‫‪early orthodontic treatment‬‬

‫ﺍﻟﻤﻌﺎﻟﺠﺔ ﺍﻟﺘﻘﻮﻳﻤﻴﺔ ﺍﻟﻤﺒﻜﺮﺓ‬

‫ﺍﻟﺪﻛﺘﻮﺭ ﻣﻬﻨّﺪ ﺍﻟﻘ ّﺰﺍﺯ‬

‫ﺇﺧﺘﺼﺎﺻﻲ ﺗﻘﻮﻳﻢ ﺍﻷﺳﻨﺎﻥ – ﺗﻮﻟﻮﺯ ‪-‬ﻓﺮﻧﺴﺎ‬
‫‪DR. M. KAZZAZ‬‬
‫‪MSc , Dip Ortho , CES‬‬
 ‫ﻣﺨﻄﻂ ﺍﻟﺒﺤﺚ‬
‫ً‬
‫‪ ‬ﺃﻭﻻ ‪ :‬ﺃﻗﺴﺎﻡ ﺍﳌﻌﺎ�ﺝﺔ ﺍﻟﺘﻘﻮ�ﻤﻴﺔ‪:‬‬
‫‪ ‬ﻣﻌﺎ�ﺝﺎﺕ ﺗﻘﻮ�ﻤﻴﺔ ﻭﻗﺎﺋﻴﺔ‪.‬‬
‫‪ ‬ﻣﻌﺎ�ﺝﺎﺕ ﺗﻘﻮ�ﻤﻴﺔ ﺍﻋ��ﺍﺿﻴﺔ ﺃﻭ ﺗﻮﻗﻌﻴﺔ‪.‬‬
‫‪ ‬ﻣﻌﺎ�ﺝﺎﺕ ﺗﻘﻮ�ﻤﻴﺔ ﺗ�ﺡﻴﺤﻴﺔ‪.‬‬
‫ً‬
‫‪ ‬ﺛﺎﻧﻴﺎ‪ :‬ﻟﺘﻮﻗﻴﺖ ﻷﺍﻣﺜﻞ ﻟﻠﻤﻌﺎ�ﺝﺎﺕ ﺍﻟﺘﻘﻮ�ﻤﻴﺔ‪.‬‬
‫ً‬
‫‪ ‬ﺛﺎﻟﺜﺎ‪:‬ﻭﺭ ﻃﺒﻱﺐ ﻷﺍﺳﻨﺎﻥ ﺍﳌﻤﺎﺭﺱ‪.‬‬
‫ً‬
‫‪ ‬ﺭﺍ�ﻌﺎ‪:‬ﺍﳌﻌﺎ�ﺝﺔ ﺍﳌﺒﻜﺮﺓ ﻟﻼﺿﻄﺮﺍﺑﺎﺕ ﺍﻟﺘﻘﻮ�ﻤﻴﺔ ﻏ�� ﺍﻟهﻴ�ﻠﻴﺔ‪:‬‬
‫‪Occlusal Relationship Problems‬‬ ‫‪ ‬ﺻﻄﺮﺍﺑﺎﺕ ﺑﺎﻟﻌﻼﻗﺎﺕ ﻻﺍﻃﺒﺎﻗﻴﺔ‬
‫ﺍﻟﻌﻀﺎﺕ ﺍﳌﻌﻜﻮﺳﺔ ﺫﺍﺕ ﺍﳌﻥﺸﺄ ﺍﻟﺴ�ﻱ )ﺍﻣﺎﻣﻴﺔ ﻭ ﺍ�ﺥﻠﻔﻴﺔ(‬
‫ﺍﻟﻌﻀﺔ ﺍﳌﻔﺘﻮﺣﺔ ﻭﺍﻟﻌﺎﺩﺍﺕ ﺍﻟﻔﻤﻮ�ﺔ ﺍﻟﺴﻱﺌﺔ‬
‫ﺍﻟﻌﻀﺔ ﺍﻟﻌﻤﻴﻘﺔ ﺳﻥﻴﺔ ﺍﳌﻥﺸﺄ‬

