ISBN: 2-912550-37-8
978-2-912550-37-8 , 9782912550378

124 pp (softcover); 250 illus (mostly color)

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Preface

Why and When to Begin Early Orthodontic Treatment

Orthodontists have made remarkable progress in their understanding of physiology, growth, tissue response, increasingly sophisticated diagnostic techniques, available materials, and information; nevertheless, with all these advances, many practitioners still find themselves at a total loss when confronted with that eternal dilemma: to intervene or not to intervene before the eruption of the complete permanent dentition.

Two opposing schools of thought exist. One philosophy is embraced by those who do not initiate treatment until the second molars and all the premolars have erupted. These clinicians assert that it is easier to begin treatment when major growth has been completed and when a treatment time of 2 to 3 years can be predicted with reasonable assurance, thereby avoiding the need to compensate for unexpected variations in the growth pattern. Often, treatment undertaken in this time framework is accompanied by therapeutic extractions and requires the use of cumbersome, complex appliances that can pose serious risks to the health of the teeth and the surrounding tissues.

Adherents of the bioprogressive school of Ricketts, Gugino, Bench, Duchateaux, Philippe, Langlade, and many others, including Fränkel, Graber, and McNamara, insist that there are many disadvantages to waiting for the 12-year molars to erupt. Not the least of these drawbacks is the failure to take advantage of the potential to eliminate or modify deviations in skeletal growth and the functional matrix (associated with mouth breathing, atypical swallowing, and other abnormal behavior) and the opportunity to orchestrate dentoalveolar development.

Beginning orthodontic treatment early seems eminently logical because it enables the complete or partial correction of many incipient discrepancies or, at least, a reduction in their capacity to grow worse. Interception—or early intervention—employs simple therapeutic techniques that do not overtax the limited stores of cooperation young patients can bring to the therapeutic encounter. Its objective is eliminating or minimizing dentoalveolar and skeletal disorders that interfere with growth, function, esthetics, and the psychological well-being of children.

Orthodontic treatment should be in harmony with modern medical thought: It is better to prevent than to cure. We should not treat the symptom; we should treat the cause. The therapeutic devices available for this endeavor are not complex, but deciding which ones to use and when to employ them is far from simple. The therapeutic choice is nothing more than the last act in a complete diagnostic process. To be capable of determining the optimum moment to begin treatment, orthodontists must possess a profound comprehension of fundamental information that forms the basis of understanding the pathogenesis of different malocclusions: normal and pathologic craniofacial growth, orofacial functional behavior, morphogenesis of the dental arches, and child psychology. Armed with this knowledge, orthodontists can accurately discern which discrepancies would benefit from early treatment and not fall into the trap of indiscriminately treating every patient they examine during the mixed dentition stage.

It is important that orthodontists perform this “triage” so that they will not get caught up in a relentless therapeutic cycle leading only to long, drawn-out treatments, patient and parent fatigue, and professional frustration. The ideal age for an initial orthodontic visit, in the authors’ view, is when the patient is about 5 or 6 years old. The goals of this first examination are to discover any discrepancies that would worsen in time; any transversal, vertical, or sagittal interferences that are disrupting normal growth; and any functional matrixes that are disturbed by mouth breathing, atypical swallowing, and postural problems, as well as destructive habits such as thumb and lip sucking.

There are three types of treatment that can be adapted to meet the clinical needs of each patient:
1. Modification of functional behavior, without appliances, through myofunctional therapy or occlusal equilibration
2. Orthopedic treatment of the maxilla or mandible
3. Treatment with simple removable or fixed orthodontic appliances

These treatments will be followed eventually by retention and reevaluation after eruption of the permanent dentition is completed: Has the intervention completely resolved the problem, or will a second phase of treatment be needed to finish aligning the teeth? The objective of early treatment is to avoid or to simplify treatment of the permanent dentition.

This volume addresses the different anomalies according to their Angle classification and with regard to their stage of development in either the primary or mixed dentition. The text has been carefully kept as concise as possible to leave adequate space for photographic documentation of clinical situations.

“The earlier treatment begins, the more the face will adapt to your standards; the later treatment begins, the more your standards will have to adapt to the face.”—C. Gugino

Antonio Patti, MD, DUO
Director
The International Center for the Study of Clinical Orthodontics
Verona, Italy

Guy Perrier D’Arc
Former Head
Department of Orthodontics
University of Nice
Nice, France

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