Aesthetic perception of patient in developmental age in interceptive orthodontic treatment.

AIM: Patients at development age show considerable attention to the shape of the face from both an aesthetic and relational point of view, to arouse interest from researchers. There are few studies related to profile analysis in patients of developmental age. Therefore, the objective of the present study was to analyse the importance of the aesthetic perception of the patient in development age in relation to the profile, before and after interceptive orthodontic treatment. MATERIALS: A sample of 25 patients who came to our observation for dentoskeletal malocclusions was considered. A questionnaire was proposed to each patient, before and after the interceptive orthodontic treatment (T0 and T1), to evaluate the aesthetic perception before and after the orthodontic treatment and its psychosocial impact. Profile analysis was performed using photographic documentation (at T0 and T1). The variables considered were the Ricketts line, the facial convexity angle, the nasolabial angle, and the labiomental angle. CONCLUSION: Interceptive orthodontic treatment has proven to be of valid clinical and psychological help. This result is confirmed by the complete aesthetic satisfaction of the patient in the frontal and latero-lateral planes.

An epidemiological study on early orthodontic treatment need among eastern Saudi Arabian children in the mixed dentition stage.

Estimation of early orthodontic treatment need among children is essential for planning orthodontic interventions in the mixed dentition stages thereby reducing the burden in a publicly funded healthcare system. The present study aimed to assess the early orthodontic treatment need among children with mixed dentition in the Eastern Saudi Arabia. A descriptive cross-sectional study was conducted among Saudi children visiting the outpatient clinics in a University dental setting, and data were collected based on Index for preventive and interceptive orthodontic need (IPION). Descriptive statistics, chi-square test and Fisher's exact test were used for data analysis with statistical significance set at p < 0.05. The category of 'no treatment need' accounted for 11.3% while 'moderate treatment need' and 'definite treatment need' categories accounted for 29.3% and 59.4% respectively. There was no statistical difference between males and females in the distribution of the three categories of treatment need (p = 0.513). This study demonstrated a very high need for early orthodontic treatment among Saudi children in the mixed dentition stage. Emphasis should be placed on increased awareness and benefits of seeking early orthodontic treatment involving preventive and interceptive procedures in the mixed dentition.

Skeletal and dental effects of function-generating bite appliance compared to rapid palatal expander and untreated controls.

INTRODUCTION: Maxillary expansion is a fundamental interceptive orthodontic treatment, which can be achieved through either a rapid expansion protocol or functional devices. However, no data exist about the efficacy of functional devices in achieving skeletal expansion. Therefore, the aim of this study was to compare the effects of the rapid palatal expander (RPE) and the function-generating bite type M (FGB-M) on the transversal dimension of the maxilla, and on the maxillary and mandibular dental arch width. METHODS: One hundred eighty-one skeletal Class I patients, aged between 6 and 12 years and with a cervical vertebral maturation stage II or III, with maxillary transversal deficiency were retrospectively enrolled; among these 55 were treated with FGB-M, 73 were treated with RPE and 51 were untreated subjects retrieved from historical databases. The pre-treatment (T0) and post-treatment (T1) frontal cephalograms were retrieved, and the maxillary and mandibular widths, and the distance between upper and lower first molars were measured. T1-T0 interval was of 17.3 months (RPE), 24.6 months (FGB-M) and 18.2 months (controls). RESULTS: The statistical analysis showed that there were no statistically significant differences between the RPE and FGB-M groups regarding skeletal and dental expansion, while the untreated control group differed significantly from the other two groups. CONCLUSION: The comparison between patients treated with RPE and FGB-M showed that there were no statistically significant differences between the RPE and FGB-M groups regarding the amount of skeletal expansion and dental arch width, suggesting that both appliances can be used to achieve similar results.

Redirection of palatally ectopic maxillary canines: Case report and proposition of an interceptive sequential guideline.

The eruptive deviation of the permanent maxillary canine must be identified early, at the beginning of the second transitional period of the mixed dentition. Acting at this moment is fundamental for its spontaneous redirection and eruption. The aim of the paper is to present a case where the extraction of the deciduous canines was the choice for redirecting the maxillary permanent canines with eruptive palatal deviation, as well as to suggest a sequence of procedures for diagnosis and choice of treatment. The success of deciduous canine extraction in redirecting the ectopic permanent canines is discussed in this case, as well as aspects that might lead to failure. Still, it highlights the importance of computed tomography for choosing conservative treatment or traction, including it in the sequential guideline for acting in these cases.

Early orthodontic treatment need in paediatric age: a prospective observational study in Italian school-children.

