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).

Effectiveness of extraction of primary canines for interceptive management of palatally displaced permanent canines: a systematic review and meta-analysis.

Background: Although extraction of primary canines in the mixed dentition has been suggested as a measure to prevent impaction of palatally displaced permanent canines (PDCs), the relevant evidence has been inconclusive. Objective: To assess the effectiveness of this practice and investigate the quality of the evidence. Search methods: Search without restrictions in 15 databases and hand searching until April 2017. Selection criteria: Randomized clinical trials comparing extraction of primary canines in the mixed dentition to no treatment. Data collection and analysis: Following study retrieval and selection, data extraction, and individual study risk of bias assessment using the Cochrane Risk of Bias Tool, the random effects method of combining treatment effects was used. The overall quality of the available evidence was assessed with the Grades of Recommendation, Assessment, Development, and Evaluation approach. Results: Finally 5 studies were identified involving 214 individuals, followed for up to 48 months post-intervention. Two studies were at low and the rest at high risk of bias. Although at the 12-month evaluation, extraction of the primary canine did not result in a statistically significant difference [risk ratio (RR): 1.537; 95% confidence interval (CI): 0.656-3.601, P = 0.323; 1 study, n = 67 individuals], beyond 12 months a benefit was noted (RR: 1.784; 95% CI: 1.376-2.314, P = 0.000; 5 studies, n = 214 individuals; I2 = 0%). Analysis of the studies at low risk of bias confirmed the above-mentioned result (RR: 1.713; 95% CI: 1.226-2.394, P = 0.002; 2 studies, n = 91 individuals; I2 = 0%; moderate quality evidence). No difference was observed regarding root resorption of adjacent permanent teeth (RR: 0.602; 95% CI: 0.277-1.308, P = 0.200; 1 study; n = 67 individuals; moderate quality evidence). Conclusions: Extraction of primary canines in the mixed dentition may increase the chance of subsequent successful eruption of PDC in the long term. However, better study standardization is necessary.

The use of panoramic radiographs to decide when interceptive extraction is beneficial in children with palatally displaced canines based on a randomized clinical trial.

Objective: To evaluate which palatally displaced canines (PDCs) benefit from interceptive extraction of the deciduous canine, to assess possible side effects from the extraction, and to analyse other dental deviations in patients with PDCs. Design, settings, participants, and intervention: A sample of 67 patients (40 girls, mean age: 11.3 ± 1.1; 27 boys, mean age ± SD: 11.4 ± 0.9) with unilateral (45) or bilateral (22) PDCs were consecutively recruited and randomly allocated to extraction or non-extraction using block randomization. No patients dropped out after randomization or during the study. The patients were given a clinical examination and panoramic radiographs were taken at baseline and after 6 (T1) and 12 months (T2). An individual therapy plan was made for the PDCs that had not erupted at T2. Measurements were performed blindly and the outcome measures were: canine position and angulation, root development, midline shift, rotation, or movement of adjacent teeth into the extraction site, and frequency of other dental deviations. Results: Interceptive deciduous canine extraction is beneficial if the alpha angle is between 20 and 30 degrees. A PDC located in sector 4 with an alpha angle >30 degrees should have immediate surgical exposure, while canines angulated less than 20 degrees and located in sector 2 can be observed without prior interceptive extraction. Deciduous canine extraction was more beneficial in younger patients with less advanced root development. Minor side effects, such as rotation or migration of teeth into the extraction space, were observed in 15 out of 35 patients. A majority of the patients had other dental deviations than PDC in the dentition. Limitations: The results are only valid for patients with no space deficiency in the maxilla and with PDCs located in sector 2-4. Harms: No harms were detected. Conclusions: The alpha angle and sector position are good diagnostic predictors of when interceptive extraction is beneficial. Minor side effects are seen after the extraction and the majority of the patients had other dental deviations too. Registration: This trial was registered at http://www.fou.nu/is/sverige, registration number: 211141.

Interceptive treatment in ectodermal dysplasia using an innovative orthodontic/prosthetic modular appliance. A case report with 10- year follow-up.

