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1. D362-Q362
Division of Orthodontic & Paediatric Dentistry
University of Western Ontario

2. INCISOR GUIDANCE

3. GUIDING THE DEVELOPING
DENTITION
“LOWER INCISOR CROWDING IN THE
EARLY MIXED DENTITION”

4. SPECIFIC OBJECTIVES:
1. Know how to approach the problem of
lingually erupting lower incisors.
2. Know when to assess a child patient’s tooth
size-arch length relationship.
3. Identify when discing of lower cuspids is
required.

5. SPECIFIC OBJECTIVES (cont):
4. Explain leeway space control and the role of
the mandibular lingual arch in assisting
lower incisor alignment.
5. Be able to design an appliance to improve
lower incisor alignment.
_____________________________________
REQUIRED READING:
Preceding material in this Syllabus.

6. REQUIRED READING:
(In manual)
Article: Early Mixed Dentition Developmental Module
Article: Management of lower incisor crowding in the
early mixed dentition. T. Foley, G. Wright,
S. Weinberger, Journal of Dentistry for
Children, May-June, 1996, pp 169-174.

7. ESSENTIAL FACTORS FOR A SMOOTH
TRANSITION FROM PRIMARY TO
PERMANENT DENTITION
1. Primate space
2. General spacing
3. Preservation of “leeway space”
4. Sequences of eruption
5. Tooth size and jaw in harmony

8. Crowding and protrustion of the
incisors must be considered two
aspects of the same thing: how
crowded and irregular the incisors are
reflects both how much room is
available and where the incisors are
positioned relative to the supporting
bone.

9. THE AIMS OF THIS
PRESENTATION ARE:
• Identify WHY incisor guidance is needed.
• List WHAT is to be considered.
• Indicate WHEN incisor guidance is
appropriate.
• Suggest HOW incisor guidance is performed.

10. WHY INCISOR GUIDANCE?
• To help prevent orthodontic relapse.
• Prevent unnecessary periodontic problems.

11. WHAT VARIABLES ARE TO BE
CONSIDERED?
• Interdental spacing.
• Intercanine distance.
• Increase of the arch perimeter.
• Size ratio between the primary and permanent
teeth.

21. PROBABILITY OF CROWDING
1° - 4 YEARS
CROWDING
NO SPACE
0-3 MM SPACE
3-6 MM SPACE
> 6 MM SPACE
PERMANENT
- 10/10
- 7/10
- 5/10
- 2/10
- 0/10
B. C. LEIGHTON

24. WHEN AND HOW TO TREAT??
• Continue to observe the case.
• Disc primary teeth.
• Extract primary teeth.
• Refer to an orthodontist.

25. CASES TO OBSERVE
Those < 2mm. crowding may
resolve into good alignment. (Profitt)

29. CASES FOR DISCING
Those with 3 – 4 mm. arch crowding.
The goal is to transfer the anterior crowding
posteriorly into the leeway space.

34. CASES FOR EXTRACTION
When arch crowding is 4 to 9 mm.

35. The goal is improve incisor alignment
(unraveling), perhaps preventing periodontal
problems and improving post-orthodontic
stabliity.

40. WHEN TO REFER??
Most class I cases having more than 10 mm.
crowding should be referred to an orthodontic
specialist by general dentists and (perhaps
paediatric dentists).

41. 7 years old 9 years old 14 years old
Changes in the axial inclination due to the eruption of the maxillary anterior
teeth (Broadbent, 1957).

44. BENEFITS OF EARLY
TREATMENT
• Avoid unnecessary periodontal problems.
• Enhance the long term stability of orthodontic
treatments.
• Involve more clinicians in guiding the
developing dentition.

45. D362 / Q362
Division of Orthodontic & Paediatric Dentistry
University of Western Ontario
Dr. Sahza Hatibovic-Kofman
ECTOPIC ERUPTION AND
SPACE REGAINING
2004-2005

46. ECTOPIC ERUPTION

47. GENERAL OBJECTIVE:
To discuss the problem of ectopic
eruption generally.
To discus the problem of ectopic eruption
the canine and first permanent molar and
its management.
ECTOPIC ERUPTION

48. SPECIFIC OBJECTIVES:
1. Define ectopic eruption.
2. Know the frequency of ectopically
eruption first permanent molars.
3. Explain the reasons for ectopic eruption
occurring with first permanent molars.
4. Distinguish between a reversible and
non-reversible ectopic eruption.

