Early treatment (phase 1): Topic summary AAO meeting 2022

orthodontics In summary

Join me for a summary of early treatment lectures from this years AAO meeting from May 2022. Topics will cover trauma, airway diagnosis and orthodontic treatment, and optimal timing of class 2 correction

Lectures:

• Dental Trauma Eustaquio A. Araujo
• Airway-centered Orthodontic Diagnosis & Treatment for Pediatric Patients Hong He
• Predictors of Success for Early Mixed Dentition Treatment Heesoo Oh

Dental Trauma Eustaquio A. Araujo

Trauma protocol

• Reposition with firm grip
• 16x22NT
• Bite props to eliminate occlusal interference
• Soft diet
• Recall 2 weeks

Re-implantation of avulsion success

• Less than 1hour 75%
• Up to 24 hours 25%

• Conclusion – look at the neighbours

Airway-centered Orthodontic Diagnosis & Treatment for Pediatric Patients Hong He

Nasal breathing Vs mouth breathing

• NB = Tongue rests on the palate. MB = Tongue floor of the mouth
• NB = Pressure of the cheeks is balanced with the tongue. MB Pressure of the cheeks is unopposed by tongue
• NB = U shape upper arch (normal). MB = V shaped arch

Tonsillar hypertrophy

• Oropharynx obstruction
• Ventilation impaired
• Occlusal effects
  • Tongue and mandible forwards Iwasaki 2017
  • Mandibular protrusion
    • Class 3 malocclusion
• He’s study n=1776
• Greater tonsillar hypertrophy in children with class 3

Caution as limited studies pre-pubertal and controls also improved in scores

Predictors of Success for Early Mixed Dentition Treatment Heesoo Oh

When is it best to treat class 2 cases

Study: optimal timing of the effectiveness and efficiency

• Early class 2 equally effective not as efficient
• BUT
  • Mean changes = mask individual response
  • Philosophy – correct some / all features of malocclusion
    • Reduce / eliminate need for phase 2
• Angle orthodontist Oh 2017

Treatment protocol

• 7-9 years
• Headgear night wear 11 hours
• RME
• 2 x 4 fixed appliances
• Lingual arch
• Greater 33 months = unsuccessful (time only marker of success, as occlusal and skeletal the same at the end)

Results

• 15/54 (28%) phase 1 only
• Comparison
  • No differences in occlusal and skeletal outcomes
• Time
  • Total treatment times (phase 1 + phase 2):
    • 67% less than 18 months in treatment active treatment
    • 20% 4-5 years of total treatment time