‫‪Eruption Problems‬‬ ‫‪ ‬ﺿﻄﺮﺍﺏ �� ﺑﺰﻭﻍ ﻷﺍﺳﻨﺎﻥ‬

‫ﺍﻟﺒﻘﺎﺀ ﺍﳌﺪﻳﺪ ﻟﻸﺳﻨﺎﻥ ﺍﳌﺆﻗﺘﺔ‬
‫ﺍﺳﻨﺎﻥ ﺍﻟﺰﺍﺋﺪﺓ‬
‫ﺍﺳﻨﺎﻥ ﺍﳌﺆﻗﺘﺔ ﺍﳌﻠﺘﺼﻘﺔ‬
‫ﺍﺳﻨﺎﻥ ﺍﳌﻨﺤﺼﺮﺓ ﻭ ﺍﳌﻨﻄﻤﺮﺓ‬
‫‪Space-Related Problems‬‬ ‫‪ ‬ﺍﺿﻄﺮﺍﺑﺎﺕ ﺍﳌﺘﻌﻠﻘﺔ ﺑﺎﳌﺴﺎﻓﺎﺕ‬
‫ﺍﻟﺴﻘﻮﻁ ﺍﳌﺒﻜﺮ ﻟﻸﺳﻨﺎﻥ ﺍﳌﺆﻗﺘﺔ ﻣﻊ ﻭﺟﻮﺩ ﻣﺴﺎﻓﺔ �ﺎﻓﻴﺔ )ﺣﻔﻆ ﺍﳌﺴﺎﻓﺔ(‬
‫ﺍﻟﺴﻘﻮﻁ ﺍﳌﺒﻜﺮ ﻟﻸﺳﻨﺎﻥ ﺍﳌﺆﻗﺘﺔ ﻣﻊ ﻭﺟﻮﺩ �ﺝﺰ ﺑﺎﳌﺴﺎﻓﺔ )ﺍﺳﺘﻌﺎﺩﺓ ﺍﳌﺴﺎﻓﺔ(‬
‫ﺍﻟﻔﺮﺍﻍ ﺍﳌﺘﻮﺳﻂ ﺑ�ﻥ ﺍﻟﺜﻨﺎﻳﺎ ﺍﻟﻌﻠﻮ�ﺔ‬
‫ﺯﺩﺣﺎﻡ ﺍﻟﺴ�ﻱ ﻟﻠﻘﻮﺍﻃﻊ ﻷﺍﻣﺎﻣﻴﺔﺍ�ﺥﻔﺒﻒ ﺇ�� ﺍﳌﺘﻮﺳﻂ ﺍﻟﺸﺪﺓ‬
‫ﺍﺯﺩﺣﺎﻡ ﺍﻟﺴ�ﻱ ﺍﻟﺸﺪﻳﺪ )؟ ﺍﻟﻘﻠﻊ ﺍﻟﺪﻭﺭﻱ(‬
 ‫ً‬
‫‪ ‬ﺭﺍ�ﻌﺎ‪:‬ﺍﳌﻌﺎ�ﺝﺔ ﺍﳌﺒﻜﺮﺓ ﻟﻼﺿﻄﺮﺍﺑﺎﺕ ﺍﻟﺘﻘﻮ�ﻤﻴﺔ ﺍﻟهﻴ�ﻠﻴﺔ‪:‬‬
‫ﺍﻟﻮﻗﺖ ﺍﳌﻨﺎﺳﺐ ﻟﺘﻌﺪﻳﻞ ﺍﻟﻨﻤﻮ‬ ‫‪‬‬
‫ﺍﻟﺘﻀﻴﻖ ﺍﻟﻔ�ﻲ ﺍﻟﻌﻠﻮﻱ‬ ‫‪‬‬
‫ﻣﺸﺎ�ﻞ ﺍﻟﺼﻨﻒ ﺍﻟﺜﺎﻟﺚ‬ ‫‪‬‬
‫ﻣﺸﺎ�ﻞ ﺍﻟﺼﻨﻒ ﺍﻟﺜﺎ�ﻲ‬ ‫‪‬‬
‫ﺸﺎ�ﻞ ﻋﺪﻡ ﺍﻟﺘﻨﺎﻇﺮ ﺍﻟﻮﺟ�ﻱ ﻋﻨﺪ ﻷﺍﻃﻔﺎﻝ‬ ‫‪‬‬
 ‫ﺃﻭﻻ ً‪ :‬ﺃﻗﺴﺎﻡ ﺍﻟﻤﻌﺎﻟﺠﺔ ﺍﻟﺘﻘﻮﻳﻤﻴﺔ‬

‫ﻳﻤﻜﻦ ﺍﻟﺘﻤﻴﻴﺰ ﺑﻴﻦ ﺛﻼﺛﺔ ﺃﻗﺴﺎﻡ ﻟﻠﻤﻌﺎﻟﺠﺔ ﺍﻟﺘﻘﻮﻳﻤﻴﺔ ﺍﻋﺘﻤﺎﺩﺍً ﺑﺸﻜﻞ ﺧﺎﺹ ﻋﻠﻰ‬
‫ﻋﻤﺮ ﺍﻟﻤﺮﻳﺾ‪:‬‬
‫‪ ‬ﺍﻟﻤﻌﺎﻟﺠﺎﺕ ﺍﻟﺘﻘﻮﻳﻤﻴﺔ ﺍﻟﻮﻗﺎﺋﻴﺔ‪.‬‬
‫‪ ‬ﺍﻟﻤﻌﺎﻟﺠﺎﺕ ﺍﻟﺘﻘﻮﻳﻤﻴﺔ ﺍﻻﻋﺘﺮﺍﺿﻴﺔ ﺃﻭ ﺍﻟﺘﻮﻗﻌﻴﺔ‪.‬‬
‫‪ ‬ﺍﻟﻤﻌﺎﻟﺠﺎﺕ ﺍﻟﺘﻘﻮﻳﻤﻴﺔ ﺍﻟﺘﺼﺤﻴﺤﻴﺔ‪.‬‬
 ‫‪Preventive orthodontics‬‬
‫ﺍﻟﻤﻌﺎﻟﺠﺔ ﺍﻟﺘﻘﻮﻳﻤﻴﺔ ﺍﻟﻮﻗﺎﺋﻴﺔ‬

‫‪ Profitt and Ackermann (1980)-has defined it as‬‬

‫‪prevention of potential interference with occlusal development‬‬

‫ﻟﺬﻟﻚ ﻳﺪﺧﻞ ﺗﺤﺖ ﻣﻔﻬﻮﻡ ﺍﻟﺘﻘﻮﻳﻢ ﺍﻟﻮﻗﺎﺋﻲ ﺍﻟﻮﺳﺎﺋﻞ ﺍﻟﻤﺘﺒﻌﺔ ﻟﺘﺼﺤﻴﺢ ﺟﻤﻴﻊ ﺍﻟﻌﺎﺩﺍﺕ ﺍﻟﻔﻤﻮﻳﺔ ﺍﻟﺴﻴﺌﺔ ﻭﺍﻟﺸﺬﻭﺫﺍﺕ‬
‫ﺍﻟﻮﻅﻴﻔﻴﺔ ﺍﻟﺘﻲ ﻗﺪ ﺗﺴﻲء ﺇﻟﻰ ﺍﻟﻨﻤﻮ ﺍﻟﻄﺒﻴﻌﻲ ﻟﻠﻔﻜﻴﻦ ﻭﺍﻷﺳﻨﺎﻥ‪ ،‬ﻛﺬﻟﻚ ﺍﻟﻤﺤﺎﻓﻈﺔ ﻋﻠﻰ ﺍﻟﻤﺴﺎﻓﺔ ﺍﻟﻼﺯﻣﺔ ﻟﺒﺰﻭﻍ‬
‫ﺍﻷﺳﻨﺎﻥ ﺍﻟﺪﺍﺋﻤﺔ ﻭﺗﻄﺒﻴﻖ ﺑﻌﺾ ﺍﻹﺟﺮﺍءﺍﺕ ﺍﻟﺨﺎﺻﺔ ﻓﻲ ﺣﺎﻟﺔ ﻓﻘﺪﺍﻥ ﺑﻌﺾ ﺍﻷﺳﻨﺎﻥ ﺍﻟﻤﺆﻗﺘﺔ )ﺗﻄﺒﻴﻖ ﺣﺎﻓﻈﺎﺕ‬
‫ﺍﻟﻤﺴﺎﻓﺔ ‪(Space maintainers‬‬
 interceptive orthodontic
‫ﺍﻟﻤﻌﺎﻟﺠﺔ ﺍﻟﺘﻘﻮﻳﻤﻴﺔ ﺍﻻﻋﺘﺮﺍﺿﻴﺔ‬
 American Association of Orthodontics has defined ‘

interceptive Orthodontics as that phase of the science and art of orthodontics

employed to recognize and eliminate potential irregularities and malpositions in
the developing dentofacial complex'.