AIM: This study evaluates the prevalence of Interceptive Orthodontic Treatment Need (IOTN) in Italian school-children. METHODS: A prospective observational study was conducted to assess the prevalence of IOTN in patients undergoing a first visit at the Santa Chiara Hospital Paediatric Dentistry Unit in Pisa, Italy. Two thousand, one hundred ninetynine subjects met the inclusion criteria and were enrolled in the study; data on age, gender and concomitant systemic pathologies were collected from medical records. All participants were examined for individual IOTN: the presence of anterior and/or unilateral/bilateral crossbite with or without midline deviation, bad habits (finger, sucking habits, mouth breathing, and tongue thrust), overjet > 3 mm, lack of space for 1.2 and 2.2 eruption were investigated. The presence of one of the above mentioned parameters was considered positive for IOTN. Chi-square test was used to evaluate any statistically significant difference (p < 0.05). CONCLUSION: The study confirms the presence of a significant percentage of paediatric patients who need IOTN; early treatment is highly recommended to reduce malocclusion outcomes in the adult population.

Interceptive orthodontics: awareness and prevention is the first cure.

It is widely recognised by the scientific dental community that the correct development of the deciduous and mixed dentitions is paramount to the oral health of paediatric patients. In this respect, interceptive orthodontics plays a fundamental role in the process. Specifically, the paediatric dentist monitors the condition of the mouth from early childhood, distinguishing three age brackets for intervention, each defined by their own characteristics. It would also be desirable for other professionals who treat young patients and their mothers to various extents, such as paediatricians, gynaecologists, obstetricians and speech therapists to share valuable information with us. What follows is a brief summary of important conditions and key information regarding interceptive orthodontics. Age range 0-3 years: breastfeeding during the first months of life has been shown to have a positive effect on the development of the jaws. Later on, the transition to solid food, promoted by the eruption of the deciduous teeth, further stimulates their growth. During this phase, it is recommended to monitor and intercept any muscular hypotonia and low tongue postures. Additionally, it is essential to instruct parents on the proper dietary and lifestyle behaviours needed to ensure the physiological growth of the child, while protecting the health of their oral cavity. Age range 4-6 years: attention should be paid to the deciduous dentition and the development of the upper and lower maxillary bones, along with prompt interception and correction of bad habits such as the continued use of the pacifier, finger sucking, oral breathing and atypical swallowing. Age >6 years: within this phase, the careful monitoring of the space available in the arch, the natural exfoliation of milk teeth, the eruption of the permanent teeth and their occlusal relationship, as well as the maxillomandibular relationship are all important. If necessary, in addition to removing any risk factor, fixed or mobile orthodontic appliances can also be used during the above stages, especially stage 2 and 3, depending on the occlusal and skeletal status of the patient. Early diagnosis of malocclusion is crucial, as well as the sharing of information with other clinicians that deal with children and their parents, who need to be informed about the various therapies that their child may need. The paediatric dentist could, in fact, directly reach out to families to make them understand that malocclusion and other manifestations linked to conditions affecting oral functions such as breathing, sleeping, chewing and feeding often show the first signs as early as pre-school age, long before eruption of the first milk tooth, which is the time when the first dental visit is usually booked! We trust that awareness is the first form of prevention, and this is the message that must be conveyed to all of those involved in paediatric dentistry, patients and professionals alike: awareness and prevention is the first cure.

Do the various interceptive treatment modalities improve the position of palatally displaced permanent canines? A meta-analysis.

BACKGROUND: Removal of maxillary primary canines and other interceptive treatment modalities in the mixed dentition have been suggested as methods used to increase the rate of normal eruption of palatally displaced permanent canines (PDCs). However, the information on the overall effect on PDCs' position has been inconclusive. OBJECTIVE: To assess whether this practice improves the position of PDCs and to investigate the quality of the evidence. SEARCH METHODS: Unrestricted searches in 7 databases and manual searching of the reference lists in relevant studies were performed up to June 2022 (Medline via PubMed, CENTRAL, Cochrane Database of Systematic Reviews, Scopus, Web of Science, ClinicalTrials.gov, ProQuest Dissertations, and Theses Global). SELECTION CRITERIA: We looked for data on the positional changes of PDCs (mesial inclination, vertical position, canine crown cusp tip to midline) from randomized controlled trials assessing the various interceptive treatment modalities. DATA COLLECTION AND ANALYSIS: Following study retrieval and selection, relevant data were extracted, and the risk of bias was assessed using the Cochrane Risk of Bias 2 Tool. Exploratory synthesis and meta-regression were conducted using the random effects model and the overall quality of the available evidence was assessed with the Grades of Recommendation, Assessment, Development, and Evaluation approach. RESULTS: Five studies (3 at low risk of bias) were identified, involving 238 individuals, followed for up to 18 months post-intervention with OPG (orthopantomogram) or CBCT (cone-beam computed tomography). Exploratory data synthesis showed that PDCs' position improved more in the extraction sites compared to non-extraction. Analysis of the studies at low risk confirmed the above observations (6- and 12-month). Improvements were observed in patients using headgear after extraction of primary canines compared to extraction alone, but not in patients with double extraction of primary canines and first molars. The quality of available evidence was rated at best as moderate. CONCLUSIONS: Interceptive treatment modalities in the mixed dentition may improve the position of PDCs. However, more studies are necessary in order to determine the clinical significance of the changes. REGISTRATION: PROSPERO (CRD42015029130).

