2023-09-18

Treatment of Non-skeletal
Problems in Preadolescent
Children 3

Dr. Fernando Inocencio

DDS, Dip. in Ortho.
Division of Orthodontics and
Paediatric Dentistry

Space-Related Problems
Irregular and malaligned teeth in the early mixed
dentition arise from two major causes:
• (1) lack of adequate space for alignment, which
causes an erupting tooth to be deflected from its
normal position in the arch; and
• (2) interferences with eruption, which prevent a
permanent tooth from erupting on a normal
schedule and secondarily can lead to space problems
because other teeth drift to improper positions.

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Space-Related Problems
• A major goal of early treatment is to prevent molars
or incisors from drifting after premature loss of
primary teeth, reducing the space available for
unerupted teeth.
• Early treatment to align crowded incisors when space
ultimately would be adequate, or to create some
additional space when a space deficiency exists, may
or may not be indicated.

Space-Related Problems
Excess Space
• Generalized Spacing of Permanent Teeth: Excess
space is not a frequent finding in the mixed dentition
in the absence of incisor protrusion. There is little or
no advantage to early treatment.
• A small maxillary midline diastema, which is present
in many children, is not necessarily an indication for
orthodontic treatment. When a larger diastema (>2
mm) is present, a midline supernumerary tooth or
intrabony lesion must always be suspected.

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Space-Related Problems
Missing Permanent Teeth
• When permanent teeth are congenitally missing, the
patient must have a thorough evaluation to
determine the correct treatment because any of the
diagnostic variables of
• profile,
• incisor position,
• tooth color and shape,
• skeletal and dental development,
• space availability or deficiency

Missing Permanent Teeth

Prosthetic Replacement or Orthodontic Substitution?

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Missing Permanent Teeth

Canine Substitution

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Missing Permanent Teeth

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Missing Permanent Teeth

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Missing Permanent Teeth

Case 1

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Missing Permanent Teeth

Case 1

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Missing Permanent Teeth Case 2

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Missing Permanent Teeth Case 3

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Missing Permanent Teeth Case 3

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Missing Permanent Teeth Case 3

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Severe Crowding of Incisors Without

Adequate Space

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Severe Crowding > 9 mm

Serial Extractions

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Serial Extractions
In many children with severe crowding, a decision can be
made during the early mixed dentition period that expansion
is not advisable and that some permanent teeth will have to
be extracted to make room for the others.
A planned sequence of tooth removal can reduce crowding
and irregularity during the transition from the primary to the
permanent dentition.
It will also allow the teeth to erupt over the alveolus and
through keratinized tissue, rather than being displaced
buccally or lingually.
This sequence, often termed serial extraction, simply involves
the timed extraction of primary and, ultimately, permanent
teeth to relieve severe crowding.

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CASE SELECTION

 Class I Molar
 Facial Skeleton must be balanced
 Slight or no protrusion of the incisors
 10 mm of crowding
 Midlines on
 No deep bite

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