‫ﺍﻟﻬﺪﻑ ﺍﻟﺮﺋﻴﺴﻲ ﻟﻠﻤﻌﺎﻟﺠﺎﺕ ﺍﻟﺘﻮﻗﻌﻴﺔ ﺍﻟﻜﺸﻒ ﺍﻟﻤﺒﻜﺮ ﻋﻦ ﺣﺎﻻﺕ ﺳﻮء ﺍﻹﻁﺒﺎﻕ ﻭﻣﻌﺎﻟﺠﺘﻬﺎ ﻭﻫﻲ ﻣﺎ ﺗﺰﺍﻝ ﻓﻲ‬
‫ﻁﻮﺭﻫﺎ ﺍﻟﺒﺪﺍﺋﻲ ﻭﺑﺎﻟﺘﺎﻟﻲ ﺗﺼﺤﻴﺢ ﺍﻟﺤﺎﻟﺔ ﺑﺸﻜﻞ ﻣﺒﻜﺮ ﺃﻱ ﺧﻼﻝ ﻓﺘﺮﺓ ﺍﻹﻁﺒﺎﻕ ﺍﻟﻤﺨﺘﻠﻂ ﺑﺸﻜﻞ ﻧﻬﺎﺋﻲ ﺃﻭ ﺗﻬﻴﺌﺔ‬
.‫ﺍﻟﺤﺎﻟﺔ ﻛﻲ ﻳﺘﻢ ﺇﻧﻬﺎﺅﻫﺎ ﺑﺈﺟﺮﺍءﺍﺕ ﺗﻘﻮﻳﻤﻴﺔ ﺑﺴﻴﻄﺔ ﺧﻼﻝ ﻓﺘﺮﺓ ﺍﻹﻁﺒﺎﻕ ﺍﻟﺪﺍﺋﻢ‬
What is the definition of early treatment ?

‫ﺍﻟﻤﻌﺎﻟﺠﺔ ﺍﻟﺘﻘﻮﻳﻤﻴﺔ ﺍﻟﻤﺒﻜﺮﺓ‬

 According to American Board of Orthodontics:

Treatments started in either the primary or mixed dentitions
that are performed to enhance the dental and skeletal
development before the eruption of the permanent
dentition.
 Its purpose is to either correct or intercept a malocclusion
and to reduce the need or the time for treatment in the
permanent dentition.
What are some perceived advantages
of early treatment?
Ability to modify skeletal growth
Better and more stable treatment
results
Less iatrogenic tooth damage
Better cooperation
Improved patient self esteem
 ‫ ﺇﻣﻜﺎﻧﻴﺔ ﺗﻌﺪﻳﻞ ﺍﻟﻨﻤﻮ ﺍﻟﻬﻴﻜﻠﻲ‬
 ً ‫ ﻧﺘﺎﺋﺞ ﺍﻟﻤﻌﺎﻟﺠﺔ ﺃﻓﻀﻞ ﻭ ﺃﻛﺜﺮ ﺛﺒﺎﺗﺎ‬
‫ ﺃﻗﻞ ﺇﻣﻜﺎﻧﻴﺔ ﻟﻠﻀﺮﺭ ﺑﺎﻷﺳﻨﺎﻥ‬

 ‫ ﺗﻌﺎﻭﻥ ﺍﻟﻤﺮﻳﺾ ﺃﻓﻀﻞ‬
 ‫ ﺗﻌﺰﻳﺰ ﺛﻔﺔ ﺍﻟﻤﺮﻳﺾ ﺑﻨﻔﺴﻪ‬
 What are the perceived disadvantages
of early treatment?

 Variation in results and stability ‫ ﺗﻌﺪﺩ ﺍﻟﻤﺘﻐﻴﺮﺍﺕ ﺍﻟﺘﻲ ﺗﺆﺛﺮ ﻋﻠﻰ ﻧﺘﺎﺋﺞ ﻭ ﺍﺳﺘﻘﺮﺍﺭﺍﻟﻤﻌﺎﻟﺠﺔ‬

 Increased treatement duration ‫ ﺍﺯﺩﻳﺎﺩ ﻓﺘﺮﺓ ﺍﻟﻌﻼﺝ ﻭ ﺗﻜﻠﻔﺔ ﺍﻟﻤﻌﺎﻟﺠﺔ‬

and costs
‫ ﺗﻀﺎﺅﻝ ﺣﻤﺎﺱ ﻭ ﺗﻤﻠﻤﻞ ﺍﻟﻤﺮﺿﻰ‬
 Patient “ burnout”
 ‫ﺛﺎﻧﻴﺎً‪ :‬ﺗﻮﻗﻴﺖ ﺍﻟﻤﻌﺎﻟﺠﺔ ﺍﻟﺘﻘﻮﻳﻤﻴﺔ‬
‫‪timing for orthodontic treatment‬‬

‫ﻳﻤﻜﻦ ﺇﺟﺮﺍء ﺍﻟﻤﻌﺎﻟﺠﺔ ﺍﻟﺘﻘﻮﻳﻤﻴﺔ ﻓﻲ ﺟﻤﻴﻊ ﺍﻷﻋﻤﺎﺭ ﻟﻜﻦ ﺍﻹﻣﻜﺎﻧﻴﺎﺕ ﻭﺍﻟﻮﺳﺎﺋﻞ ﺍﻟﻌﻼﺟﻴﺔ ﺗﺨﺘﻠﻒ ﻣﻦ ﻋﻤﺮ‬
‫ﻵﺧﺮ ﻭﺍﻟﺘﻮﻗﻴﺖ ﺍﻟﻤﺜﺎﻟﻲ ﻟﻠﻤﻌﺎﻟﺠﺔ ﺍﻟﺘﻘﻮﻳﻤﻴﺔ ﻳﻜﻮﻥ ﺑﺸﻜﻞ ﻋﺎﻡ ﻓﻲ ﻋﻤﺮ ‪ 9‬ـ ‪ 11‬ﺳﻨﺔ ﻭﺫﻟﻚ ﻟﺴﺒﺒﻴﻦ‪:‬‬