49. SPECIFIC OBJECTIVES (continued):
5. Know methods for correcting ectopic
molar eruption.
6. Explain why long term follow-up is needed
for corrected ectopic eruption cases.
REQUIRED READING
Article: Weinberger, S., Wright, G., “The
Unpredictability of primary molar resorption
following ectopic eruption of permanent
molars”, Journal of Dentistry for Children,
Nov-Dec, 1987.

50. REQUIRED READING (continued)
Article: Weinberger, S., “Correction of bilateral
ectopic eruption of first permanent molars
using a fixed appliance”, Pediatric
Dentistry, Nov-Dec, 1992, Vol 14, No. 6

51. Malposition of a permanent tooth
bud can lead to eruption in the
wrong place, and usually the tooth
on its way resorbs the tooth that it
is not supposed to resorb.

52. ANOMALIES OF POSITION

66. ECTOPIC ERUPTION
OF THE
FIRST PERMAMENT MOLAR

67. Reported prevalance of ectopic
eruption of the first permanent molars
Authors Year of
study
Country Number Of
CHILDREN
Children With
NUMBER
Ectopic Eruption
PERCENT
Cheyne & Wessels 1947 USA 500 9 2
Young 1957 USA 1,619 52 2
O'Meara 1962 USA 315 6 2
Pulver 1968 USA 831 26 3.1
Bjerklin & Kurol 1981 Sweden 2,903 126 4.3
Mackerle-Heporauto 1981 Switzer-
land
543 32 6
Kimmel et al 1982 USA 5,277 250 3.8
Kurol-1986

68. TWO TYPES OF ECTOPIC
MOLARS ARE:
1. REVERSIBLE OR “JUMP”.
2. IRREVERSIBLE OR “LOCK” TYPE.

74. HOW MANY WAYS ARE THERE
TO MANAGE ECTOPIC ERUPTION

83. A ligature wire is passed through beneath the
contact and then twisted tightly.

87. REGAINING SPACE IN THE
MIXED DENTION

88. GENERAL OBJECTIVE:
Diagnose and regain the space loss.
REGAINING SPACE IN THE MIXED
DENTITION

89. SPECIFIC OBJECTIVES:
1. Explain how space loss occurs in the
posterior region.
2. Describe indications for space regaining
in regards to the magnitude of space loss.
3. Describe the differences between
maxillary and mandibular arch space
regaining.
4. Describe indications for tipping and
bodily tooth movement to regain the
space.

90. SPECIFIC OBJECTIVES (continued):
5. List the diagnostic aids required prior to
initiating space regaining.
6. Present the maximum amount of space
that can likely be regained with removable
appliances and the time for the treatment.
7. Describe the most commonly used
appliances for space regaining, such as:
(a) removable applicant with finger
spring

91. SPECIFIC OBJECTIVES (continued):
7. (b) removable appliance with jackscrew
(c) fixed appliance with coil spring
(d) lip bumper
REFERENCE:
Proffit, Contemporary Orthodontics, 2nd
ed., 1993, Chapter 13, pp. 382-387

92. Space regaining procedures
should be limited to re-
establishing 3 mm. Or less of
space in a localized area.

93. Generally, space is easier to
regain in the maxillary arch than in
the mandibular arch.

94. Space lost from tipping can be
regained when the crown of the
tooth is tipped back to its original
position, but space lost by bodily
tooth movement requires that the
tooth be bodily repositioned.

95. If the primary second molar has
been lost prematurely in a single
quadrant, up to 3 mm. of space
may be regained by tipping the
molar back distally.

96. If space loss is bilateral, the limit
of space regaining is about 4 mm.
for the total arch, or 2 mm. per
quadrant.

97. Croll
Kesling
Halterman
Weinberger

110. CLOSELY OBSERVE
CORRECTED ECTOPIC
ERUPTION CASES