AIM: The treatment of a complex case of hypohidrotic ectodermal dysplasia (HED) with severe oligodontia. CASE REPORT: A 6 years old boy with HED, was treated with an orthodontic/prosthetic modular appliance. The device is custom made and consists of two parts, upper and lower, which were partially removable and partially fixed. The patient was prepared to receive dental implants for definitive oral rehabilitation. The treatment begun with heath-cured acrylic resin removable appliance with expansion screw in the maxilla and in the mandible. Afterwards, an innovative orthodontic/prosthetic modular appliance was made in the maxilla and in the mandible, fixed with bands on the first permanent molars, with expansion screw and telescopic screw that follow and support the resin prosthetic teeth during the orthopaedic expansion. The resin prosthetic teeth are removable from the metallic fixed structure of this appliance.The patient was followed for 10 years from the beginning of treatment. CONCLUSION: The modular appliance here described and our therapeutic approach showed to be efficient and durable in the achievement of many goals in the treatment of a complex case of HED. The objectives were not only just orthodontic, but also prosthetic and psychological.

Bilateral Scissor Bite Treated by Rapid Mandibular Expansion Following Corticotomy.

Scissor bite is defined as buccal displacement of the maxillary posterior teeth, with or without contact between the lingual surface of the maxillary lingual cusp and the buccal surface of the buccal cusp of its mandibular antagonist. Here we report treatment of bilateral scissor bite in the posterior region using rapid expansion following corticot-omy. The patient was a boy aged 17 years and 11 months in whom skeletal maxillary prognathism with bilateral scissor bite was diagnosed. The distance between the tips of canines and the mesial buccal cusps of the first molars was increased by use of a bonded rapid expansion appliance following corticotomy. Appropriate occlusion and lateral pro-file were obtained and maintained after retention. In addition, no gingival recession, hyperesthesia, or root surface caries occurred. These results suggest that mandibular lateral expansion following corticotomy is effective in young adult patients with a narrow mandibular arch.

Posterior Open Bite Due to Failure of Maxillary Molar Eruption.

Posterior open bite can cause problems with occlusion. It arises from systemic or local factors such as physical or functional interference, ankylosis, and failure of eruption. Primary failure of eruption (PFE) is a rare condition that is difficult to differentiate from ankylosis and requires complex treatment strategies. Here we report a 12-year-old girl who was referred to our hospital by her dentist for re-evaluation of eruption failure of the left maxillary secondary premolar and first and second molars with congenitally missing maxillary lateral teeth. The maxillary first molar was extracted for a therapeutic diagnosis. The left maxillary secondary premolar and second molar reacted well to subsequent orthodontic treatment. Auto-transplantation of the mandibular premolar to the maxil-lary arch was carried out to achieve optimal overjet, overbite, and occlusion. The active treatment period spanned 4 years and 1 month. Assessment of the patient's medical and dental history, prior trauma, and clinical conditions resulted in a therapeutic diagnosis of PFE. Satisfactory orthodontic treatment results were achieved.

Etiology, Classification and Management of Ectopic Eruption of Permanent First Molars.

Ectopic eruption of a permanent tooth involves abnormal resorption of a portion or all of the adjacent primary tooth. Among the most commonly ectopically erupted teeth are the permanent first molars. Ectopically erupting molars may require intervention to allow for full eruption, or they may spontaneously self-correct and erupt into occlusion. Decisions regarding the necessity of intervention, its ideal timing, and intervention type are multifactorial. Treatment options for the ectopically erupting permanent first molar include the elastomeric separator, brass wire, pre-fabricated clip separator, custom made appliances (Humphrey appliance, Halterman appliance), or extraction of the primary molar. Early intervention when indicated can ensure proper full eruption of the permanent first molar and prevent mesial angulation, arch perimeter loss, tooth impaction and ankylosis. Two cases are described that manage ectopic eruption of the permanent first molar.

One year treatment effects of the eruption guidance appliance in 7- to 8-year-old children: a randomized clinical trial.