‫ﺍﻟﺴﺒﺐ ﺍﻷﻭﻝ‪ :‬ﺃﻥ ﻫﺬﻩ ﺍﻟﻔﺘﺮﺓ ﺗﻮﺍﻓﻖ ﻣﺮﺣﻠﺔ ﺗﺴﺎﺭﻉ ﻧﻤﻮ ﺍﻟﻮﺟﻪ ﻭﺍﻟﻔﻜﻴﻦ ﺍﻟﺘﻲ ﺗﺴﺒﻖ ﻣﺮﺣﻠﺔ ﺍﻟﺒﻠﻮﻍ ﺍﻟﺠﻨﺴﻲ‬ ‫‪‬‬
‫‪ ،‬ﻓﺈﺫﺍ ﺗﻢ ﺍﻟﺘﺪﺍﺧﻞ ﻓﻲ ﻫﺬﻩ ﺍﻟﻔﺘﺮﺓ ﻳﻤﻜﻦ ﺍﻻﺳﺘﻔﺎﺩﺓ ﻣﻦ ﻣﻌﺪﻻﺕ ﻧﻤﻮ ﺍﻟﻔﻜﻴﻦ ﺍﻟﺘﻲ ﺗﻜﻮﻥ ﻓﻲ ﻁﻮﺭ ﺍﻟﺘﺴﺎﺭﻉ ﻭﺗﺼﻞ‬
‫ﺣﺪﻫﺎ ﺍﻷﻗﺼﻰ ﺧﻼﻝ ﻓﺘﺮﺓ ﺍﻟﻮﺛﺒﺔ ‪ Spurt‬ﻭﺑﺎﻟﺘﺎﻟﻲ ﺗﻮﺟﻴﻪ ﻧﻤﻮ ﺍﻟﻘﻮﺍﻋﺪ ﺍﻟﻔﻜﻴﺔ ﺑﺸﻜﻞ ﻣﻼﺋﻢ ﻟﺘﺄﺳﻴﺲ ﻋﻼﻗﺎﺕ‬
‫ﻗﺎﻋﺪﻳﺔ ﻁﺒﻴﻌﻴﺔ‪.‬‬

‫ﺍﻟﺴﺒﺐ ﺍﻟﺜﺎﻧﻲ‪ :‬ﻫﺬﺍ ﺍﻟﻌﻤﺮ ﻛﻤﺎ ﻧﻌﻠﻢ ﻳﻮﺍﻓﻖ ﻓﺘﺮﺓ ﺗﺒﺪﻳﻞ ﺍﻷﺭﺣﺎء ﺍﻟﺜﺎﻧﻴﺔ ﺍﻟﻤﺆﻗﺘﺔ ﻭﺑﺰﻭﻍ ﺍﻟﻀﻮﺍﺣﻚ ﺍﻟﺜﺎﻧﻴﺔ‬ ‫‪‬‬
‫ﻭﻳﻤﻜﻦ ﺑﻮﺍﺳﻄﺔ ﺍﻟﺘﺪﺍﺧﻞ ﺍﻟﻌﻼﺟﻲ ﻗﺒﻞ ﺳﻘﻮﻁ ﺍﻟﺮﺣﻰ ﺍﻟﻤﺆﻗﺘﺔ ﺍﻻﺳﺘﻔﺎﺩﺓ ﻣﻦ ﺍﻟﻤﺴﺎﻓﺔ ﺍﻹﻳﺠﺎﺑﻴﺔ ﺍﻟﻨﺎﺗﺠﺔ ﻋﻦ‬
‫ﺍﻟﻔﺮﻕ ﺑﻴﻦ ﺣﺠﻤﻬﺎ ﻭﺣﺠﻢ ﺍﻟﻀﺎﺣﻚ ﺍﻟﺜﺎﻧﻲ ﺗﺒﻠﻎ ﻗﻴﻤﺔ ﻫﺬﻩ ﺍﻟﻤﺴﺎﻓﺔ ﻛﻤﺎ ﻧﻌﺎﻡ ﺣﻮﺍﻟﻲ ‪ 4‬ﻣﻠﻢ ﻋﻠﻰ ﺍﻟﻔﻚ ﺍﻟﺴﻔﻠﻲ ﻭ‪3‬‬
‫ﻣﻠﻢ ﻋﻠﻰ ﺍﻟﻔﻚ ﺍﻟﻌﻠﻮﻱ ﻭﻳﻤﻜﻦ ﺍﻻﺳﺘﻔﺎﺩﺓ ﻣﻨﻬﺎ ﻛﺜﻴﺮﺍً ﻟﺘﺨﻔﻴﻒ ﺣﺎﻻﺕ ﺍﻟﺘﺮﺍﻛﺐ ﺍﻟﺴﻨﻲ ﺧﻼﻝ ﻓﺘﺮﺓ ﺍﻹﻁﺒﺎﻕ‬
‫ﺍﻟﻤﺨﺘﻠﻂ ﻭﺑﺎﻟﺘﺎﻟﻲ ﺗﺠﻨﺐ ﻗﻠﻊ ﺑﻌﺾ ﺍﻟﻮﺣﺪﺍﺕ ﺍﻟﺴﻨﻴﺔ ﺍﻟﺪﺍﺋﻤﺔ‪.‬‬
 ‫هﻨﺎﻙ �ﻌﺾ ﺍ�ﺡﺎﻻﺕ ﺍﻟﺘﻘﻮ�ﻤﻴﺔ ﺍﻟ�ﻱ �ﺸﺬ ﻋﻦ ﺍﻟﻘﺎﻋﺪﺓ ﻭﺗﺘﻄﻠﺐ ﻣﻌﺎ�ﺝﺔ ﺗﻘﻮ�ﻤﻴﺔ ﻣﺒﻜﺮﺓ ﻭﺃهﻢ هﺬﻩ ﺍ�ﺡﺎﻻﺕ‪:‬‬

