Treatment of Class I alveolar anomalies 

Treatment of Class I  alveolar anomalies

1. Introduction : 

  Alveolar anomalies in the presence of maxillo-mandibular sagittal harmony and Cl I sheathing occlusion are not simple cases to treat because the alveolar processes and dental structures can present different degrees of severity, thus complicating the treatment, the latter etiological or morphological must face these problems, with the aim of aligning the teeth and improving the occlusion.

2. Definitions:

• BALLARD’s skeletal Cl I: harmonious relationships between the maxillae. 
• Class I of canine ANGLE: tip of the upper canine at the level of the embrasure between the canine and the lower premolar.
• ANGLE molar class I: the lower first molar is mesialized by half a cusp paraport to the upper first molar. 

3. Principle of treatment of alveolar anomalies:

    Mechanically modifying the shape of an arch means creating a new neuro-muscular balance which will determine the new post-therapeutic shape of the arch. If this new balance is not achieved, there will be a relapse after the removal of the device because the arch will undergo the same muscular constraints which determined the shape of the arch which existed before the treatment.

        Treatment therefore requires the removal of the etiological factors that caused these anomalies.

         Muscle pressures must be eliminated by vestibular screens at a distance from the teeth and the alveolar processes.

       Similarly, lingual volume and posture play a preponderant role in the direction of eccentric or concentric growth of the alveolar processes.

4. Treatment of alveolar anomalies in the sagittal direction:
5.  Superior proalveolism:

   – In mixed dentition:

The treatment is first etiological by:

• Elimination of distorting habits (thumb sucking, interposition of an object, etc.)
• Re-education of lingual behavior in posture and during functions

This by:

* rehabilitation devices e.g.: nocturnal lingual envelope (ELN), Balters Bionator accompanied by hypotonic lip gymnastics.

* Mechanical devices comprising a vestibular arch. 

             – In permanent dentition: Multi-attachment therapy with a radiculo-palatine torque at the level of the incisal arch.

2.   Inferior proalveolus:

It is due to excessive tongue pressure which can decrease at puberty.

            In mixed dentition:

• In case of proglossia: rehabilitation e.g.: ELN
• In case of macroglossia: Extractions with prior glossoplasty.

            In adult dendure:

                 – In case of proglossia: extractions + fixed therapy

                 – In case of macroglossia: Extractions with glossoplasty.

3.  Superior retroalveolism:

-The treatment is carried out using palatal hooks, e.g. serpentine, omega or a posterior-anterior action jack.

-In case of iatrogenic retroalveolism, the vestibular arch must be released (passive arch)

– Fixed appliances in permanent dentition e.g.: Ricketts expansion base arch.

4.  Inferior retroalveolus:

• Remove the cause: thumb sucking, interposition of the lower lip under the upper incisors.
• In case of hypertonicity of the lower lip: 

• Put the tongue in a forward position.
• Use the bumper

    – Associate an inclined plane with an upper plate that extends down to the lower incisors.

 – 

Fixed appliances in permanent dentition associated with a lingual arch

         4.5 Biproalveolism:

Goals: – Move the inc back and obtain a labial junction.

        – Obtain a correct incisal slope (fct role).

     * Mild biproalveolia: (diastemas).

 – Plate with “language guide” / ELN.

 – Lip exercises.

     * Moderate biproalveolism: 

 – Exo of the 4 PM.

 – Multi-attachment app + anchor loss.

   p* Significant biproalveolism: 

– 4 PM exercise + Multi-attachment app.

 – FEB on molars to maintain anchorage (trend towards class II)

 – FEB on molars + Cl III elastics (perfect Cl I)

        4.6 

6. Treatment of biretroalveolism:

• caused by an imbalance: small and posteriorly positioned tongue, and toned lips.
• goal: to move the lips away from the dental arches using labial “bumpers” on removable or fixed devices.
• Re-education of the lingual position.
• Vestibulo for inc: lingual arch.
• Stability requires long-term retention: passive plate + overcorrection.

5. Treatment of vertical alveolar anomalies:

       5.1 Treatment of ant infraclusion (open bite):

        – TRT in mixed dentition:

• Elimination of the interposition of an object, intervene before 6-7 years.
• Removal of language interposition: Bionator, ELN, TUCAT pearl.

        – TRT in adult teeth:

 – Multi-attachment app + vertical elastics

 – Flatten the Spee curve and increase the inc slope.

The conditions for obtaining the closure of the gap: 

1. Post position of the tongue (adenoidectomy – tonsillectomy…).

2.Facial muscles become powerful.

2. Treatment of molar infra alveolus:

• Causes: Lingual interposition in molar areas + constant primary swallowing.
• Etiological treatment by “guide-tongue” device: ELN / Bionator.

3. Treatment of overbite inc:

• Principle: ingression inc / egression mol.
• PLANAS Equiplan: 0.4 mm thick metal plate held on the lower inc
• CHÂTEAU has made changes to the thickness 2.5 – 3 mm.

     Activation: add the resin on the inclined plane (2 to 3 mm thick) per control session.

• One-sided elevation gutter:

 – Indicated between 4-7 years.

 – Causes egression on the opposite side, the gutter is subsequently removed and consequently egression on the gutter side will be obtained.

• Palatal plate + retro-inc elevation surface.
• More complicated case: T. Multi-attachment Ricketts base arc of ingression.

Treatment of Class I alveolar anomalies 

6. Treatment of transverse alveolar anomalies:

  6.1 Treatment of symmetrical endo alv without laterodeviation:

      – TRT in mixed dentition:

 Sup expansion plate + occlusal splint covering the lateral teeth.

      – TRT in adult teeth:

 – Quad Helix.

 – Multi-attachment app.

2. Treatment of symmetrical endo alv with laterodeviation:

• Elimination of occlusal interferences.
• Grinding of temporary cans.
• Quad Helix + elevation.
• Overcorrection.
• Primary swallowing rehabilitation.
• Contention: palatal arch, removable plate.

 6.3 Treatment of asymmetric endo alv:

• Objective: To correct unilateral linguoclusion without modifying the transverse relationships on the opposite side.
• In mixed dentition:

 – Grinding of the temporary canines on the reverse side.

 – Palatal plate with lateral flap.

 – Trt from 06 months to 01 years.

 – 6 month restraint.

• In adult teeth: 

 – Quad’helix. 

 – Criss-Cross.

4. Treatment of mandibular   endoalveolitis :

• In mixed dentition:

 – Functional apps.

• In permanent dentition:

 – Reverse criss-cross .

 – Bihelix .

5.  Treatment of exoalveolus:

• These are rare anomalies, most often maxillary and unilateral, the treatment possibilities are:
• Mandibular expansion.
• Correction of PM, M overbite with a sealed splint.
• Poorly monitored expansion: fixed apparatus with inverted criss-crosses.

Treatment of Class I alveolar anomalies 

7. Conclusion :

• Cl I alveolar anomalies have diverse clinical forms and etiologies. Their early detection and treatment can help prevent certain complications such as malocclusions and skeletal anomalies. 
• Their essentially etiological treatment carried out from a young age makes it possible to avoid more complex, more costly and longer treatment in adulthood .

Treatment of Class I alveolar anomalies 

Deep cavities may require root canal treatment.
Interdental brushes effectively clean between teeth.
Misaligned teeth can cause chewing problems.
Untreated dental infections can spread to other parts of the body.
Whitening trays are used for gradual results.
Cracked teeth can be repaired with composite resins.
Proper hydration helps maintain a healthy mouth.
 

Treatment of Class I alveolar anomalies