2012 Joint AAO-AAPD Conference - MIA Missing in Action: The Usual Suspects, and the Case for Natural Substitution and Retention/Supernumerary Teeth: Diagnosis, Treatment Planning, and Mechanical Changes

MIA Missing in Action: The Usual Suspects, and the Case for Natural Substitution and Retention

This lecture will make the case for orthodontic space closure, the natural substitution of missing teeth, and the parsimonious rationale of long term retention of site specific primary teeth. It will address the esthetics and functional implications of space closure and natural substitutions and the advantages, problems & solutions of long-term primary tooth retention, in and out of the Esthetic Zone.

Biomechanical considerations will be discussed for optimizing and positioning of replacement teeth as well as appliance design, bracket placement and selection, push pull mechanics and TADs. The role of anticipatory guidance in the primary, mixed and adolescent dentition as it relates to enhanced treatment outcome and patient acceptance will be explored.

Learning Objectives:

• Discuss prevalence, etiology and diagnostic rationale.
• Discuss biomechanics, case selection, treatment decisions and problem solving.
• Provide anticipatory guidance for treatment, patient and parent.
• Review best evidence available.

Supernumerary Teeth: Diagnosis, Treatment Planning, and Mechanical Changes

This lecture will focus on extra teeth, and will be broken down by region and incidence: incisors, canines, premolars and molars. The greatest emphasis will be on (maxillary) incisors, the most common of the supernumerary teeth and those having the greatest impact on surrounding permanent teeth. The orthodontist and pediatric dentist also have the opportunity to identify and treat the patient with supernumerary incisors prior to the typical age of identification of patients with extra canines, premolars and molars. Extra canines are very rare, while extra premolars can appear prior to, during, or even after orthodontic treatment. Supernumerary molars are typically identified last but can also interfere with erupting adjacent molars and require identification and treatment.

Digitally enhanced 2D imaging and 3D imaging can be used to more precisely locate supernumerary teeth. Treatment planning considerations can include choosing which teeth to extract, when to extract, and the sequencing of treatment. Potential risks of retrieval of teeth impacted as a result of adjacent supernumerary teeth will also be highlighted, as well as the mechanical challenges to the orthodontic practitioner.

Learning Objectives:

• Demonstrate the advantage of enhanced 2D digital imaging for identification of supernumerary teeth.
• Provide examples of 3D imaging for precise location of supernumerary teeth and visualization of dental anomalies.
• Review the factors influencing the extraction decision and the mechanics of retrieving displaced teeth.