‫ﺣﺎﻻت ﺷﻘﻮق اﻟﺸﻔﺔ وﻗﺒﺔ اﻟﺤﻨﻚ اﻟﺘﻲ ﺗﺘﻄﻠﺐ ﺳﻠﺴﻠﺔ ﻣﻦ اﻟﻤﻌﺎﻟﺠﺎت اﻟﺘﻘﻮﻳﻤﻴﺔ اﻟﺘﻲ ﻗﺪ ﺗﺒﺪأ ﻣﻨﺬ اﻟﺸﻬﺮ اﻷول ﺑﻌﺪ اﻟﻮﻻدة‪.‬‬ ‫‪‬‬

‫‪ ‬اﻟﻌﻀﺎت اﻟﻤﻌﻜﻮﺳـﺔ اﻷﻣﺎﻣﻴـﺔ واﻟﺨﻠﻔﻴـﺔ ﺧﺎﺻـﺔ ﺗﻠـﻚ اﻟﺘﺮاﻓﻘـﺔ ﺑـﺎﻧﺤﺮاف وﻇﻴﻔـﻲ واﻟﺘـﻲ ﺗﺘﻄﻠـﺐ ﻣﻌﺎﻟﺠـﺔ إﺳـﻌﺎﻓﻴﺔ ﻓـﻮر اﻛﺘﺸـﺎﻓﻬﺎ ﻋﻠـﻰ‬
‫اﻋﺘﺒــﺎر أن اﺳــﺘﻤﺮارﻳﺘﻬﺎ ﺧــﻼل ﻓﺘــﺮة اﻹﻃﺒــﺎق اﻟﻤﺨــﺘﻠﻂ ﺳــﻮف ﻳــﻨﺠﻢ ﻋﻨــﻪ ﻏﺎﻟﺒـﺎً ﺗﺸــﻮﻫﺎت ﻫﻴﻜﻠﻴــﺔ داﺋﻤــﺔ ﺑﺴــﺒﺐ اﻟﻨﻤــﻮ ﻏﻴــﺮ اﻟﻄﺒﻴﻌــﻲ‬
‫ﻟﻠﻔﻜﻴﻦ‪.‬‬
‫ﺣﻴ ــﺚ ﻗ ــﺪ ﻳﻨﺸ ــﺄ ﻋ ــﻦ اﻟﻌﻀ ــﺔ اﻟﻤﻌﻜﻮﺳ ــﺔ اﻷﻣﺎﻣﻴ ــﺔ اﻟﻮﻇﻴﻔﻴ ــﺔ ﺣﺎﻟ ــﺔ ﺻ ــﻨﻒ ﺛﺎﻟ ــﺚ ﺣﻘﻴﻘﻴ ــﺔ )ﺑ ــﺮوز ﻓ ــﻚ ﺳ ــﻔﻠﻲ ‪Mandiular‬‬
‫‪ (prognathism‬وﻋﻦ اﻟﻌﻀﺔ اﻟﻤﻌﻜﻮﺳﺔ اﻟﺨﻠﻔﻴﺔ اﻟﻮﻇﻴﻔﻴﺔ ﻋﺪم ﺗﻨﺎﻇﺮ وﺟﻬﻲ ‪.Facial asymmetry‬‬

‫‪ ‬ﺣﺎﻻت اﻟﺼﻨﻒ اﻟﺜﺎﻟﺚ ﺧﺎﺻﺔً ذات اﻟﻤﻨﺸﺄ اﻟﻮﻇﻴﻔﻲ اﻟﺴﻨﻲ‪.‬‬

‫‪ ‬ﺣــﺎﻻت اﻟﺒــﺮوز اﻟﻤﻔــﺮط ﻟﻠﻔــﻚ اﻟﻌﻠــﻮي ﻟﺘﻔــﺎدي ﺧﻄــﺮ اﻧﻜﺴــﺎر اﻟﻘﻮاﻃــﻊ اﻟﻌﻠﻮﻳــﺔ ﻧﻈــﺮاً ﻷﻧﻬــﺎ ﺗﻜــﻮن ﻋﺮﺿــﺔ ﻟﻠﺮﺿــﻮض ﺑﺴــﺒﺐ ﺑﺮوزﻫــﺎ‬
‫اﻟﺸﺪﻳﺪ‪.‬‬

‫‪ ‬ﺣــﺎﻻت اﻟﻌﻀــﺔ اﻟﻤﻐﻠﻘــﺔ ‪ Closed bite‬وذﻟــﻚ ﻟﺘﺤﺮﻳــﺮ اﻟﻨﻤــﻮ اﻷﻣــﺎﻣﻲ ﻟﻠﻔــﻚ اﻟﺴــﻔﻠﻲ وﻟﺘﻔــﺎدي اﻟﻤﺸــﺎﻛﻞ اﻟﺮﻋﻠﻴــﺔ اﻟﻨﺎﺗﺠــﺔ ﻋــﻦ‬
‫إﻃﺒﺎق اﻷﺳﻨﺎن اﻷﻣﺎﻣﻴﺔ ﻋﻠﻰ اﻷﻧﺴﺠﺔ اﻟﺮﺧﻮة اﻟﻔﻤﻮﻳﺔ‪.‬‬

‫‪ ‬ﺟﻤﻴﻊ اﻟﻌﺎدات اﻟﻔﻤﻮﻳﺔ اﻟﻤﺘﺮاﻓﻘﺔ ﺑﻌﺎدات ﻓﻤﻮﻳﺔ ﺳﻴﺌﺔ وﻓﻌﺎﻟﻴﺎت ﻏﻴﺮ ﻃﺒﻴﻌﻴﺔ ﻟﻠﻌﻀﻼت اﻟﺸﻔﻮﻳﺔ وﺣـﻮل اﻟﻔﻤﻮﻳـﺔ واﻷوﺿـﺎع اﻟﺨﺎﻃﺌـﺔ‬
‫ﻟﻠﺴﺎن‪.‬‬
 ‫‪Appropriate treatment timing‬‬ ‫ﺍﻟﺘﻮﻗﻴﺖ ﺍﻷﻣﺜﻞ ﻟﻠﻤﻌﺎﻟﺠﺔ ﺍﻟﺘﻘﻮﻳﻤﻴﺔ‬
‫‪Primary dentition‬‬ ‫‪Early mixed‬‬ ‫‪Late mixed‬‬ ‫‪Permanent‬‬ ‫‪Permanent‬‬
‫ﺍﻹﻁﺒﺎﻕ ﺍﻟﻤﺆﻗﺖ‬ ‫ﺍﻻﻁﺒﺎﻕ ﺍﻟﻤﺨﺘﻠﻂ ﺍﻟﻤﺒﻜﺮ‬ ‫ﺍﻻﻁﺒﺎﻕ ﺍﻟﻤﺨﺘﻠﻂ ﺍﻟﻤﺘﺄﺧﺮ‬ ‫)‪( Growing‬‬ ‫)‪( Non –Growing‬‬
‫ﺍﻹﻁﺒﺎﻕ ﺍﻟﺪﺍﺋﻢ‬ ‫ﺍﻹﻁﺒﺎﻕ ﺍﻟﺪﺍﺋﻢ‬
‫‪4-6 years‬‬ ‫‪6-8 years‬‬ ‫‪8-11 years‬‬ ‫)ﺍﻟﻨﻤﻮ ﻣﺘﺒﻘﻲ(‬ ‫)ﻧﻬﺎﻳﺔ ﺍﻟﻨﻤﻮ(‬

