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INTRODUCTION The time to start orthodontic treatment is a basic problem in which there should be considerable harmonious agreement and understanding

But unfortunately there is considerable confusion among various groups within the profession
Some are of opinion that appliances should be placed as soon as any permanent teeth erupts in an abnormal position,while some thinks that no treatment until all permanent teeth have been erupted

Some think that there is importance of balance of environment forces to a good stable occlusion Such people apply principles of growth and development and starting treatment at various ages whenever a definite plan of treatment can be determined where by best stable results can be obtained

The literature of first twenty five years of twentieth century contained many advantages of early treatment

The conclusion was made from this work that early treatment influenced amount and direction of growth of facial bones particularly the mandible
Dr Brodie carried out study on facial pattern and observed that a. orthodontic appliances did not always obtained the result that were observed clinically b. Maxillary teeth did not move distally as was concluded from clinical observation but rather mandibular teeth moved forward in relation to maxillary teeth as well as body of mandible

The findings suggested that the treatment did not change the pattern nor stimulate growth of facial bone .the changes resulting from treatment were confined to alveolar bone

Due to early treatment


teeth placed in normal functioning relationship Better alveolar bone growth Better balance of environmental forces More stable results Tissue destruction and disturbance minimal

Tratment had been postponed

Maxillary arch remained locked within mandibular arch The canines would have been erupted into labial position and protruded into lip The environmental forces,tongue,facial musculature could not have reached their well developed form,position and tonicity

Alveolar bone development would have been retarded Long treatment time and retention period


Reason for failure of some of mixed dentition treatment

Definite rules for treatment : the orthodontic profession has great tedency toward giving rule for treatment Standardization of treatment in various types of malocclusion does not seem possible in orthodontics Principles should be there relating to treatment and time of treatment which can readily be applied to each individual case but not rules


good stable orthodontic result requires a balance of forces of occlusion which means good tongue position and function, good facial musculature and harmonious functional relationship of teeth


Case analyses

analysis of class II malocclusion prior to 1930 etiology mainly was underdevelopment of mandible Treatment plan: a. Place appliances in maxillary and mandibular arch using intermaxillary elastics,thereby stimulating mandibular growth



mandibular growth cannot be increased beyond regular intended growth rate nor could the pattern be changed such cases mandibular teeth moved mesially en masse placing them in protrusive position




such cases reinforce anchorage of mandibular teeth by changing axial inclination it was seen that mandibular teeth still moved mesially



growing alveolar bone is in continuous state of flux and teeth in this type of bone will not provide much anchorage
Change of axial inclination failed to reinforce anchorage as intended



resulted in collapse and failure which were most difficult to treat In second period of treatment after remaining permanent teeth have been erupted


Two points to be considered in use of occipital hedgear: headcap must be comfortable

Hedcap and ill placed arch

the direction of pull on arch is very important principle: move molars distally and pull of transseptal fibres of periodontal membrane will move buccal deciduous teeth in same direction .if molar is tipped distally too severly, contact with deciduous molar will be lost and effect of transseptal fibre pull will be lost


Why early treatment?

Alveolar bone is very responsive to change,produced by changes in position and relationship of teeth This is followed by secondary changes in facial outline and contour with apparent changes in environmental forces of denture namely facial musculature


Alveolar process grows rapidly at timeof eruption of teeth,which is from birth till 14 years of age
So responseof bone will begreater during most active growth period

Considerations during treatment in mixed dentition period

What part of face is in best balance to environmentl forces of face Which teeth are in best relationship and position to supporting facial bones




guide the malpositioned teeth in correct position,relationship and balance to disturb teeth that are in good relationship and balance




alignment of teeth,good arch form,good relationship to supporting bone,good balance to their environmental forces



the time to start orthodontic treatment is basic problem in treatment in which profession should have more uniformity of thought and practice Should have knowledge of fundamental sciences Do not blindly follow rules of treatment which have results in mechanical concepts without consideration of biological reaction



not neglect treatment in mix dentition period Position and relationship of teeth can be changed which can influence growth and development of facial musculature and produce better functioning The philosophy of mix dentition treatment should be guiding alveolar bone growth and eruption of teeth thereby producing more stable results with less destruction and loss of tissue



treatment will require a change in analysis and treatment plan with special consideration of anchorage archlength and width cannotbe extendedbeyond their balance to environmental forces,if arch length and width increased then mandible cannot be use for anchorage




Comprehensive mixed dentition treatment

Steven A. Dugoni AJODO VOL113 ISSUE 1 JAN 1998

At the University of the Pacific, a patient had a severe skeletal ANB discrepancy of 7, lower incisors crowding, and 12 mm of overjet He was considered an excellent candidate for Phase I treatment to reduce the severity of the problem. philosophy was to take advantage of the growth potential in a patient by initiating Phase I treatment between the ages of 7 and 9 years, depending on the eruption of the permanent first molars and incisors and the severity of the malocclusion. leeway space was used to resolve crowding and to align lower incisors in the early mixed dentition. it was found that these young patients are more compliant with orthodontic treatment than most adolescent patients.


If treatment was postponed until eruption of the permanent dentition, there would have been one chance for correction of the problem rather than a Phase I and Phase II (if needed) approach. the key to successful Phase I treatment is this comprehensive approach to early treatment. The entire malocclusion is addressed at an early age rather than only addressing one or two problems and postponing the majority of the orthodontic correction until the permanent dentition.


Occurrence of malocclusion and need of orthodontic treatment in early mixed dentition

Katri Keski-Nisula, Raija Lehto AJODO 2003 VOL6

A prediction of occlusal development can often be made with a reasonable degree of accuracy, the question of whether orthodontic treatment is warranted in the deciduous or the early mixed dentition remains.

The problem is complex and cannot be answered on the basis of the information presently available. In addition to early diagnostics, other factors such as organizatio nof the orthodontic care, cooperation of the children, risks involved if treatment is postponed, risk of relapse,and direct and indirect costs are important and should be considered along with the timing of treatment


The rationale of early treatment is based on the assumption that occlusal development can effectively be corrected by intervention in the early stages. So this assumption should be tested and follow up the changes in the occlusion and the need of treatment as the children mature.