Orthodontics

INTERCEPTIVE ORTHODONTICS

Between 5 and 10 years of age during the growth phase we have the possibility of intercepting and treating, with  predictable results, problems of the maxillary skeleton and / or of the jaw, which are the bases on which the permanent teeth will be positioned, intervening to remedy them lest they present difficult-to-resolve structural conditions in later life. For this reason, in child orthodontics, we focus on the reciprocal positions of the dental arches on the 3 planes of  space, analyzing both the existing skeletal conformation and any anomalous positions of the deciduous teeth that may structure an altered occlusion on which the maxillary and mandibular skeleton  could conform wrongly.

Depending on the seriousness of the problems we encounter, it may be necessary to intervene as early as possible (5 – 6 years), or evaluate the young patient during his growth and, if necessary, intervene around 9 – 10 years.

Dental-skeletal dysfunctions that we encounter in this growth phase may originate from several factors:

• genetic factors
• traumatic factors
• bad habits (protracted sucking of the thumb or pacifier …)
• early loss of milk teeth
• altered positions of the milk teeth
• oral respiration

The diagnosis of these problems is carried out by the specialist clinician, through a rigorous course of examination linked to both the anamnesis and to a direct study of the specific case.

Here, we summarize the problems frequently encountered in children comparing them with a correct occlusion.

PALATAL EXPANDER

The palatal expander or separator is a fixed device used in interceptive practices, which permit the enlargement of the palatine bone to solve functional problems at the jaw bone level.

The age range useful for this type of treatment varies from 5 – 6 years up to 9 – 10 years. The age of the patient is not a negligible factor, since up to 11-12 years (approximately) the bones of the palate continue to grow and are therefore easily malleable. After this,  growth stops and the bones of the palate merge together becoming a single element, therefore impossible to modify, if not in a surgical way.

The creation of this device is done in the laboratory. The technician is given the impression of the upper arch taken in the clinic with all the useful information to calibrate the device, which will be cemented into the patient’s mouth and removed at the end of the therapy.

Once a  mouth, the device will undergo “activation”, that is, it will be gradually enlarged until it reaches the appropriate shape of the palate.

MYOFUNCTIONAL DEVICE

The myofunctional device is a removable device that works simultaneously on the bone, muscles and dental elements. This therapy can be in addition to a previous palatal expander therapy or can be inserted individually according to the specific case.

ORTHODONTICS AND POSTURE

Adequate cranial mandibular growth is of great importance not only for the development of the oral cavity, but also for the realization of a correct postural construction.

The relationship between the mouth and the postural system is now widely credited and for this reason, the growth phase plays a fundamental role in programming  development.

There are different assessments that are carried out at our centre which are fundamentally linked to the verification, as early as possible, of various types of imbalances that are sought through observation of the craniofacial area. This is to prevent it from becoming structured in such a way to involve a functional alteration of the mouth, as well as triggering off a descending imbalance that may affect the child’s postural development.

A visit as early as possible in children offers the possibility to prevent  or remedy  problems that are more difficult to solve in adulthood, as well as allowing precise and predictable therapies in harmony with the general system of the body.

Dr. de Nicolo has structured protocols with his team that permit a careful evaluation of the subject where needed, by means of a multidisciplinary evaluation in various specialized areas (Osteopathy, Massage Therapy, Ophthalmology, Otolaryngology, Speech Therapy, Podiatry …), in order to intercept the cause of the imbalance and mediate it with the appropriate specialist.

PRE- ALIGNMENT

Generally, interceptive orthodontic therapy does not provide for dental alignment, in that it is not necessary.

Dental pre-alignment can be expected in particular cases such as:

• Serious imperfections that could cause socio-psychological inconvenience in the child;
• Severe dental crowding that could interfere with the correct development of the skeleton.

Pre-alignment, which is carried out exclusively on the upper arch, involves the central incisors and the lateral incisors, on which orthodontic brackets are cemented, smaller than those used for fixed orthodontic therapy. Within these brackets an arch is mounted which starts the alignment.

This orthodontic therapy is called pre-alignment as it precedes the definitive alignment of the fixed orthodontic therapy.

WHAT IS MALOCCLUSION

The term malocclusion refers to all those factors that negatively affect the dento-skeletal balance.

This can be manifested in several ways:

• Dental misalignment
• Disharmony between jaw bone and jaw growth

They can be caused by multiple factors including:

• Inheritance
• Disorders in the development of the bases of the bone and the teeth (skeletal imbalances)
• Bad habits (such as prolonged sucking on a pacifier and / or thumb; oral breathing; onychophagy; incorrect swallowing)
• Premature loss of deciduous or permanent dental elements (due to caries and / ortrauma)

Many malocclusions can be prevented by controlling environmental factors that can negatively influence the growth of the jaws and the development of the teeth.  Other forms of prevention can be carried out by the dentist, intercepting and removing the problems that can hinder a correct development.

Since malocclusion is, in fact, a break in the balance, the main purpose of orthodontics is to restore the dento-skeletal balance, thereby improving the aesthetics of the smile.