‫‪crossbite without functional shift‬‬ ‫‪Surgical Class II‬‬

‫‪Space management‬‬ ‫ﺍﻟﻌﻀﺎﺕ ﺍﻟﻤﻌﻜﻮﺳﺔ ﻏﻴﺮ ﺍﻟﻤﺘﺮﺍﻓﻘﺔ ﺑﺎﻧﺤﺮﺍﻑ ﻭﻅﻴﻔﻲ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺎﺕ ﺍﻟﺘﻘﻮﻳﻤﻴﺔ‬
‫ﺇﺩﺍﺭﺓ ﻭﺗﻮﺯﻳﻊ ﺍﻟﻤﺴﺎﻓﺎﺕ‬ ‫ﺍﻟﺠﺮﺍﺣﻴﺔ‬

‫‪Oral habits‬‬ ‫‪Severe crowding leading‬‬ ‫‪Moderate to severe crowding‬‬ ‫‪Surgical Class III‬‬
‫ﺍﻟﻌﺎﺩﺍﺕ ﺍﻟﻔﻤﻮﻳﺔ ﺍﻟﺴﻴﺌﺔ‬ ‫‪to serial extraction‬‬ ‫ﺍﻻﺯﺩﺣﺎﻡ ﺍﻟﺸﺪﻳﺪ ﺃﻭ ﺍﻟﻤﺘﻮﺳﻂ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺎﺕ ﺍﻟﺘﻘﻮﻳﻤﻴﺔ‬
‫ﺍﻻﺯﺩﺣﺎﻡ ﺍﻟﺸﺪﻳﺪ ﺍﻟﺬﻱ ﻳﺘﻄﻠﺐ‬ ‫ﺍﻟﺠﺮﺍﺣﻴﺔ‬
‫ﺍﻟﺴﻴﺮ ﺑﺎﻟﻘﻠﻊ ﺍﻟﺪﻭﺭﻱ‬
‫‪crossbite with‬‬ ‫‪Class II malocclusions‬‬
‫‪functional shift‬‬ ‫ﻣﻌﺎﻟﺠﺔ ﺃﺳﻮﺍء ﺍﻹﻁﺒﺎﻕ ﻣﻦ ﺍﻟﺼﻨﻒ ﺍﻟﺜﺎﻧﻲ‬
‫ﺍﻟﻌﻀﺎﺕ ﺍﻟﻤﻌﻜﻮﺳﺔ‬
‫ﺍﻟﻤﺘﺮﺍﻓﻘﺔ ﺑﺎﻧﺤﺮﺍﻑ ﻭﻅﻴﻔﻲ‬

‫‪Class III malocclusions : facemask therapy‬‬

‫‪Class II malocclusions‬‬
‫ﻣﻌﺎﻟﺠﺔ ﺃﺳﻮﺍء ﺍﻹﻁﺒﺎﻕ ﻣﻦ ﺍﻟﺼﻨﻒ ﺍﻟﺜﺎﻟﺚ‬
‫ﺛﺎﻟﺜﺎً‪ :‬ﺩﻭﺭ ﻁﺒﻴﺐ ﺍﻷﺳﻨﺎﻥ ﺍﻟﻤﻤﺎﺭﺱ‬
‫‪ ‬ﺍﻹﻟﻤﺎﻡ ﺑﺠﻤﻴﻊ ﺇﻣﻜﺎﻧﺎﺕ ﺍﻟﻤﻌﺎﻟﺠﺔ ﺍﻟﺘﻘﻮﻳﻤﻴﺔ ﻋﻠﻰ ﺍﺧﺘﻼﻑ ﺃﻧﻮﺍﻋﻬﺎ‪.‬‬

‫‪ ‬ﺍﻟﺘﻤﻜﻦ ﻣﻦ ﺍﻟﻤﻌﺎﻟﺠﺔ ﺍﻟﺘﻘﻮﻳﻤﻴﺔ ﺍﻟﻮﻗﺎﺋﻴﺔ ﺍﻟﺘﻲ ﺗﺒﺪﺃ ﻣﻦ ﺍﻟﻤﺮﺣﻠﺔ ﻣﺎ ﻗﺒﻞ ﺍﻟﻮﻻﺩﺓ‪.‬‬

‫‪ ‬ﻣﻌﺮﻓﺔ ﻣﻤﻴﺰﺍﺕ ﺟﻤﻴﻊ ﻣﺮﺍﺣﻞ ﺍﻹﻁﺒﺎﻕ ﺍﻟﺴﻨﻲ ﺍﻟﻤﺆﻗﺖ ‪ -‬ﺍﻟﻤﺨﺘﻠﻂ – ﺍﻟﺪﺍﺋﻢ‪.‬‬

‫‪ ‬ﺗﺸﺨﻴﺺ ﺟﻤﻴﻊ ﺃﺳﻮﺍء ﺍﻹﻁﺒﺎﻕ ﻭﻣﻌﺮﻓﺔ ﺍﻟﺘﻮﻗﻴﺖ ﺍﻷﻣﺜﻞ ﻟﻤﻌﺎﻟﺠﺔ ﻛﻞ ﻣﻨﻬﺎ‪.‬‬

‫‪ ‬ﻣﻌﺎﻟﺠﺔ ﺍﻟﺤﺎﻻﺕ ﺍﻟﺒﺴﻴﻄﺔ ﻣﻦ ﺃﺳﻮﺍء ﺍﻹﻁﺒﺎﻕ ﻏﻴﺮ ﺍﻟﻬﻴﻜﻠﻴﺔ ﻓﻲ ﻣﺮﺣﻠﺔ ﺍﻹﻁﺒﺎﻕ ﺍﻟﻤﺨﺘﻠﻂ‪.‬‬

