Orthodontic Treatment in the Primary Dentition

Abstract The goals of orthodontic care in the primary dentition should be to treat conditions that predispose one to develop a malocclusion in the permanent dentition or to monitor conditions that are best treated later. Some primary dentition problems can be effectively managed and the result provides a long-term benefit. With other conditions, treatment should be deferred until intervention can provide a long-term benefit. The clinician needs to differentiate skeletal problems from dental to fulfill these goals. Treatment of skeletal malocclusions in this age group is ordinarily deferred until a later age; the delay is generally for practical reasons rather than an inability to alter skeletal structure at this age. Three general reasons are offered for delaying treatment. First, the diagnosis of skeletal malocclusion is difficult in this age group. Subtle gradations of skeletal problems and immature soft tissue development make clinical diagnosis of all but the most obvious cases difficult. Second, although the child is growing at this stage, the amount of facial growth remaining when the child enters the mixed dentition years is sufficient to aid in the correction of most skeletal malocclusions. Third, any skeletal treatment at this age requires prolonged retention because the initial growth pattern tends to reestablish itself when treatment is discontinued. In essence, retention is active treatment over a sustained period of years to maintain the correction. On the other hand, several dental problems merit attention during the primary dentition years.