2 × 4 appliance in the mixed dentition stage: a scoping review of the evidence.

A great emphasis is currently given to the early correction of malocclusions to prevent further complications if left untreated. Interceptive orthodontics not only simplifies but also eliminates the need for later procedures. The 2 × 4 appliance is an orthodontic treatment modality applied during the mixed dentition period, particularly for malpositioned permanent upper incisors. This scoping review was aimed to examine the breadth and depth of the published literature on this clinical topic, as well as knowledge gaps, about this fixed appliance during mixed dentition, for the correction of incipient anterior malocclusions (incisor crowdings, midline diastemas, or crossbites). PubMed, Cochrane Library, Google Scholar, Dentistry & Oral Sciences Source, and two grey literature databases were explored; under a structured PICO question (Patient, Intervention, Comparison, Outcome) and eligibility criteria, for relevant clinical trials, observational studies, and case reports/series (in English or Spanish), using different searching terms. Titles and abstracts were screened. Full-text articles were critically reviewed for bias risk and a data charting table was constructed. 161 references were identified, after which 115 titles remained after removing duplicates. After the abstract screening, 18 potential full-text articles were reviewed. Finally, 16 studies were included, according to the performed critical appraisal. The 2 × 4 appliance is suitable for mixed dentition patients with mild or severe malocclusions, particularly when removable appliance usage is a critical problem.

Is there a better interceptive treatment for unerupted palatally displaced canines? A network meta-analysis.

This systematic review aimed to investigate if there is a better interceptive treatment for palatally displaced canines (PDC) in the mixed dentition stage. The PubMed/MEDLINE, CENTRAL, Scopus, and EMBASE databases were searched for randomized clinical trials related to the research topic. The gray literature and reference lists were also assessed. Network meta-analysis was conducted to analyze the effects of different approaches on PDC eruption. The surface under the cumulative ranking area was calculated to rank the treatments. The certainty of the evidence was evaluated using the GRADE approach. Of the 892 eligible studies, 18 were selected for full-text analysis and 9 for meta-analysis, involving 506 participants and 730 PDC, to compare 9 approaches. The proportion of erupted PDC was significantly higher for all interceptive treatments compared with control (no intervention). Furthermore, the proportion of erupted PDC was higher in patients subjected to rapid maxillary expansion (RME) than those who underwent double extraction of primary canine and primary molar (relative risk (RR) = 2.68 ICr95%: 1.12-9.35). A higher proportion of erupted PDC was found for RME (RR = 3.07 ICr95%: 1.31-10.67), RME plus use of transpalatal arch (TA) plus extraction of primary canine(s) (EC) (RR = 1.43 ICr95%: 1.09-1.95), EC plus use of cervical pull headgear (RR = 1.38 ICr95%: 1.11-1.79), and EC plus use of TA (RR = 1.36 ICr95%: 1.00-1.9) than for EC. RME was most likely to be considered as the best interceptive treatment. Overall, the certainty of the evidence was considered low due to imprecision and indirectness. In conclusion, no intervention in the mixed dentition stage is the worst choice for PDC.

Outcome of Surgical Extraction of Linguoverted Deciduous Mandibular Canine Teeth, Performed as an Interceptive Orthodontic Procedure in Puppies, on Permanent Occlusion.

Linguoversion of deciduous mandibular canine teeth can be a painful condition, interferes with the development and growth of the jaws, and potentially leads to further malocclusions affecting permanent dentition. Extraction of linguoverted deciduous mandibular canines is considered an interceptive orthodontic procedure that would allow unimpeded development of the jaws and permanent teeth. This study assessed clinical records of 124 dogs that had linguoverted deciduous mandibular canine teeth surgically extracted between October 2010 and September 2019 in a veterinary dental referral clinic. Seventy-seven cases fulfilled the study criteria. Fifty-one percent of these patients required further orthodontic treatment of the permanent occlusion and forty-nine percent demonstrated atraumatic permanent occlusion. The study found no correlation of the outcome with age at the time of surgery. The class of malocclusion (class 1 or class 2) at the time of surgery was also not associated with the outcome.