‫‪ ‬ﺇﺣﺎﻟﺔ ﺍﻟﺤﺎﻻﺕ ﺍﻟﺼﻌﺒﺔ ﺑﺎﻟﺘﻮﻗﻴﺖ ﺍﻟﻤﻨﺎﺳﺐ ﻟﻸﺧﺼﺎﺋﻲ‪.‬‬

 ‫ً‬
‫‪ ‬ﺭﺍ�ﻌﺎ‪:‬ﺍﳌﻌﺎ�ﺝﺔ ﺍﳌﺒﻜﺮﺓ ﻟﻼﺿﻄﺮﺍﺑﺎﺕ ﺍﻟﺘﻘﻮ�ﻤﻴﺔ ﻏ�� ﺍﻟهﻴ�ﻠﻴﺔ‪:‬‬
‫‪Eruption Problems‬‬ ‫‪ ‬ﺿﻄﺮﺍﺏ �� ﺑﺰﻭﻍ ﻷﺍﺳﻨﺎﻥ‬
‫ﺍﻟﺒﻘﺎﺀ ﺍﳌﺪﻳﺪ ﻟﻸﺳﻨﺎﻥ ﺍﳌﺆﻗﺘﺔ‬
‫ﺍﺳﻨﺎﻥ ﺍﻟﺰﺍﺋﺪﺓ‬
‫ﺍﺳﻨﺎﻥ ﺍﳌﺆﻗﺘﺔ ﺍﳌﻠﺘﺼﻘﺔ‬
‫ﺍﺳﻨﺎﻥ ﺍﳌﻨﺤﺼﺮﺓ ﻭ ﺍﳌﻨﻄﻤﺮﺓ‬

‫‪Space-Related Problems‬‬ ‫‪ ‬ﺍﺿﻄﺮﺍﺑﺎﺕ ﺍﳌﺘﻌﻠﻘﺔ ﺑﺎﳌﺴﺎﻓﺎﺕ‬

‫ﺍﻟﺴﻘﻮﻁ ﺍﳌﺒﻜﺮ ﻟﻸﺳﻨﺎﻥ ﺍﳌﺆﻗﺘﺔ ﻣﻊ ﻭﺟﻮﺩ ﻣﺴﺎﻓﺔ �ﺎﻓﻴﺔ )ﺣﻔﻆ ﺍﳌﺴﺎﻓﺔ(‬
‫ﺍﻟﺴﻘﻮﻁ ﺍﳌﺒﻜﺮ ﻟﻸﺳﻨﺎﻥ ﺍﳌﺆﻗﺘﺔ ﻣﻊ ﻭﺟﻮﺩ �ﺝﺰ ﺑﺎﳌﺴﺎﻓﺔ )ﺍﺳﺘﻌﺎﺩﺓ ﺍﳌﺴﺎﻓﺔ(‬
‫ﺍﻟﻔﺮﺍﻍ ﺍﳌﺘﻮﺳﻂ ﺑ�ﻥ ﺍﻟﺜﻨﺎﻳﺎ ﺍﻟﻌﻠﻮ�ﺔ‬
‫ﺯﺩﺣﺎﻡ ﺍﻟﺴ�ﻱ ﻟﻠﻘﻮﺍﻃﻊ ﻷﺍﻣﺎﻣﻴﺔﺍ�ﺥﻔﺒﻒ ﺇ�� ﺍﳌﺘﻮﺳﻂ ﺍﻟﺸﺪﺓ‬
‫ﺍﺯﺩﺣﺎﻡ ﺍﻟﺴ�ﻱ ﺍﻟﺸﺪﻳﺪ )؟ ﺍﻟﻘﻠﻊ ﺍﻟﺪﻭﺭﻱ(‬

‫‪Occlusal Relationship Problems‬‬ ‫‪ ‬ﺻﻄﺮﺍﺑﺎﺕ ﺑﺎﻟﻌﻼﻗﺎﺕ ﻻﺍﻃﺒﺎﻗﻴﺔ‬

‫ﺍﻟﻌﻀﺎﺕ ﺍﳌﻌﻜﻮﺳﺔ ﺫﺍﺕ ﺍﳌﻥﺸﺄ ﺍﻟﺴ�ﻱ )ﺍﻣﺎﻣﻴﺔ ﻭ ﺍ�ﺥﻠﻔﻴﺔ(‬
‫ﺍﻟﻌﻀﺔ ﺍﳌﻔﺘﻮﺣﺔ ﻭﺍﻟﻌﺎﺩﺍﺕ ﺍﻟﻔﻤﻮ�ﺔ ﺍﻟﺴﻱﺌﺔ‬
‫ﺍﻟﻌﻀﺔ ﺍﻟﻌﻤﻴﻘﺔ ﺳﻥﻴﺔ ﺍﳌﻥﺸﺄ‬

