Early Treatment


EarlyTreatment.pngOrthodontic treatment for children who have both deciduous teeth and permanent teeth developing is technically known as “Early Treatment.” Most children do not have treatment until all their deciduous teeth have been lost, but in some cases early treatment is necessary for an immediate problem or to prevent or reduce a developing problem. Most children who have early treatment still require braces when the permanent teeth have emerged. A child of eight years of age has enough teeth and enough jaw development for an orthodontist to quite accurately assess whether or not orthodontic treatment will be required in the future.

Generally, early orthodontic treatment is kept to a minimum because of the likelihood of further treatment being necessary later. No patient wants early treatment for something that can be more easily fixed when the permanent teeth are through.

Mostly removable appliances are used for early treatment and the usual problems requiring this are crossbites of the front or back teeth, thumb-sucking habits and regaining or holding spaces following the early loss of deciduous teeth.

Anterior Crossbites

The upper front teeth were caught behind the lower front teeth when biting together. An upper removable appliance gently moved the upper front teeth forward, correcting the crossbite.
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Posterior Crossbite

The width of the upper arch of teeth is slightly contracted compared to the lower arch, and the lower jaw has to move to one side or the other for a comfortable bite. This sideways jaw movement is called “a mandibular deviation.” If it persists without early treatment there is the possibility that it may cause a permanent asymmetry of the lower jaw. An upper removable appliance or a fixed “Quad Helix” can be used to expand the upper arch to match the lower and thereby reduce or eliminate the sideways movement of the lower jaw when biting.
Posterior-Crossbite.jpg

Thumb-sucking

When a patient would like assistance to stop his or her thumb-sucking habit, a very simple upper removable appliance can be worn or, in more persistent cases, a fixed appliance like a “Quad Helix” can be placed with loops behind the upper front teeth to prevent the thumb from entering. (Also see under FAQs: thumb-sucking).
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Functional appliances

The most usual functional appliance is “Twin Blocks” which consist of upper and lower removable appliances. The upper appliance has a built up wedge towards the back while the lower has a built up wedge towards the front – the wedges are designed and positioned so that every time the patient closes their mouth, the lower jaw is pushed forward by the way that the wedges act against each other. This persistently pushes the lower jaw forward, creating a potential space at the jaw joint. If the patient has the inherent and natural growth potential, the jaw may grow towards this potential space and therefore improve the forward positioning of the lower jaw. Success of the appliance depends upon:

The patient must be at a good growing stage and have the potential for a primarily forward growth pattern of the lower jaw. The appliance is mostly used for patients who have a relatively small lower jaw. However, it does not work as well in those who have long narrow faces with a relatively small lower jaw.
A very high degree of cooperation is required as the appliances must be worn absolutely all the time apart from cleaning or some sports. As the appliances are worn for nine to twelve months, this requires a great deal of determination on the patient’s behalf. If the patient’s cooperation is inadequate, no result at all will be achieved.


Functional appliances do not correct crowding or other irregularities but only attempt to improve the front-to-back jaw and tooth relationships.  There is no scientific evidence for a predictable increase in jaw length of a practicable amount (“clinically significant amount”) for a given patient beyond what would be expected anyway without use of the appliances.  Never-the-less, significant tooth movement can be achieved which does make a difference.  The appliance is often used when all the deciduous teeth have just been lost and before fixed braces are fitted (hence "early treatment").    Almost all patients still require fixed braces after the use of twin blocks.
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Fixed Braces

With some more complicated problems, removable appliances are inadequate and fixed braces are required. This may be for very irregular front teeth that are in crossbite or for impacted teeth that need to be rescued early as they will continue to worsen.
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EarlyTreatment.png“早期治疗”是在小孩同时有乳牙和恒牙时候进行治疗。大部 小孩通常会等到换完乳牙之后才开始治疗。但是,有一些 病例需要用早期治疗来防止或减少它的严重程度。当恒牙 萌出后,多数小孩子还是需要戴固定矫正器来完成治疗。一个八岁小孩的牙齿和颌骨的发育程度完全可以让专科医 生诊断它是否有需要在将来进行治疗。

通常,我们会尽可能不做早期矫正治疗因为这些病例以后可 能需要二次治疗。当恒牙长出以后再治疗会让治疗变得更 方便与彻底。

早期治疗通常是用活动矫正器,来纠正前后反颌,吸手指和 保持乳牙缺失的牙间隙。

 

前反颌

如下图:看见上面的前牙咬在下面的前牙后面。可以用上颌 活动矫正器把上前牙往前移纠正了反颌。
Anterior-Crossbites.jpg

后反颌

上牙弓的后部宽度比下面的更窄,当咬在一起的时候会使 下颌骨移到一边。这是叫“下颌偏斜”。如果早期不纠正,会 造成下颌骨的永久不对称。一个上颌活动矫正器或固定 “Quad Helix”矫正器可以把上牙弓扩大使得它和下牙弓相配,来减少下颌偏斜。
Posterior-Crossbite.jpg

吸手指

当病人自己想改掉吸手指的不良习惯,我们可以根据习惯 的持久性来决定是否要装固定还是活动的器具。(请看常 见问题:吸手指部分)
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功能性矫正器

最常用的功能性矫正器是叫“Twin Blocks”,有上下两部分 活动器具组成。上下矫正器有交叉的塑料块,每次病人咬 合时会把下面的颌骨往前推,使得颌关节往前移,留出空 间给下颌骨生长。下颌骨只有在病人还在生长的时候才会 这样生长。使用功能性矫正器治疗的成功率是取决于:

 病人下颌骨是否还在发育。通常用在下颌骨比较小的病人。但是在长窄脸型的病人上使用效果不好。
 病人的完全配合度。这器具除了吃饭和运动以外,每天每晚都需要带着,否者不会有效果。

功能性矫正器除了改善上下前后咬合和颌骨关系,不会纠 正牙齿拥挤或其他的问题。它也不会造成下颌骨的发育超 过天生自定的长度,可是它会使牙齿移动。功能性矫正治 疗经常在乳牙刚刚掉失的时候进行,做完后还需要戴固定 矫正器来结束治疗。
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固定矫正器

有些复杂的病例,是需要用固定矫正器来尽早治疗。比如 前牙的严重不齐或阻生牙,是需要尽早治疗。
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