Dentistry (then Pedodontics-Indiana University) and Orthodontics (Boston University), boarded by examination in both specialties. I had the magnificent fortune to join Dr. Doyle in his practice. Educationally, I could not be more privileged. And that is why I am passionate about teaching interested pediatric dentists and GP’s what I have been so fortunate to learn and practice. We dentist are a funny bunch. The dentists in one’s community often are insulated and unaware-perhaps wary-of their geographically close colleagues. Yet, as we extend out into the world-for me, all over the United States, and to Dubai, UAE and China, we find colleagues hungry to learn and practice at a new transformative level. What a privilege and honor it is to share with our colleagues. Dr. Len Carapezza has over 30 years of clinical experience in pediatric orthodontics including a successful private practice in Wayland, MA. He lectures internationally on “Early Treat-ment of Malocclusion” for general and pediatric dentists and he is the founder and director of the Institute for Growth and Development in Pediatric Dentistry. This makes him a great closer for our interviews on Early Treat-ment. Dr. Carapezza spoke with me about what he feels early treatment is as well as its benefits and the protocols he uses. Len Carapezza Early treatment, as I practice it, is treatment in the primary and early mixed dentition. Treatment is performed to enhance the dental and skeletal devel-opment before the eruption of the full permanent denti-tion. My goals of early treatment are to achieve proper overbite, over jet, proper molar relation, serial guidance (-redirection of eruption) and lip seal. First and foremost when I talk about early treatment, I am talking about the guidance of eruption-redirec-tion of eruption. There truly is some-thing pediatric dentists and generalist can do during the eruption process to 32 Spring 2014 JAOS alter the course of eruption and to change the final arrival of the teeth. Early treatment calls for prioritizing crowding, deep overbite, and molar rotation and then secondarily manag-ing the Class II and Class III issues. Early treatment has always been thought of as prioritizing the skeletal issues first; managing them with func-tional appliances rather than managing crowding, deep overbite and molar rotation first. The redirection of the eruptive element, which addresses crowding, deep overbite and molar rotation, has been totally neglected by our profession. With Early Treatment as I practice it, my young patients finish treatment at a younger age. While other kids are just starting with braces at age 12 or 13 years of age, the early treatment kids are finishing comprehensive ortho by age 12 or 13. Their permanent teeth arrive in the mouth earlier and are better aligned. How old a child is when they receive Early Treatment is not as important as the problem they present with or their stage of development, which will vary from child to child. Dental development and somatic growth do not coincide. Generally you can base it on the maturity of the roots of the permanent bicuspid teeth. I use panoramic films to check whether the first bicuspid roots are half developed, and the majority of my early treatment begins at that time. But, that in itself is not a hard and fast rule. Again, it depends on the problem and its delete-rious effects on the dentition and skeletal development. I have found that there are three general benefits to early treatment. First, finishing at a younger age: second, a much shorter time in FULL fixed appliances; and third, less inva-sive and less mechanical forces are delivered to the teeth which have already erupted earlier and straighter. What I see as the major benefit to early treatment is obtaining growth modifi-cation where the orthodontic case finishes with dental Class I and Skele-tal Class I relationship in 90% of the early treatment cases. My experience evaluating late mixed or early perma-nent dentition distalalization treat-ment mechanics which is the gold standard for conventional Class II treatment evidences Class I dental but camouflages a remaining retrognathic mandible with also the potential of a retrognathic maxilla. We can see there are benefits to early treatment but some pediatric dentists and generalists are still hesi-tant to move forward with this treat-ment for their young patients. To help understand what early treatment can do for a patient. It is important to really study growth, development and the eruption of teeth: By doing this you will learn to use the eruption of permanent teeth to your advantage. Consider that as erupting teeth travel from within the bone into the mouth, you can change and control their erup-tion. Think of eruption as tooth move-ment but movement with eruption rather than with braces. It is possible to redirect eruption, resolve crowding, molar rotation and deep overbites during a transitional occlusion. Maxil-lary insufficiency, mandibular prog-nathism and Class III occlusions can also be addressed but manage the crowding, deep overbite and molar rotation first then the Class II and III issues. A protocol involving the above concepts can completely change your perspective on Early Treatment. My Early Treatment protocols that I routinely use involve: ᕡ Arch Development appliances of a fixed nature i.e. a. E-arches b. RPE (Rapid Palatal Expansion) c. NPE (Nitanium Palatal Expansion) ᕢ Basic and Advanced Utility Arch Wire Mechanics ᕣ Serial Guidance – redirection of eruption ᕤ Philosophy, concepts and treat-ment techniques of the Andrews’ Straight-Wire Appliance I have employed these protocols with my young patients for years. When I started my practice forty years ago, nobody in my community stated comprehensive ortho treatment in the early mixed dentition. The conflict arose between dentists like me – who believed in early intervention and asked the basic question: “can we do anything before all the permanent teeth arrive in the mouth?”-and the
Journal of the American Orthodontic Society Spring 2014: Page 32
