Treatment of alveolar anomalies
- TREATMENT OF PROALVEOLISM
Proalveolism is an anomaly characterized by an exaggerated inclination of the upper incisors often due to a functional problem such as mouth breathing or atypical swallowing, or to a parafunction such as thumb sucking.
Etiological treatment:
- Swallowing rehabilitation
- Speech rehabilitation
- Suppression of parafunctions: thumb sucking, lower lip sucking.
- myotherapy of the orbicularis oris
Mechanical treatment:
The devices used are generally very simple, based on a resin palatal plate onto which an active vestibular arch made from 0.6mm diameter stainless steel wire is fixed. The plate is retained by two Adams hooks.
The resin in contact with the palatal surface of the incisors will be notched to allow palatal movement of the upper incisors.
Activation: activation of the vestibular arch will be done on average once a month by closing the 1mm U-shaped loops.
- Duration of treatment: between 3 and 6 months.
- Retention: a Hawley plate worn for an average of one year will ensure the stability of the result.
Factors to consider before treatment:
- Open bite: It is necessary to differentiate between a proalveolus with or without open bite:
– without gap: correction of the proalveolus will cause a certain degree of incisor overbite to appear, so fixed treatment is necessary;
-with slight gap: treatment using a removable plate is possible.
- Diastemas: it is also necessary to differentiate between proalveolism with or without diastemas:
- Without diastemas: Correcting an incisor protrusion without diastemas will cause inter-incisor overlap to appear.
- With diastemas: treatment using a removable plate is possible
- TREATMENT OF RETROALVEOLITIS
Incisor retroalveolism is an alveolar anomaly of the anteroposterior direction located in the incisors and characterized by lingual version of the upper or lower incisors.
Superior retroalveolitis : treatment of superior retroalveolitis is based on vestibuloversion using devices such as:
- “Quad helix” with anterior extensions
- Removable appliance with unit springs (vestibular) and resin elevation.
- A resin plate with SHWARTZ spring in case of multiple retroalveolitis.
- A resin plate with a posterior-anterior action jack (the jack will be activated by a
quarter turn every week)
Inferior retroalveolitis :
Etiological treatment:
- Rehabilitation of functions
- Correction of the low position of the tongue (frenulum….)
- Stopping lower lip sucking
Active treatment:
- A resin plate with spring from SHWARTZ.
- A “Bi-helix crozat”
- Lip Bumper:
The Lip Bumper:
Definition: removable device intended to increase the perimeter of the arch, thanks to the pressure exerted by the lower (or sometimes upper) lip.
It is therefore a device with intrinsic forces, consisting of an arc of 1 millimeter in diameter located on the vestibular side and adjusted on 2 rings at the level of 36 and 46 (or 85 and 75) and comprising at the incisor-canine level a band of soft resin located 3 or 4 mm from the vestibular faces of the incisors.
Dental effects:
- vestibulo-version of the incisors, the pressure of the lower lip no longer being exerted, only lingual pressure persists;
- blocking or slight distalization of the first molars, by transmission of labial pressure to the molar level.
- TREATMENT OF SUPRACLUSION :
Overbite is an excessive overlap of the lower incisors by the upper incisors exceeding 3 mm and in severe cases reaching up to 10 mm.
Overbite can be due either to anterior supra-alveolus (excess vertical growth of the alveolar processes) or to posterior infra-alveolus.
Treatment principle: excessive incisal overlap can be corrected either by molar egression or by vestibulo-version of the incisors, if the incisal guide allows it, or by incisal intrusion, which constitutes the most stable process.
Devices used:
- molar egression: a resin palatal plate with an anterior elevation creates a posterior inocclusion, thus causing the egression of the molars.
Indication: incisor overbite due to posterior infraalveolus Contraindications: Increased Dv, long face.
- Incisor intrusion: only multi-attachment devices provide the possibility of ingressing
the incisors.
All teeth have attachments. Correction can be done:
- Either using continuous arches, with miniscrews located between the roots of the incisors allowing them to be intruded.
- Either using segmented arches, this is the principle of the Ricketts technique which uses basic intrusion arches which connect the molars to the incisors.
Duration of correction: This is a difficult and dangerous movement to perform for the apices (root resorption). The forces applied must be of low intensity. On average, the amount of intrusion should not exceed 1 mm per month.
Contention: silicone gutter; Sved plate.
- TREATMENT OF ANTERIOR OPEN BITES
The search for etiology is essential in establishing the treatment plan for an anterior open bite. It is necessary to differentiate isolated anterior open bites, of functional origin, from anterior open bites which constitute the accompanying sign of a severe basal anomaly of the vertical dimension, which is called skeletal open bites.
Functional treatment:
- elimination of parafunctions and distorting habits;
- swallowing rehabilitation, lip myotherapy, masticotherapy;
- nasal ventilation rehabilitation;
Mechanical treatment:
- Functional devices:
- Anti-tongue grid: it is a device that allows the stopping of thumb sucking and
avoids the interposition of the tongue between the incisors.
- Removable lingual compartment in resin or fixed on molar bands
- Tucat pearl on removable plate.
- Tongue sticks fixed to the palatal surfaces of the upper incisors:
Some mild anterior gaps, of functional origin, regress without active mechanical treatment after removal of the deforming habit and maturation;
- Active mechanical devices:
Complete multi-bracket device and anterior vertical intermaxillary traction, either upper lingual and lower vestibular, or lingual-lingual, or vestibular-vestibular. Both arches must be fully bracketed.
- TREATMENT OF TRANSVERSE ALVEOLAR ANOMALIES
Symmetrical endoalveolitis , with latero-deviation : this treatment must be carried out as soon as possible, after the development of the 6-year teeth , in stable mixed dentition or in stable adolescent dentition.
Treatment objectives: correction of the endoalveolus and elimination of occlusal interferences causing the laterodeviation.
Conduct of the treatment:
- Elimination of occlusal interferences: grinding of unabraded temporary canines, vestibular cusps of lower temporary molars and lingual cusps of upper temporary molars, at the level of the linguocclusal sector in
- CM
- Active treatment: mechanical device:
- Removable plate with central jack.
- Quad’hélix:
Definition: The Quad’hélix is a fixed expansion appliance, consisting of a palatal arch made of round wire with a large diameter of 0.9 mm, comprising 4 helical loops. This arch is welded onto 2 bands fitted to the upper first molars.
Mode of action: it causes expansion at the level of the molars, premolars and canines, by modifying their axial inclination.
Activation: every 6 weeks,
There is a variant in the mandible called “Bihelix”. Contention: Hawley plate
Asymmetrical endoalveolitis :
Objectives: To correct unilateral linguocclusion without modifying the transverse relationships on the normal side.
Mechanical device: removable plate comprising a low elevation, a vestibular and lingual lateral flap on the side with normal occlusion and an asymmetrical jack placed as close as possible to the side of the anomaly.
Duration of treatment: very slow correction, between 6 months and one year.
Contention: the removable plate also serves as a contention plate after removal of the elevation and the vestibular flap.
In adult teeth: multi-bracket device and crossed lateral TIM (CRISS-CROSS) (lower vestibular and upper lingual attachment).
Treatment of alveolar anomalies
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