BACKGROUND: The eruption guidance appliance (EGA) aims to correct sagittal and vertical occlusal relations concomitantly with alignment of the incisors. Few reports have been published on treatment effects with the EGA but no randomized studies have been available. OBJECTIVES: The aim was to find out if 1 year active treatment time with EGA was sufficient for achieving normal occlusal relationships and dental alignment in 7- to 8-year-old children. PARTICIPANTS, STUDY DESIGN, AND METHODS: Eligibility criteria for participants were: fully erupted upper central incisors, and Angle's Class I or Class II molar relationship combined with any of the following traits: deep bite, increased overjet ≥5mm, moderate anterior crowding with overjet ≥4mm. After screening of 148 children, 48 7- to 8-year-old children were recruited in the study. The participants were randomly assigned into a treatment group (N = 25) and a control group (N = 23). Children in the treatment group received treatment with the EGA for 1 year. The controls had no orthodontic treatment. Changes in overjet, overbite, Angle's Class, and crowding were used as primary outcome measures. Occlusal assessments were performed on dental casts obtained from all subjects at start of the study (T1) and after 1 year (T2). Lateral cephalograms were obtained from all subjects at T1 and from the treatment group at T2. All measurements on dental casts and cephalograms were carried out blinded. RESULTS: Forty-six children completed the study. Mean overjet and overbite decreased significantly in the treated subjects during 1 year, in contrast to a slight increase in the controls. Class II molar relationship decreased from 46 to 4 per cent in the treatment group, with no significant change in the control group. Mandibular anterior crowding decreased significantly in the treated subjects, while the controls showed a slight increase. CONCLUSIONS: In short term, the EGA seems to be effective in correcting increased overjet and overbite, Class II malocclusion, and lower anterior crowding in the early mixed dentition. Follow-up data are needed to assess long-term effects of this treatment. REGISTRATION: This study was not registered.

Extraction of the deciduous canine as an interceptive treatment in children with palatal displaced canines - part I: shall we extract the deciduous canine or not?

OBJECTIVES: To analyse whether extraction of the deciduous canines facilitates eruption of the palatal displaced canines (PDCs), and to analyse root resorption in adjacent teeth caused by the PDCs. MATERIALS AND METHODS: Eligibility criteria for participants were as follows: children at age 10-13 years with either maxillary unilateral or bilateral PDC, persisting deciduous canine and no previous experience of orthodontic treatment. Sixty-seven patients (40 girls and 27 boys; age: mean ± standard deviation: 11.4±1.0) with unilateral (45) or bilateral (22) PDCs were consecutively recruited and randomly allocated using permuted block randomization method to extraction or non-extraction. No patients dropped out after the randomization or during the study. Patients underwent a clinical examination and cone beam computed tomography at baseline (T0), after 6 (T1) and 12 months (T2). The total observation time was 24 months. Outcome measures were eruption, positional changes, length of time until eruption, and root resorption of adjacent teeth. The baseline images were measured blinded while the 6- and 12-month control images were not, since it was not possible to blind the extracted canine. RESULTS: Significantly more spontaneous eruptions of the PDCs were seen in the extraction group (EG) than in the control group (CG), with rates of 69 and 39 per cent, respectively, with a mean eruption time of 15.6±5.6 months in the EG and 18.8±5.8 months in the CG. Significant differences in changes between the groups, in favour of the EG, were found for all variables except for the sagittal angle. In the EG, the changes in the distances of the canine cusp-tip were larger during the first 6 months, while the change of apex was larger between 6 and 12 months. There were no significant differences in resorption of adjacent teeth between the groups. LIMITATIONS: Imputation values were used for the PDCs who had erupted at T2, since no x-rays were taken for ethical reasons, which might have given uncertainty in the positional changes between T1 and T2. CONCLUSIONS: Extraction of the deciduous canine is an effective treatment in patients with PDCs. Significantly more positional changes and shorter mean eruption time were seen in the EG. Resorptions of lateral incisors were seen in both groups, but none exceeded grade 2 (resorption up to half of the dentine thickness to the pulp). REGISTRATION: This trial was registered in "FoU i Sverige" (http://www.fou.nu/is/sverige), registration number: 40921. PROTOCOL: The protocol was not published before trial commencement.

Extraction of the deciduous canine as an interceptive treatment in children with palatally displaced canines - part II: possible predictors of success and cut-off points for a spontaneous eruption.

