Adanya ankiloglosis atau tongue tie menghalangi perkembangan fungsional yag normal karena posisi

lidah rendah dan abnormalitas saat pengucapan dan menelan, oleh sebab itu harus dikoreksi secara
pembedahan (Gambar 32.1)
Pemeriksaan Kebiasaan Oral dan Edukasi
Kebiasaan seperti menghisap jari dan jempol, menggigit kuku, ,tonge thrusting, dan menggigit bibir harus
diidentifikasi dann baik pasien maupun orangtua harus diedukasi mengenai efek penyakit dari kebiasaan
tersebut dan dimotivasi untuk menghentikan kebiasaan itu (Gambar 32.11)
Pencegahan kerusakan Milwaukee Brace

Milwaukee brace merupakan sebuah alat ortopedi digunakan utuk koreksi skoliosis (Gambar
32.12)
Alat ini memberikan gaya yang luar biasa pada mandibula dan perkembangan oklusi
menyebabkan pertumbuhan mandibula yang terlambat dan kemungkinan deformitas
Intraoral splint, actvaors positioners, dan alat ortopedik dentofasial yag didesain khusus dapat
mencegah terjaidnya maloklusi, atau setidaknya mengurangi efek-efek yang mengganggu.

Manajemen gigi permanen molar pertama yag tertanam sangat dalam

Terkadang, gigi permanen molar pertama dapat tertanam jauh kedalam dibawah crest kontur pada
permukaan distal gigi desidui molar kedua (Gambar 32.13)
Slicing permukaan distal gigi desidui molar kedua membantu dalam

Slicing th distal surface of the 2nd deciduous molars helps in guiding the eruption of first
permanent molars.
Sometimes, locked permanent 1st molars may resorb the 2nd deciduous molar the at the cervical
part of the tooth. If root resorption is severe, deciduous 2nd molar has to be extracted and space
maintained for the 2nd premolar.
Slightly locked permanent 1st molar usually erupts whitout treatment. Passing a ligature wire or
separation interddentally frees the slight lock.

Hal 1
Presence of anyloglosia or tangue the prevents normal fuctional development due to lowered
position of tongue and abnormalities in speech and swallowing and hence should be surgically
corrected (fig.32.10)

Oral Habits Check-Up And Education

Habits such as finger and thumb sucking, nail biting, tongue thrusting and lip biting should be identified
and the patient/ parents should be educated on the ill effects of these habits nd should be motivated to
stop the habit (fig.32.11)

Preventing milwaukee brace damage

Milwaukee brace is an orthopedic appliance used for the correction of scoliosis (fig.32.12).
This appliance exerts tremenndous force on the mandible and the developing occlusion leading to
retardation of mandibular growth and possibe deformites
Specially designed intraoral splints, activators positioners and dentofacial orthopedic appliances
may prevent malocclusion, or at least reduce the deleterious effects.

Management of deeply locked permanent firts molars.

Occasionally, the first permanent, molar may get deeply locked under the crest of contour of the
distal surface of deciduous 2nd molar fif.32.13)
Slicing th distal surface of the 2nd deciduous molars helps in guiding the eruption of first
permanent molars.
Sometimes, locked permanent 1st molars may resorb the 2nd deciduous molar the at the cervical
part of the tooth. If root resorption is severe, deciduous 2nd molar has to be extracted and space
maintained for the 2nd premolar.
Slightly locked permanent 1st molar usually erupts whitout treatment. Passing a ligature wire or
separation interddentally frees the slight lock.

Hal 2 (395)
SPACE MAINTAINERS ( DETAILED IN CHAPTER 35)

Premature loss of deciduous teeth ccan cause drifting of the adjacent teeth into the space. It
can result in banormal axial incinnation of teeth, spacing between teeth and shift in the dental
midline. This prevents the normal eruption path of permanent teeth leading to malocclusion.
So corrective procedure may require some type of passive space maintainers, active tooth
guidance or a combination of both, depending on the present problem.
Space maintainer is a device used t maintain the space created by the loss of a deciduoud
tooth ( fig. 32.14A to I)
An important part of preventive orthodontics is the correct handling of spaces created by the
untimely loss of deciduous teeth.

Pre-requisites for sace maintainers

They should maintain the mesiodistal dimension of the space created by the lost tooth.
They should be functional, if possible, at least to the extent of preventing the over-eruption
of the opposing tooth.
They should be simple in construction.
They should be strong enough to withstand occlusal forces.
They must not endanger the remaining teeth by imposing excessive stresses on them.
They should not interfare with normal vertical eruption of the adjacent teeth.
They should be easily adjustable.

Their costruction should be such that they do not restrict normal growth and developmental
processes.
They should not interfere with functions such as mastication, speech or deglutition
They must be easily cleansable and not serve as traps for food debris,etc, which might
enchance dental caries and soft tissue pathology.
Durable and corrosion resistant
Reasonable in cost.