‫‪‬‬

‫‪.‬‬
Ectopic Eruption
 ‫‪Ectopic Eruption‬‬
‫ﺍﻷﺳﻨﺎﻥ ﺍﻟﻤﻨﻄﻤﺮﺓ‬
‫‪Impacted teeth‬‬
‫ﺇﺫﺍ ﻟﻢ ﺗﺒﺰﻍ ﺍﻟﺴﻦ ﺍﻟﺪﺍﺋﻤﺔ ﺑﻌﺪ ‪ 6‬ـ ‪ 12‬ﺷﻬﺮﺍً ﻣﻦ ﺑﺰﻭﻍ ﺍﻟﺴﻦ ﺍﻟﻤﻨﺎﻅﺮﺓ ﻟﻬﺎ ﻳﺠﺐ ﺍﻻﺷ�ﺘﺒﺎﻩ ﺑﻮﺟ�ﻮﺩ ﻣﺸ�ﻜﻠﺔ‬
‫ﻣﺎ ﺃﻭ ﻋﺎﺋﻖ ﻳﻤﻨﻊ ﺍﻟﺒﺰﻭﻍ ﺍﻟﻄﺒﻴﻌﻲ‪.‬‬
‫ﻭﻣﻦ ﺍﻷﺳﺒﺎﺏ ﺍﻟﺘﻲ ﻳﻤﻜﻨﻬﺎ ﺗﺄﺧﻴﺮ ﺍﻟﺒﺰﻭﻍ ﻛﻤﺎ ﺫﻛﺮﻧﺎ ﺳﺎﺑﻘﺎ ً‪:‬‬
‫ﺍﻟﻮﺿﻊ ﺍﻟﺸﺎﺫ ﻟﻠﺒﺮﻋﻢ ـ ﺍﻟﺒﻘﺎء ﺍﻟﻤﺪﻳ�ﺪ ﻟﻠﺴ�ﻦ ﺍﻟﻤﺆﻗﺘ�ﺔ ـ ﺍﻷﺳ�ﻨﺎﻥ ﺍﻟﺰﺍﺋ�ﺪﺓ ـ ﺗﺸ�ﻜﻞ ﺣ�ﺎﺟﺰ ﻟﻴﻔ�ﻲ‬
‫ﻟﺜﻮﻱ ﻓﻮﻕ ﺍﻟﺒﺮﻋﻢ ـ ﺍﻷﻛﻴﺎﺱ ﻭﺍﻷﻭﺭﺍﻡ ﺍﻟﺴﻨﻴﺔ ـ ﺍﻟﻌﺠﺰ ﺍﻟﻘﺎﻋﺪﻱ‪.‬‬
10 years
 following removal of the
supernumerary teeth

7 months later
Occlusion 3 years after initial presentation
 ‫ً‬
‫‪ ‬ﺭﺍ�ﻌﺎ‪:‬ﺍﳌﻌﺎ�ﺝﺔ ﺍﳌﺒﻜﺮﺓ ﻟﻼﺿﻄﺮﺍﺑﺎﺕ ﺍﻟﺘﻘﻮ�ﻤﻴﺔ ﻏ�� ﺍﻟهﻴ�ﻠﻴﺔ‪:‬‬
‫‪Eruption Problems‬‬ ‫‪ ‬ﺿﻄﺮﺍﺏ �� ﺑﺰﻭﻍ ﻷﺍﺳﻨﺎﻥ‬
‫ﺍﻟﺒﻘﺎﺀ ﺍﳌﺪﻳﺪ ﻟﻸﺳﻨﺎﻥ ﺍﳌﺆﻗﺘﺔ‬
‫ﺍﺳﻨﺎﻥ ﺍﻟﺰﺍﺋﺪﺓ‬
‫ﺍﺳﻨﺎﻥ ﺍﳌﺆﻗﺘﺔ ﺍﳌﻠﺘﺼﻘﺔ‬
‫ﺍﺳﻨﺎﻥ ﺍﳌﻨﺤﺼﺮﺓ ﻭ ﺍﳌﻨﻄﻤﺮﺓ‬

‫‪Space-Related Problems‬‬ ‫‪ ‬ﺍﺿﻄﺮﺍﺑﺎﺕ ﺍﳌﺘﻌﻠﻘﺔ ﺑﺎﳌﺴﺎﻓﺎﺕ‬

‫ﺍﻟﻔﺮﺍﻍ ﺍﳌﺘﻮﺳﻂ ﺑ�ﻥ ﺍﻟﺜﻨﺎﻳﺎ ﺍﻟﻌﻠﻮ�ﺔ‬
‫ﺍﻟﺴﻘﻮﻁ ﺍﳌﺒﻜﺮ ﻟﻸﺳﻨﺎﻥ ﺍﳌﺆﻗﺘﺔ ﻣﻊ ﻭﺟﻮﺩ ﻣﺴﺎﻓﺔ �ﺎﻓﻴﺔ )ﺣﻔﻆ ﺍﳌﺴﺎﻓﺔ(‬
‫ﺍﻟﺴﻘﻮﻁ ﺍﳌﺒﻜﺮ ﻟﻸﺳﻨﺎﻥ ﺍﳌﺆﻗﺘﺔ ﻣﻊ ﻭﺟﻮﺩ �ﺝﺰ ﺑﺎﳌﺴﺎﻓﺔ )ﺍﺳﺘﻌﺎﺩﺓ ﺍﳌﺴﺎﻓﺔ(‬
‫ﺯﺩﺣﺎﻡ ﺍﻟﺴ�ﻱ ﻟﻠﻘﻮﺍﻃﻊ ﻷﺍﻣﺎﻣﻴﺔﺍ�ﺥﻔﺒﻒ ﺇ�� ﺍﳌﺘﻮﺳﻂ ﺍﻟﺸﺪﺓ‬
‫ﺍﺯﺩﺣﺎﻡ ﺍﻟﺴ�ﻱ ﺍﻟﺸﺪﻳﺪ )؟ ﺍﻟﻘﻠﻊ ﺍﻟﺪﻭﺭﻱ(‬

‫‪Occlusal Relationship Problems‬‬ ‫‪ ‬ﺻﻄﺮﺍﺑﺎﺕ ﺑﺎﻟﻌﻼﻗﺎﺕ ﻻﺍﻃﺒﺎﻗﻴﺔ‬

‫ﺍﻟﻌﻀﺎﺕ ﺍﳌﻌﻜﻮﺳﺔ ﺫﺍﺕ ﺍﳌﻥﺸﺄ ﺍﻟﺴ�ﻱ )ﺍﻣﺎﻣﻴﺔ ﻭ ﺍ�ﺥﻠﻔﻴﺔ(‬
‫ﺍﻟﻌﻀﺔ ﺍﳌﻔﺘﻮﺣﺔ ﻭﺍﻟﻌﺎﺩﺍﺕ ﺍﻟﻔﻤﻮ�ﺔ ﺍﻟﺴﻱﺌﺔ‬
‫ﺍﻟﻌﻀﺔ ﺍﻟﻌﻤﻴﻘﺔ ﺳﻥﻴﺔ ﺍﳌﻥﺸﺄ‬

‫‪‬‬

‫‪.‬‬
Space-Related Problems
 Excess Space
 Maxillary Midline Diastema ‫ﺍﻟﻔﺮﺍﻍ ﺍﳌﺘﻮﺳﻂ ﺑ�ﻥ ﺍﻟﺜﻨﺎﻳﺎ ﺍﻟﻌﻠﻮ�ﺔ‬

"ugly duckling" Frenotomy

Mesiodens