AIM: To analyse factors affecting the success rate of palatally displaced canines (PDCs) and eruption time and to find cut-off points to predict when interceptive extraction is beneficial versus unnecessary. MATERIALS AND METHODS: Sixty-seven patients, 40 girls, 27 boys (10-13 years) with uni- (45) or bilateral (22) PDCs, persisting deciduous canine and no previous orthodontic treatment were randomly allocated for extraction or non-extraction using the block randomization method. There were no dropped out after the randomization or during the trial. Clinical examination and cone beam computed tomography was performed at 0, 6, and 12 months. Blinded measurements were done on baseline images. RESULTS: Erupted PDCs had a significantly smaller mesioangular angle, shorter distance of canine cusp tip-dental arch plane, and larger distance of canine cusp tip-midline, and the patients were younger compared to the non-erupted group. Faster eruption was noted of PDCs in the extraction group. Spontaneous eruption was achieved without prior deciduous canine extraction with cut-off points: initial canine cusp tip-midline of 11mm, canine cusp tip-dental arch plane of 2.5mm, or a mesioangular angle of 103 degrees. PDCs with a less favourable position, i.e. an initial cusp tip-midline of 6mm, a canine cusp tip-dental arch plane of 5mm, or a mesioangular angle of 116 degrees, will need surgical exposure despite interceptive extraction of the deciduous canine. The canine cusp tip-midline had the best predictive measure for assessing the outcome. LIMITATIONS: Decision on where to place the cut-off points may differ from one operator to another, therefore results from several studies are needed to get average cut-off points. CONCLUSIONS: Deciduous canine extraction is the variable that affects the spontaneous eruption of the canine most. Canine cusp tip-midline, canine cusp tip-dental arch plane, and mesioangular angle might be useful for distinguishing when an interceptive extraction of the deciduous canine is beneficial or when exposure of the PDC should be implemented without previous interceptive treatment. REGISTRATION: This trial was registered in 'FoU i Sverige' (http://www.fou.nu/is/sverige), registration number: 40921. PROTOCOL: The protocol was not published before trial commencement.

Interceptive Treatment Of Palatally Displaced Canines.

BACKGROUND: In 2% of the Swedish population the canine fails to erupt and in 85% of the cases the canine is palatally displaced. The most common interceptive treatment of palatally displaced canines (PDCs) is extraction of the deciduous canine at the age of 10-13 years and follow-up of the canine for 12 months to monitor whether its eruption path will normalize. In case the canine does not erupt spontaneously, a surgical exposure and orthodontic treatment is commonly considered. However, an early and easy interceptive treatment is preferable both from a health economic perspective as well as to reduce the risk of root resorption of the adjacent teeth and to avoid later comprehensive treatments. OBJECTIVE: The aims of this thesis were: to develop a reliable and valid method to measure the position of PDCs on 3D images (Cone Beam Computed Tomography, CBCT) (paper I). To evaluate children's subjective experience before, during and after extraction of the deciduous canine (paper II). To compare whether extraction of the deciduous canine more often results in spontaneous eruption of the permanent canine compared to non extraction (paper III) and to find out which clinical cases benefit from interceptive extraction (paper IV). MATERIALS AND METHODS: In total 89 PDCs in 67 children (10-13 years of age) were randomly assigned to either have their deciduous canine extracted (extraction group, EG) or not extracted (control group, CG). Clinical and radiographic examinations were carried out at baseline (TO), after 6 (T1) and 12 months (T2) in both groups. 3D images of 20 patients out of 67 were randomly chosen and measured by two dentists at different occasions. The validity of the method to measure the displaced canines was assessed by comparing measurements on the 3D images with measurements on a dry skull. Children who had extraction of the deciduous canine were asked to answer a questionnaire before, the same day as and one week after the extraction. RESULTS: The radiographic method to measure and assess the position of the PDCs on 3D images was reliable and had a high validity (paper I). The reported pain and discomfort were in overall low. The injection was experienced as more painful compared to the extraction, and analgesics were taken the first evening by 42% of the children (paper II). Extraction of the deciduous canine resulted in eruption of the PDCs in 69% of the cases compared to 39% in the CG. Significantly more positional changes and a shorter mean eruption time were seen in the EG (paper III). PDCs with a mesioangular angle of 103 degrees, distance of the canine cusp tip-dental arch plane of 2.5 mm and distance of the canine cusp tip-midline of 11 mm in patients < 11 years will likely erupt without interceptive extraction. However, PDCs with a less favourable position, i.e. a mesioangular angle of 116 degrees, canine cusp tip-dental arch plane of 5mm and canine cusp tip-midline of 6 mm, in patients > 11-12 years old, will not erupt spontaneously in spite of interceptive extraction of the deciduous canine (paper IV). CONCLUSIONS: The radiographic method to measure and assess the position of the PDCs was reliable and valid and can be used in future studies. Adequate analgesics and dose should be given to children before and after extracting the deciduous canine. Interceptive extraction of the deciduous canine at 10-13 years of age was effective and will result in significantly more spontaneous eruptions of the permanent canine compared to a control group. The cutoff points may be a helpful tool for the clinician to chose whether the patient benefit from interceptive extraction of the deciduous canine or whether immediate surgical exposure should be performed.

