Qu i c k T i m e a n d a Gra p h i c s d e c o m p r e s s o r a re n e e d e d to s e e t h i s p i c t u r e

Class I Type 5

Definition

Class I
Normal mesiodistal relation of the mandibular arch to the maxillary arch Mesiobuccal cusp of the maxillary 1st permanent molar is occluding in the mesiobuccal groove of the mandibular 1st permanent molar

Class I
There is a slight mesial step The profile is straight or slightly convex The problem is dental in origin Neutrocclusion (Lischers classification)

Class I

Type 5
Classified by DeweyAnderson as a condition where there is drifting of molar, resulting from premature loss of teeth.

Definition

Causes

Causes
1.

Premature loss of deciduous second molars

Reduced mesiodistal dimension of deciduous molars due to extensive caries lesions

2.

Premature Loss of Mandibular 2nd Deciduous Molar (Neutrocclusion)

The maxillary 2nd deciduous molar can overerupt and thereby obstruct the migration of the mandibular 1st permanent molar.

Premature Loss of Maxillary 2nd Deciduous Molar (Neutrocclusion)

The mand 2nd deciduous molar has a broader crown than its antagonist. As a result it occludes with two teeth and when the max 2nd molar is lost, the mand molar is still in occlusion with the 1st deciduous molar in the maxilla.

Premature Loss of Maxillary 2nd Deciduous Molar (Neutrocclusion)

In this case of Class I Type 5, the mandibular teeth are not distally positioned, but the maxillary teeth have migrated mesially.

Class I Type 5
Class I Type 5 gives the appearance of a Class II or distocclusion, if the relationship of the cusps of the maxillary and mandibular molars is the only factor considered and studied. In here, a frequent error in judgment occurs in diagnosis.

Premature Loss of 2nd Deciduous Molars (Neutrocclusion)

The 1st molars in both jaws migrate mesially. The max molar does that to a greater degree. The movement of the mand 1st molar frequently takes place in association with a certain degree of mesiolingual rotation.

MESIAL SHIFT
Physiologic movement of the tooth

MESIAL DRIFT
Caused by local factors, that could lead to malocclusion

Mesial Drift
Mesial drift of the first permanent molars involves three separate kinds of tooth movements: 1. mesial crown tipping 2. rotation 3. translation Mesial Crown Tipping

Mesial Drift
Rotation Translation

Modes of Mesial Movement

There are distinct differences in the mode of mesial movement between the upper and lower first molars caused by variations in the
1. 2.

3.

crown shape number of roots occlusal relationships

Crown Shape

Number of Roots

Occlusal Relationship

Maxillary First Permanent Molar

Quickly tips mesially with the loss of crown substance of the maxillary 2nd primary molars.
Mesial tipping causes the distobuccal cusp to become more prominent occlusally.

The large lingual root of the maxillary 1st permanent molar causes the rotation of the crown with mesial tipping.

Maxillary First Permanent Molar

If 2nd primary molar is lost prior to the eruption of the 1st permanent molar, translation of the first permanent molar during eruption may be seen.

Mandibular 1st Permanent Molar

Display mesial tipping, crown rotation, and translation as well but they are more likely to show lingual tipping during mesial movement. The lingual tipping is caused by the absence of a lingual root and the fact that occlusal function occurs buccally to the center mass of the lower molar, a condition aggravated as the first molar drifts mesially.

Mandibular 1st Permanent Molar

Definition

Causes

Treatment

Objectives of Treatment
Facilitate a more conservative, ideal restoration.
Eliminate plaqueforming areas.

Improve crown to root ratio. Re-establish long axis force loading of the teeth.

Improve the alveolar ridge contour.

Treatment
1.

Distalize permanent first molars using space regainers.

Restore proximal surfaces of carious deciduous molars to restore mesiodistal dimension of adjacent teeth.

2.

Space Regainers
Space regainers are appliances used for regaining space lost in the line of the dental arch. They are used to tip to upright positions those teeth that have drifted after other teeth have been lost

Space Regainers
Space regainers find their greatest use in the mixed dentition after premature loss of primary molars in positioning permanent teeth. The space regainers are not to be used for creating space in the line of arch that was never there.
Regaining what was once there is entirely different from creating that which was never there.

Reduction in available dental arch length resulting from migration after premature loss of deciduous molars can sometimes be regained, at least in part. The conditions are more favorable in the mandible than in the maxilla; regaining space seldom occurs in the latter.

Factors to Consider in Using Space Regainers:

1. 2. 3.

Crown Shape Bone Structure Jaw Form

The lack of space regaining in the maxilla is partly attributable to the rhombic form of the maxillary 1st permanent molar. The space between the 1st premolar that has just emerged and the rotated 1st permanent molar is trapezoidal, yet the succeeding tooth is more rectangular.

In the mandible, the 1st permanent molar that have migrated mesially can move distally with the eruption and emergence of the 2nd premolars. Likewise, 1st premolars that have drifted distally can move mesially. In the maxilla, this phenomenon is seldom seen.

It is not only on mechanical grounds that a mandibular 2nd premolar can, on eruption and emergence, regain the space originally intended for it.
There are also more favorable conditions of bone structure and of jaw form in the mandible than in the maxilla.

MAXILLA The trapezoid area previously described contains bone that is not compact but cancellous.
MANDIBLE The corresponding bone structures more dense, and the limited buccolingual dimension of the jawbone forms an additional restriction for escape.

Types of Space Regainers

1.
2. 3. 4. 5.

Split-saddle Acrylic Space Regainer Slingshot Regainer Recurved Helical Spring Sliding Yoke Regainer Expansion Screw Space Regainer

Split-Saddle Acrylic Space Regainer

Slingshot Regainer

Recurved Helical Spring

Sliding Yoke Regainer

Expansion Screw Space Regainer

Space Regainers
Do not overextend the space regaining appliance. Space regaining appliances are intended to be used solely for recovering space that once was there. Space regaining is not space creating.

Space Regainers for Extensive Loss of Arch Length

Amount to be Regained 0-2 mm
2-4 mm >4 mm Mandible Helical Spring, Split-Saddle Slingshot, Split-Saddle Maxilla Split-Saddle, Helical Spring Split-Saddle, Sliding Yoke Extraoral Force

Space Regainers
The timing of space regaining is important. Since the position and stage development of the 2nd permanent molar often is a limiting factor.
When the simpler space regaining appliances cannot complete the task, one may resort to extraoral traction, but before using extraoral traction, the case should be reassessed completely to make certain that the original diagnosis still obtains.

Space Regainers
Do not overextend the space regaining appliance. Space regaining appliances are intended to be used solely for recovering space that once was there. Space regaining is not space creating.

Space Regainers
When the loss of perimeter length is so extensive as to be beyond the scope of the simpler appliances, or when there is insufficient time to recover the space before eruption of the bicuspids and 2nd permanent molars, a far more difficult clinical situation obtains and comprehensive multibanded appliance therapy usually is indicated.

Good day!