Indication for and Frequency of Early Orthodontic Therapy or Interceptive Measures

Abstract

The early treatment of nonskeletal and skeletal orthodontic anomalies in the deciduous and early mixed dentition is intended to prevent the development of pronounced anomalies in the late mixed and permanent dentition with the ultimate aim of reducing or even eliminating the need for later orthodontic treatment. There is a general consensus in the international literature that early therapy is indicated in cases of anterior and lateral crossbite and Class III malocclusion, and possibly for extreme forms of mandibular retrognathism (overjet > or =10 mm) and of open bite. However, evidence of the efficiency of early orthodontic measures is just as rare as studies providing serviceable information on the incidence of tooth malalignments and malocclusions in the deciduous and early mixed dentition, some of whose findings are in any case highly divergent. This makes it substantially more difficult to draw conclusions on the extent to which early orthodontic therapy may be indicated. In order to obtain information on the incidence of nonskeletal and skeletal orthodontic problems constituting a treatment need, 2326 first-year schoolchildren aged between 6 and 7 years were examined in Frankfurt am Main and in the Rural District of Offenbach. In only 14.7% of the children were no relevant orthodontic findings recorded. 77.2% displayed mild to severe dysgnathic symptoms, though without early orthodontic therapy being considered indicated. Treatment with orthodontic appliances was considered urgent for 187 of the children (8.04%). With 8.3% and 7.9% respectively, lateral and anterior crossbite were top of the list of anomalies with an urgent treatment need. Among the patients with lateral crossbite, the prognostically less favorable unilateral form was recorded approximately four times more often than the bilateral form. Markedly increased sagittal overjet > or =10 mm) was registered in only 1.4% of the children, and negative overjet (Class III) (with the exception of edge-to-edge bite) in 1.9%. Extreme anterior open bite > or =6 mm) was recorded in only two children (0.09%). In 19.6% of the children, a supporting zone was reduced in at least one quadrant, necessitating interceptive measures such as the insertion of a space maintainer or later orthodontic treatment (space opening or extraction therapy).

Reference Values for Craniofacial Structures in Children 4 to 6 Years Old: Review of the Literature

“…Any developmental abnormalities in children 4 to 6 years old can be treated prophylactically to prevent growth inhibition and avoid lengthy orthodontic therapy or at least reduce its scope [30]. Orthodontic treatment at that age is usually indicated in cases of pronounced skeletal malocclusion, which has a tendency to progress, may result in growth inhibition, or may not be (readily) treatable later unless significantly influenced by prophylactic measures.…”

“…Examinations are more difficult to perform at this age because these children are not compliant Einleitung Bei 4-bis 6-jährigen Kindern kann man bereits prophylaktisch auf Fehlentwicklungen einwirken, um eventuelle Wachstumshemmungen zu verhindern und um langwierige kieferorthopädische Therapien zu vermeiden oder zumindest im Umfang zu reduzieren [30]. Die Indikation für eine kieferorthopädische Behandlung in diesem Alter besteht in der Regel bei ausgeprägten skelettalen Dysgnathien, die zur Progredienz neigen, eine Wachstumshemmung zur Folge haben können oder deren erfolgreiche Behandlung zu einem späteren Zeitpunkt erschwert bzw.…”

Epidemiology of Hoffmeister?s Genetically Determined Predisposition to Disturbed Development of the Dentition in Patients with True Skeletal Class III Malocclusion

“…According to Schopf [45], Korkhaus [31], and Klink-Heckmann & Bredy [30], the prevalence of true mandibular prognathism amounts to 0.5-2% in Germany. True prognathism is of less epidemiological importance than other anomalies of the dentition, but it is more complex and requires more sophisticated therapy.…”

“…Nach Schopf [45], Korkhaus [31] und Klink-Heckmann & Bredy [30] ist die echte Progenie mit einer Häufigkeit von 0,5%-2% in Deutschland vertreten. Auch wenn der epidemiologische Stellenwert der Progenie gegenüber anderen Gebissanomalien gering ist, so ist sie doch komplexer und aufwendiger zu therapieren.…”

Cephalometric Evaluation of Bionator Therapy in the Early Treatment of Class II Malocclusions

“…The permanent incisors emerge between about 6 and 8 years of age (van der Linden and Duterloo 1976), which Broadbent (1937) has noted is the beginning of the "ugly duckling" stage of the mixed dentition. Studies show that the greater the overjet, (1) the greater the risk of trauma to these teeth (Schopf 2003;Karaiskos et al 2005) and (2) the greater the esthetic disability (Brook and Shaw 1989). Additionally, most trauma to the incisors occurs before age 10, so conventional treatment at 12 or 13 years, occurs after the interval of greatest risk.…”