Orthodontic treatment of a stubborn palatally ectopic canine: a case report.

This is a case report that highlights a different treatment approach in dealing with palatally ectopic canines. The modified transpalatal arch with an 'active' arm was used to align a palatally ectopic canine with 'push' mechanics after the initial use of more conventional 'pull' mechanics (piggy-back archwire technique) had failed.

Preprosthetic interceptive orthodontics for missing lateral incisors in late mixed dentition.

BACKGROUND: Different treatment alternatives are possible in the preprosthetic orthodontic management of missing of lateral incisors. We describe an efficient approach in a 12.11-year-old girl with incisors agenesis. CASE REPORT: Treatment started with repositioning of the permanent canines in site 2 and the deciduous canines in site 3. After growth completion the deciduous canines will be extracted and replaced by dental implants. Permanent canines will then undergo reshaping in order to look like lateral incisors. The molar and cuspid relationships were finalised in Class I, with correct overjet and overbite. The mandibular and maxillary arch forms were acceptable without crowding and rotations. Opening the space offers different solutions for maintaining the alveolar bone for a future implant, with the advantage of a molar Class I relationship and a wider arch. It would also be possible to achieve distalisation of the permanent canine, following the Kokich's principle of alveolar development. CONCLUSION: The described treatment is a valid alternative in the management of missing lateral incisors. This solution can avoid an additional orthodontic treatment in adulthood and allow easy management of the retention phase prior to final rehabilitation with single tooth implants

[Early orthodontic treatment for growth modification by functional appliances--pros and cons].

The optimal timing for commencement of orthodontic treatment has been controversial. Initial early orthodontic treatment usually begins at the deciduous dentition or early mixed dentition stage and continues for 12-18 months. In most cases, a second treatment phase will be required in the permanent dentition stage to achieve the treatment goals and a stable occlusion. One of the main purposes of the early treatment phase is to affect the growth pattern of the jaw and consequently correct skeletal imbalance and prevent future severe malocclusion by means of growth modification. Some clinicians strongly believe that early intervention with functional appliances improves facial harmony and simplifies as well as shortens the second orthodontic treatment phase. In contrast others advocate that it is unnecessary as the early treatment results will be eliminated by future growth and a recurrent treatment phase is essential in the permanent dentition stage in any case. Thus it is merely a waste of time and resources, and all treatment goals could be reached by a comprehensive single continued treatment phase in the late mixed dentition stage. This article summarizes the scientific literature on the different concepts of early functional orthodontic treatment of Skeletal Class II malocclusion correction vs. a single comprehensive orthodontic treatment process in the late mixed dentition stage. The indications and benefits of each of the approaches are discussed in detail. In conclusion, most of the researchers recommend early orthodontic intervention in children suffering psychological and social problems associated with their malocclusion. Prevention of traumatic injury in cases of maxillary incisor protrusive inclination is also considered an indication for early orthodontic treatment.

Preventive orthodontic management of tooth transposition.