Factors affecting planing for space maintenance

Time elapsed since tooth loss

Dental age of the patient
Thickness of bone covering the unerupted teeth
Sequence of eruption of permanent teeth
Congenital absence of permanent tooth

INTERCEPTIVE ORTHODONTICS
Americn Association Of Orthodontics defined interceptive orthodontics as that phase of the science and
art of orthodontics employed to recognize and eliminate potential irregularities and malposition in the
developing dentofacial complex.
According to Graber, interceptive orthodontics refers to the Measures undertaken to intercept
malocclusion that has already developed or is developing and the goal is to restore a normal function.
According to Ackerman and proffit (1980), interceptive orthodontics can be defined as,
elimination of existing interferences with the key factors involved in the development of the dentition.
Procedures undertaken in interceptive orthodontics

Serial extraction
Correction of developing cross bite
Control of abnormal habits
Space regaining
Muscle exercises
Interception of skeletal malrelation
Removal of soft tissue or bony barrier to enable eruption of teeth.

Serial extraction (detailed in chapter 36)

It is an interceptive orthodontic procedure usually initiated in the early mixed dentition.

Serial extraction is a process of extracting certain deciduous teeth and predetermined pattern
to guide the erupting permanent teeth into a more favorable position.
It is done in cases which show signs of persistent irregularities of teeth due to insufficient
space in the arch to accomodate the present amount of tooth substance.

History

Kjellgren (1929) sweden coined the term serial extraction

Nance (1940) termed serial extraction as planned progressive extraction and has been
called the father of serial extraction.
Rudolf hotz (1970) switxerland termed serial extraction as active supervision of teeth by
extraction.

Hal 3

It also is possible to tip the maxillary incissors forward with a 2 x 4 aplliance (2 molar bands, 4
bonded incisor brackets) and fixed mechanotheraphy (fig 32 18A to C)/ this may be the best
choice for a somewhat older mixed dentition patient whit crowding, rotations and more
permanent teeth in crossbite.

Functional anterior crossbite

The presence of occlusal prematurities deflects the mandible into a more forward path of closure.
So this type of crossbite results from the functional shift of the mandible.
These are commonly seen in pseudo class III type of malocclusion and are treated by eliminating
the occlusal prematurities.

Skeletal anterir crossbite

This occurs due to skeletal discrepancies in growth of maxilla or mandible.

This type crossbite usually involves the whole segment instead of one or two teeth (fig. 32.19)
It can be because of maxillary retrognathism or mandibular prognathism or both.
This type of crossbite is best intercepted by growth modification using myofuctional or
orthopedic appliance.

Control of abnormal habits (detailed in chapter 30)

Habits are referred to certain actions involving the teeth and other oral or perioral structures which are
repeated often enough to have a profound and deleterious effect on the dentofacial structures. These
deletarious oral habits include thumb sucig, tongue thrusting and mouth breathing (fig.32.20).

Space regaining (detailed in chapter 35)

If a primary molar is lost early and space maintainers are not used, a reduction in arch length by mesial
migration of the 1st molar is expected. In such cases the space host by mesial movement of the 1st molar
can be regained by distalizing it.

The space regaining procedures are preferably undertaken at an early age prior to the eruption of
2nd molar.
Commonly used space regainers are shown in figures 32.21 to 32.23.

Tabel 32.1 : muscle exercises

Exercise for the masseter muscle

Exercise for the lips (circum-oral

muscles)

Exercises for the tongue

Patient is asked to clench the teeth while countng to ten. Now the
patient is asked to relax for ten seconds and it has to be repeated oer a
period of time until the masseter muscle feels fatigued.
F the upper lip is hyotonic and flaccid, the child is instructed
to extend the upper lip as far as possible curving the vermilion
border under and behind the maxillary incisors. This exercise
should done 15 to 20 minutes a day for a period of 4 to 5
months.
Stretching of the upper lip to maintain lip seal. The patient is
asked to hold a thin piece of paper between the lips.
If the maxillary incisors are protruded, the lower lip can be
used to augment the upper lip exercise. The upper lip is first
extended uder and behind the maxillary incisors. The
vermilion border of the lower lip is then placed againts the
outside of the extended upper lip and pressed as hard as
possibleagaints the upper lip. This type of exercise exerts a
strong retracting influence on the maxillary incisors while
increasing the tonicity of both upper and lower lips. This
exercise is particlary valable for mouth breathers and should
be done for at least thrty minutes a day
Massaging of the lips
Button pull exercise : A button of 1 1/2 inch diameter is taken
and a thread is passed through the button holes. Then, the
patient is asked to place the button behind the lips and pull the
thread, while restricting it from being pulled out by lip
pressure.
Tug of war exercise : This involves use of two buttons, with
one placed bedind the lips while the other button is held by
another person to pull the thread.
Holding and pumpig of water back and forth behind the lips :
Patient is asked to hold and pump water back and forth behind
the lips until they get tired.
For a developing class II div 1 malocclusion, the playing of a
wind instrument may be an interceptive procedure.
One elastic swallow : This exercise is used for correction of
improper positioning of the tongue 5\16 inch intraoral elastic
against rugae area and swallow.

 Tongue hold exercise : 5\16 inch intraoral elastic is positioned

in a designated spot of the tongue over a prescribed period of
time with the lips closed. The patient is then asked to swallow
with elastic in place and lips apart.
Two elastic swallow: Two 516 inch elastic are placed on te
tongue, one in the midline and the other at the tip and the
patient is asked to swallow with the elastics in position.
The hold pull exercise : The tip of the tongue and the mind
point are made to contact the palate and the mandible is
gradually opened. The helps in stretching the lingual frenum.