Factors associated with the municipal provision of orthodontics in the Brazilian Unified Health System.

BACKGROUND: The Brazilian federal government issued Ministerial Ordinance No. 718 in 2010 to expand the funding of orthodontic treatment provided by Brazilian municipalities via the Unified Health System (SUS in Portuguese). AIM: To identify social and structural factors associated with Brazilian municipalities that provide fixed orthodontic appliance therapy and interceptive orthodontic therapy. METHODS: Official Brazilian government databases were used for data collection. Poisson regression with robust variance was used for statistical analysis. RESULTS: Municipalities hosting Dental Specialty Centers (DSCs) with greater installed capacity (type III DSC with 7 dental chairs or over), which employed dentists specializing in pediatric dentistry and orthodontics, were more likely to offer orthodontic services via SUS. CONCLUSIONS: Federal, state, and municipal managers need to review the funding of orthodontic services via SUS, which can be used for creating DSCs and hiring professionals with expertise in orthodontics.

Interceptive orthodontic management of mandibular lateral incisor-canine transposition using simplified and efficient biomechanical approach: A case report.

PURPOSE: Ectopic eruption anomaly, manifesting as tooth transposition, often presents a complex therapeutic challenge. Mandibular lateral incisor- canine transposition, although observed with rarity, tends to have major impact on development of proper dentition and adversely influence physical, nutritional, aesthetic and overall psychosocial well being of the patient. This report chronicles individualized one-phase orthodontic management of the case of incomplete transposition between mandibular right lateral incisor and canine in a 9-year-old boy during mixed dentition period. METHODS: Interceptive orthodontic treatment was initiated with placement of 2×4 fixed appliance in lower arch. A combination of continuous arch wire technique involving the use of improved superelastic nickel-titanium wire in conjunction with TMA rectangular wire loop was utilized to achieve biomechanically efficient mesial movement of mandibular lateral incisor. Treatment continued with sequential bonding of brackets to the rest of the mandibular dentition until the levelling and alignment of the buccal segment dentition was achieved. RESULTS: Well-timed early interceptive treatment involving simplified and controlled movements helped reinstate tooth order, promote free eruption of buccal segment teeth, reduce anchorage burden and achieve predictable and biologically compatible outcome without the use of lingual arch as an additional source of reinforcing anchorage. CONCLUSION: From an aesthetic, occlusal and functional standpoint, the treatment approach used in the reported case and the therapeutic outcome proved to be highly satisfactory. By optimizing the eruption and alignment patterns of the permanent teeth, preadolescent interceptive orthodontic treatment helps mitigate the burden of malocclusion and risks of complex orthodontic treatment in permanent dentition.

Eruption disturbances in the mixed dentition: orthodontic considerations for primary dental care.

The primary dental care clinician is in a prime position to identify deviations from normal dental development. Disturbances can affect any new erupting tooth. The objective of this narrative review is to describe several situations in which eruption disturbances can arise during the mixed dentition. It will provide an overview of the orthodontic considerations of these disturbances in addition to key summary points on interceptive management, based on the best available evidence.

How effective is maxillary expansion as an interceptive treatment in individuals with palatally displaced canines? A systematic review and meta-analysis.

BACKGROUND: The objective was to provide a synthesis of the existing literature on the effectiveness of maxillary expansion in intercepting palatally displaced canines (PDCs). METHODS: Studies that evaluated the effectiveness of maxillary expansion in subjects with PDCs in the mixed dentition period were included. The following electronic databases were searched until November 30, 2021: MEDLINE (via PubMed), Scopus, Google Scholar, Web of Science, and Cochrane library. Grey literature search and manual search were also performed. The risk of bias was assessed using the Cochrane tool for the one randomized controlled trial (RCT) and the ROBINS-I tool for the non-RCTs. The data were extracted and meta-analysis was performed using RevMan 5.4. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach was used to assess the certainty of evidence. RESULTS: Four studies were selected from 9,586 records, which included one RCT and three non-RCTs. The former demonstrated a high risk of bias whereas the non-RCTs showed moderate risk. The meta-analysis of three non-RCTs found no significant improvement in the alpha angle of canines after rapid maxillary expansion, with a difference of -4.26 (95% CI -11.41 to 2.89; P = 0.24). The RCT showed an increase in the eruption rate of high-risk canines with rapid maxillary expansion. Slow maxillary expansion did not demonstrate any favorable change. The level of evidence ranged from low to very low. CONCLUSIONS: There is insufficient evidence to recommend the use of maxillary expansion as a stand-alone procedure in intercepting PDCs. Additional well-conducted trials are required.

