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Early Orthodontic Treatment

Focusing on the influence of craniofacial growth on jaw position, this book shows how to incorporate such knowledge into diagnostic and treatment approaches to gain long-term stability. All types of malocclusion, from retrusion and asymmetry to cleft palate and hemifacial microsomia, are discussed. Case presentations demonstrate the importance of initiating orthodontic treatment at early ages to gain the greatest possible control over form and function and changes with time.

Preface:
An old adage states, @91hindsight is better than foresight.' Applying this adage to orthodontic treatment, we can say that hindsight should serve as a foundation on which to develop better foresight. This is particularly true in treating patients at early ages, where the orthodontist, using experience, careful observation, and earlier documentation (hindsight), must foretell the result of treatment (foresight). In my 40+ years in private practice and education, I have had much experience with long-term treatment of early orthodontic cases. Much information needs to be added to our knowledge of early orthodontics; despite its importance, it still is not, and may never be, fully comprehended. Early orthodontic treatment has not been routinely pursued, and so long-term observations are lacking. However, the need has recently become more pronounced. Early orthodontic treatment is now more generally accepted as a means of gaining the greatest possible control over form and function and changes with time. It seems logical to assume that certain problems should be treated early to take advantage of the most craniofacial growth. Many difficult orthodontic problems reside in maldeveloped and/or malrelated skeletal structures, or result from unfavorable functional adaptations that lead to adverse postural relationships. The dentition is what we see, and so we move teeth in an attempt to remove the 'mal'; however, the causative mechanisms may lie elsewhere. Dental alignment may give a clue as to the cause and complexity of the problem; but the fact is that as the jaws go the teeth go, and where the jaws grow the teeth must also go. An increasing number of severe malocclusions are skeletal (jaw) and/or growing malocclusions that manifest as dental malrelationships. These become increasingly difficult to treat the longer the growth' continues. If these problems could be treated early, then it might be possible to minimize the consequences of undesirable craniofacial growth. In view of this possibility, this book presents several skeletal-related problems that might develop into overtly malrelated dentitions, as well as dentoalveolar malocclusions. Whenever possible, long-term treatments, along with appropriate diagnoses and treatment plans, will be presented. The central focus of this book is jaws and jaw growth. The human head has two distinct and disjoined jaws. The dentition within these two jaws brings into being either an acceptable occlusion or a malocclusion. The size, shape, and position of the two jaws will be the deciding factor in determining the presence or absence of a skeletal malocclusion. Conceptually, jaw-related malocclusions and their treatment have not been discussed as fully as has the treatment for the more recognizable dentoalveolar malocclusions. It is my contention that knowledge and orthodontic activity in this area will continue to increase. In the meantime, we must benefit from our lessons of the past and apply such knowledge toward the future. The contributors of two chapters are gratefully acknowledged. Dr Leonard Fishman presents a unique approach to evaluating growth in the craniofacial complex. Drs Scott Stein, Ross Talents, and Mark Moss discuss some of the less understood disorders of the temporomandibular joint. I also want to acknowledge the students and patients who have helped shape this book. It is my hope that many young patients will reap benefits from the patients and concepts found in this book.