Treatment planning and therapy in the mixed dentition

Abstract

THERE are two major objectives of treatment during the period of the mixed dentition. One is the control of factors which interfere with the growth and development of the teeth and jaws. The second is the directing of occlusal development to effect a more desirable dentofacial growth. Many treatment techniques are available for meeting these objectives. One of the most useful aspects of mixed-dentition therapy is the practice of observation. By observation, I mean the collecting of information and data about growing teeth and jaws in order to determine their ability to adjust and adapt into satisfactory occlusions. Too often orthodontists feel obliged to step in and expedite dental growth and development. In this way they muddle the developmental factors with gadgets and appliances and confuse their understanding of the true nature of the problem. On the other hand, through observation of growing structures, they can gain information about the direction of growth and the real need for treatment. An example of the use of observational procedures is shown in Fig. 1, in which supernumerary teeth and an anterior crossbite are the factors that interfere with dental growth and development (Fig. 1, A). The upper cast and the roentgenograms reveal a supernumerary right lateral incisor in the central incisor position, with a supernumerary central incisor labial to the left lateral incisor. All teeth are well formed. In this case the supernumerary right lateral incisor and the supernumerary left central incisor were extracted. Then the adjacent teeth were allowed to erupt and adjust. The right central and left lateral incisors moved immediately into position. The action of the lip and tongue served to expedite these changes.