fluoride
varnish applications could be of some help in decreasing
sensitivity
Fissure sealant
Restorative requirements
Extraction combined with orthodontic treatment should be
considered as an alternative treatment especially if the molars
have a poor longterm prospect.The optimal time for
extraction is indicated by the calcification of the bifurcation of
the roots of the lower second permanent molar
76.
77.
78. Begins between the ages of 17 and mid-twenties
and progressing through into late adult life is
common
Approximately 2/3 of adolescents with good
alignment and “normal” occlusions will develop
incisor irregularity be early adulthood
79. 1. Lack of attrition
2. Soft tissue maturation: late mandibular growth changes
may bring the lower incisors into a different soft tissue
3. Late anterior growth and mandibular remodelling
4. Anterior component of occlusal forces
5. Mesial vectors of muscular contraction
6. Degenerative periodontal changes allowing teeth to drift
under light pressures
7. Mesial drift of posterior teeth by trans-septal fibres
8. Tooth size and shape which can result in contact point
displacement
9. The mandibular third molar: Mandibular third molars–
presence and position
80. Ades at al. (1990): 4 study groups all a
minimum of 10 years post retention
(Washington group) ( Absent 8s, Impacted 8s,
Erupted and functional, Extracted at least 10
years before post retention records)
No significant differences in mandibular
growth or LLS crowding between any of
the subgroups.
81. Accept
Prophylactic measurement: IPS as prophylactic
measure had been described by Peck and Peck
Permanent retainer
In the presence of significant malocclusion,
incisor crowding is best managed as part of a
comprehensive orthodontic treatment plan
either by IPS, extraction or proclination with
permanent retention.
82. The work of Little and others has shown that
although larger lower incisor changes in
position are less stable, lower incisor
alignment tends to deteriorate after
retention whether or not the lower incisor
position has been maintained Rowland 2008
found PFR is more efficient in a maintaining
the LLS position post orthodontic treatment
83. 1. Gingival recession : State of the science on controversial topics: orthodontic therapy and gingival recession (a report of the Angle
Society of Europe 2013 meeting)Ama Johal, Christos Katsaros, Stavros Kiliardis, Pedro Leito, Marco Rosa, Anton Sculean, Frank
Weiland, and Björn Zachrisson
2. Tooth ankylosis: Orthodontic implications P. PANOS Postgraduate Student, Department of Orthodontics, School of Dentistry,
Aristotle University of Thessaloniki, Thessaloniki, Greece
3. Ectopic eruption - A review and case report Syed Mohammed Yaseen, Saraswati Naik,1 and K. S. UloopiContemp Clin Dent. 2011
Jan-Mar; 2(1): 3–7. doi: 10.4103/0976-237X.79289 PMCID: PMC3220171
4. Single tooth in crossbite: Bonded compomer slope for anterior tooth crossbite correction Theodore P. Croll, DDS William H.
Lieberman, DDS Dr. Croll is in private practice in Doylestown, Pennsylvania and clinical professor, Department of Pediatric
Dentistry, University of Pennsylvania School of Dental Medicine; Dr. Lieberman is in private practice in Redbank, NJ and
coordinator of continuing education at Monmouth Medical Center in Monmouth, New Jersey.
5. Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor: clinical report Susan A.
McEvoy, DMD, MS
6. Delayed tooth eruption: Pathogenesis, diagnosis, and treatment. A literature review Lokesh Suri, BDS, DMD, MS,a Eleni Gagari,
DDS, DMSc,b and Heleni Vastardis, DDS, DMScc Boston, Mass
7. Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies: a summary of the European meeting on
MIH held in Athens, 2003 K.L. WEERHEIJM1 , M. DUGGAL2 , I. MEJÀRE3 , L. PAPAGIANNOULIS4 , G. KOCH5 , L.C. MARTENS6 ,
A-L HALLONSTEN
8. Primary eruption failure: A review Vijesh, Prashanth Kamath, Arun Kumar BR, Rajat Scindhia, Raghuraj MB
9. A long-term study of the relationship of third molars to changes in the mandibular dental arch
10. Author links open overlay panelDDS, MSDAmin G.Adesa12DDS, MSDonald R.Joondephb12DDS, MSD, PhDRobert
M.Littlec12PhDMichael K.Chapkod12
11. Contemporary Orthodontics, 5th EditionBy William R. Proffit, DDS, PhD, Henry W. Fields, Jr., DDS, MS, MSD and David M.
Sarver, DMD, MS
12. An Introduction to Orthodontics PDF by Laura Mitchell
13. Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol
Editor's Notes
can be performed by direct finger pressure or by the use of a periodontometer. The healthy tooth is able to move labio-lingually while the affected one fails to produce any kind of movement.
should be recorded after tapping the crown of the tooth vertically as well as horizontally with the handle of a probe. Ankylosed teeth have a sharp, solid sound on percussion in contrast to the dull cushioned sound of a normal tooth
usually reveals obliteration of periodontal membrane space, indicative of fusion between root cementum and the alveolar bone
The limitations of conventional radiography can be overcome by the use of ct
Although a high percussion sound and decreased mobility might be sensitive and accurate signs of ankylosis,
. It is better to allow permanent teeth to drift into the edentulous space and bring bone with them, and then reposition the teeth prior to implant or prosthetic replacement, so that large periodontal defects do not develop.
Grade III and IV ususally are Irreversible type
, with a significantly higher prevalence of ectopic canines
Balancing extractions: Removal of a second tooth in the same arch, but on the opposite side, to preserve midline and molar symmetry
Compensating extractions: Removal of a second tooth on the same side of the mouth, but in the opposite arch, to preserve the molar relationship
The advantage of using chronologic norms of eruption lies in the ease of use. Although not necessarily representating biologic age, expected time of tooth eruption often helps in forming a baseline for further clinical evaluation of a patient
During eruption of teeth, many processes take place simultaneously: the dental root lengthens, the alveolar process increases in height, the tooth moves through the bone, and, in cases of succedaneous teeth, there is resorption of the deciduous tooth. These parameters are currently used as clinical markers for orthodontic treatment planning
Moyers
and is different from skeletal crossbite
a well-known method of correcting single tooth anterior crossbite (Fig 1). When an elongated preformed incisor stainless steel crown is luted with the lingual surface facing labially, the resulting slope contacts the opposing mandibular incisors and normal occlusal forces move the incisors out of crossbite relationship. The reverse crown method corrects “dental tipping” type single tooth crossbite rapidly, comfortably, inexpensively, and without the need for special patient cooperation
(interceptive procedures and treatment in mixed dentition)
(piercing, smoking, traumatic tooth brushing)
50% risk of relapse with high incidence in patient with:
More than 2mm diastemas
Family tendency