The Efficacy of a New AMCOP® Elastodontic Protocol for Orthodontic Interceptive Treatment: A Case Series and Literature Overview.

BACKGROUND: Elastodontics is a specific interceptive orthodontic treatment that uses removable elastomeric appliances. They are functional appliances that produce neuromuscular, orthopedic and dental effects. Thus, these devices are useful in the developmental age, when skeletal structures are characterized by important plasticity and adaptation capacity, allowing to remove factors responsible for malocclusions. Elastomeric devices are generally well tolerated by patients requiring simple collaboration and management. This work can be useful to update all orthodontists already adopting these appliances or for those who want to approach them for the first time. This study aimed to describe four cases treated with new elastomeric devices called AMCOP Bio-Activators and to provide an overview of elastodontics, its evolution, indications and limits. METHODS: A total of four clinical cases were presented after a treatment period of 16-20 months to evaluate the clinical and radiological effects of the elastodontic therapy. RESULTS: The effectiveness of Bio-Activators on clinical cases was evidenced with a significant improvement in skeletal and dentoalveolar relationship, and malocclusion correction in a limited treatment period (16-20 months). CONCLUSIONS: The Bio-Activators showed clinical effectiveness to achieve therapeutic targets according to a low impact on the patient's compliance.

[Relevance of Class II interceptive treatments. Synthesis of the valid conventional means of study]. / Pertinence des traitements interceptifs de classe II. Mise en perspective avec la validité des moyens conventionnels d'étude.

The relevance of Class II interceptive therapy is controversial. The objective of this literature review was to note its indications and if a benefit is proven. We carried out a systematic search on PubMed from 1999 to 2019 by keywords on randomized trials. Fourteen articles were selected, mainly grade B or C. The criteria evaluated were dental, skeletal, psychological, aesthetic, as well as cost, duration, incisor fractures, rate of stroke, complexity and treatment need. Overjet is an important criterion for the indication of interceptive treatment, but it is not the only one. The skeletal criterion, assessed mainly by the ANB, is only significant for three articles; the improvement of self-esteem is proven in one article and the interceptive treatment allows an aesthetic improvement (alignment of the maxillary incisors). The overall cost of treatment would be higher for two-step treatment. In only two articles, the authors wonder if the interceptive treatment facilitates future treatment. The rate of compensatory strokes and extractions are widely studied. The main criteria studied are ANB (controversial indicator), incisor fracture rate (trauma) and overjet. Certain non-significant results must be put into perspective with the aim of the studies and the methods used.

Revisión de los principales manejos ortodónticos interceptivos y correctivos no quirúrgicos de la maloclusión clase III / Review of the main non-surgical interceptive and corrective orthodontic management of Class III malocclusion

La maloclusión clase III se considera un reto en la práctica de todo ortodoncista. Una de las principales dudas al respecto reside en ¿cuándo es el mejor momento para intervenir? Exis- ten dos enfoques en el manejo ortodóntico del paciente: 1) la ortodoncia interceptiva; y 2) la ortodoncia correctiva. La or- todoncia interceptiva busca la prevención del establecimiento de la malolcusión. En este grupo, se encuentra el uso de más- cara facial con disyunción maxilar y el de aparatología fija (2x4 o 2x6). Por otro lado, la intervención correctiva hace re- ferencia al camuflaje de las características que trae consigo la maloclusión clase III ya establecida; dentro de este enfoque se encuentran las extracciones de piezas, el uso de minitornillos extraalveolares y la filosofía MEAW. Se puede concluir que el adecuado manejo de la maloclusión clase III radica en el oportuno y correcto diagnóstico, que debe realizarse a través de la minuciosa inspección de las características y hallazgos intra y extraorales de los pacientes (AU)

Class III malocclusion is considered a challenge in the practice of every orthodontist. One of the main questions is: when is the best time to intervene? There are 2 approaches to the orthodontic management of the patient: 1) interceptive orthodontics, and 2) corrective orthodontics. Interceptive or- thodontics seeks to prevent the establishment of malocclusion by means of the use of a facial mask with maxillary disjunc- tion, or the use of fixed appliances (2x4 or 2x6). Corrective intervention refers to camouflaging the characteristics of a Class III malocclusion that is already established. This ap- proach uses tooth extraction, extra-alveolar mini screws or the MEAW philosophy. To conclude, proper management of Class III malocclu- sion is based on timely, correct diagnosis, which must be made through careful inspection of the characteristics and intraoral and extraoral findings in patients (AU)