The contemporary orthodontics should highlight the periodical control of growth and dental development in order to intercept possible disorders in facial growth and tooth eruption. This may allow avoidance or simplification of corrective orthodontic treatment, making it faster and less aggressive. Tooth transposition, a genetically determined eruptive disturbance, presents a relatively low prevalence in the world population and primarily affects maxillary canines and premolars. This paper presents an option for interceptive treatment of bilateral transposition of maxillary canine and premolar diagnosed early in a young individual. Longitudinal follow-up of RME performed in adequate timing to redirect the eruption pathway of permanent maxillary canines is presented.

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 treatment of an ectopic premolar to prevent molar-premolar transposition.

Orthodontic treatment is planned on an individual, case-by-case basis after thoroughly considering the patient's overall facial and dental characteristics, the expected duration of treatment, costs, patient preferences, and the orthodontist's experience. This article reports the treatment of a patient with a maxillary premolar-molar transposition in the permanent dentition that was successfully managed with orthodontic treatment. A girl, aged 10 years 2 months, came for treatment with an ectopic maxillary left premolar. Radiographic analysis indicated a developing complete transposition of the maxillary left premolar. The patient was treated with extraction of the deciduous molar and surgical exposure and ligation of the premolar. Eruption was properly guided, and the correct order of the 2 teeth was restored in the arch. This challenging treatment approach is described in detail, including the mechanics used to align the ectopic premolar. Early treatment can, in many cases, prevent a molar-premolar transposition.

Two-phase orthodontic treatment of a complex malocclusion: giving up efficiency in favor of effectiveness, quality of life, and functional rehabilitation?

The interceptive orthodontic treatment of patients with complex dentofacial abnormalities is frequently inefficient and produces less than ideal outcomes. Therefore, postponing therapy to a single-phase surgical-orthodontic approach might be considered a reasonable option. However, other relevant aspects of the patient's quality of life, such as possible psychosocial problems and functional impairments, should also be considered before deciding whether to intercept a severe dentofacial malocclusion while the patient is still growing, or wait and treat later. This case report describes the nonsurgical treatment of a young patient with a severe Class III open-bite malocclusion associated with a cervical cystic lymphangioma. Despite the poor interceptive therapy prognosis, a 2-phase approach was effective. A reflection about giving up efficiency in favor of effectiveness, functional rehabilitation, and the patient's quality of life is included.

Early interceptive treatment in the primary dentition - a case report.

This article describes treatment of a patient presenting with a class II malocclusion, maxillary and mandibular crowding, posterior crossbite and an increased deep bite, where the specific treatment goals were achieved in the early mixed dentition by only working on the primary teeth. A Haas-type rapid maxillary expansion (RME) appliance was modified to be anchored on the primary second molars and canines and activated once a day, with each activation equal to 0.20 mm. The appliance was blocked after 30 days and left as a retainer. After 6 months, the RME appliance was removed and bands were cemented to the primary second molars in order to apply traction with headgear. After complete eruption of the mandibular central and lateral incisors, sequential slicing of the lower primary teeth was performed to transfer the leeway space from the distal to the mesial part of the arch. When the patient had entered the permanent dentition, a dental class I relationship was achieved, the crossbite corrected and the crowding improved. The overjet and overbite were also improved. No permanent teeth were involved during this phase of treatment. The outcome of this case report shows that it is possible to work only on primary teeth in the mixed dentition and this can be an effective way to correct a class II malocclusion with deep bite, posterior crossbite and maxillary and mandibular crowding.

Management of skeletal class III malocclusion treated by manifold approach: 5 year follow-up.

The goal of early treatment of Class III malocclusion isfocused on providing a more favourable environment for normal growth and on improving the psychosocial development of the child by improving the facial appearance. Rapid palatal expansion with maxillary protraction and face mask has provided a predictable and effective approach to managing the treatment. We are presenting a case report of a growing Class III treated using maxillary protraction therapy, (Rapid maxillary expansion using bonded RME appliance, to loosen the nasomaxillary sutures and Petit face mask with bonded occlusal splint to unlock the maxilla). With early intervention, patient compliance is much better, most of them achieving overcorrection in less than a year. Close monitoring and follow up was done for 5 years to ensure stability of the treatment, and there was no relapse tendency.