2012 Joint AAO-AAPD Conference - Blood From a Stone: Options for the Treatment of Crowding and Protrusion/Space Management in the Mixed Dentition - CE Credits 1.5

Blood From a Stone: Options for the Treatment of Crowding and Protrusion

Given a patient with crowding and/or protrusion, there are two solutions: more bone or less tooth. As a justification for expansion, it has proved easy and popular to argue that people like protrusive profiles. Those who disagree with expansion as a universal treatment have advanced a variety of strategies space management, extraction, stripping designed both to alleviate crowding and reduce protrusion where needed. Like a ship progressively weighed down with barnacles, both approaches have accumulated decades of opinion, much of which is wishful thinking that has little to do with the individual patient. Controversy, however, can be trumped by evidence. At the end of the day, every strategy is appropriate to some patients, but no strategy is appropriate to all. The trick is to know what each treatment actually does and to match these known effects to the needs of the individual patient. Stated simply, this matching process is the essence of evidence-based treatment. Our literature is equal to the task.

Learning Objectives:

• Demonstrate that there are only two rational solutions to the problem of protrusion and crowding: more bone or less tooth.
• Show that bone can’t grow interstitially.
• Discuss how, although there are many popular substitutes for extraction (or stripping, which is disseminated extraction), none thus far has proved to be an effective substitute.

Space Management in the Mixed Dentition

A detailed presentation will be given on how space management during the early and late mixed dentition can be used to address anterior and posterior crowding problems. The presentation will include a review of literature for space management issues and arch length changes in the transitional dentition. Cases will be shown demonstrating techniques for correction of arch length problems in the mixed dentition that can reduce the incidence of extraction of permanent teeth. The benefits of arch length preservation with a mandibular lingual arch will be shown and long-term stability after lingual arch therapy. Mixed dentition arch length analyses will be reviewed to obtain an accurate assessment of mandibular arch crowding and to determine the appropriate treatment.

Learning Objectives:

• How to predict space management problems in the mixed dentition.
• How to use effective space management to prevent ectopic eruption of permanent teeth.
• How to perform an accurate arch length analysis in the early mixed dentition.