Treatment of DDM

University of Blida Saad Dahleb Faculty of Medicine

Department of Dentistry

Treatment of DDM

The objectives of the treatment

– Establish optimal static and dynamic occlusal function.

– Improvement of facial and dental appearance.

‐ Promote good periodontal health.

preventive treatment:

It consists of preventing an anomaly from occurring.

– Prevention itself :

Breastfeeding allows mandibular propulsion, normal development of the arches, normal swallowing and breathing;
Prevention will therefore consist of early screening, correction of lingual behavior, lip myotherapy, associated with the removal of vegetation and hypertrophic tonsils from the age of 5 and eliminating parafunctions and dysfunctions;
Early dental care especially proximal caries;
Avoid early extractions of baby teeth;
Place space maintainers to maintain the space of the teeth that are extracted (temporary).

A. Treatment of DDM by macrodontics :

1-Conservative treatment :
It must be undertaken in mixed dentition and completed in permanent dentition;
– The indication for avulsion of wisdom teeth may arise at the end of retention;
– Treatment will be attempted when the space deficit is less than the possibilities of expansion and distalization of the molars.

– Indications:

Light DDM less than 5mm;
Almost zero predictable DDM;
Anterior mandibular growth type;
Concave or rectilinear profile;
In case of brachygnathia.

– The goal: is to obtain an increase in the arch perimeter.

Therapeutic means

– Multi-attachment fixed devices placed on the 1st ^adult molars and the 2nd baby molars and the incisors (vestibulo-version);

-Auxiliary devices:

FEB on rings on the maxilla;
Bumper (lip bumper) at the mandible;
Lingual and palatal arches (preservation of mesial drift space);
quadhelix in the maxilla.
Bi-helix in the mandible.
-Platinum cylinder with transverse action.
-Transpalatine arch.
-Hyrax type palatine breaker.
-Four-ring circuit breaker.
-Pendulum.
-Lingual arch.

2-Semi-conservative treatment:

It is done by expanding the arches at the molar and premolar level and by grinding the proximal faces of certain anterior permanent teeth (stripping), it allows a space gain of 2 to 3mm. The gain in the transverse direction allows 3 to 4mm to be obtained in the arch perimeter.

3-Treatment with extraction :

-Indications:

DDM greater than 5mm;
Convex profile;
speed curve is inverted;
Decayed premolar and molar;
Lip inocclusion greater than 5mm;

– Treatment sequences according to age:

1- In temporary dentition :

– Do not intervene (abstain);

– The congestion may be transient

2-In mixed dentition : we have 3 therapeutic attitudes:

– Abstention until all permanent teeth appear;

-Driven extractions without immediate processing;

– Piloted extractions with simplified orthodontic treatment.

-Piloting

Piloted extraction is the extraction of certain temporary teeth (canine and 1st ^temporary molar) before their normal elimination date followed by germectomy or extraction of the 1st ^premolars as soon as they appear on the arch.

Contraindication

– Concave profile

– Horizontal growth

– Overbite

– Inferior retroalveoli

– Hypodiple development of the jaw

3-In adult teeth

For many authors, this is the preferred time for treatment to shorten the duration. Treatment is performed after the development of the second premolars or permanent molars. The device used is the fixed post-extraction technique.

-Post-therapeutic control :

Orthodontic treatment can only be considered complete after all adult teeth are functionally in place.

However, it is necessary to monitor the development of wisdom teeth, because in certain cases it is necessary to extract them to avoid recurrence.

B‐Treatment of relative microdontia :

The anomaly is characterized by the presence of numerous diastemas; these diastemas do not appear to particularly predispose to caries or periodontal disease.

The damage is often aesthetic, the danger that lies in wait for microdontia is incisor overbite which can be severe if the skeletal type lends itself to it.

-if the profile is harmonious, preferably leave the diastemas rather than move the incisors back (profile would be more convex);

– if the aesthetic damage is significant in adults, the incisors, canines and premolars can be clenched and a bridge can be provided at the level of the space created;

– if the teeth are too small, a joint prosthesis (cast crown) can be placed on each tooth.

The Contention:

The restraint can be removable or fixed.

The duration of the restraint is influenced by morphological data:

– good intercuspation will reduce the retention time.

– rotations tend to return slightly to their initial position.

– The recurrence of very crowded lower incisors is well known.

Typically, the retainer should be kept in place for at least 4 to 6 months after active treatment, the duration may be extended if there are rotations.

CONCLUSION :

Every practitioner wants to know the chances of success of the treatment strategy they are considering, whether it is conservative or extraction therapy.

We can conclude that the methods of measuring dento- maxillary disharmony allow us to decide on extraction therapy or not in a precise way, thus eliminating any risk of recurrence.