A malocclusion, if detected as soon as possible, can be eliminated or made less severe, by initiation of interceptive orthodontic procedures.

Interceptive orthodontics has been defined

as that phase of science and art of orthodontics

employed to recognize and eliminate potential

irregularities and malpositions of the

developing dento-facial complex.

The procedures undertaken in interceptive orthodontics include:1. 2. 3. 4.

5.
6. 7.

Serial extraction. Space regaining. Correction of developing cross bite. Oral habit elimination. Muscle exercises. Interception of developing skeletal malocclusion. Removal of soft tissue or bony barrier to enable eruption of teeth.

1)

Serial Extraction:
Is an interceptive orthodontic procedure usually
initiated in early mixed dentition .

It is corrected by a procedure that include planned

extraction.

Extraction of certain deciduous teeth & later specific

permanent teeth in orderly sequence. Pre-determined pattern to guide the erupting permanent teeth into a more favorable position.

Kjellgren in 1929 used the term serial extraction. Nance during 1940 popularized this technique in U.S.A. & termed it planned & progressive extraction.

Hotz in 1970 called such a procedure Active supervision of teeth by extraction.

2 Basic principles:
Arch length-tooth material discrepancy Physiological tooth movement

1.

Class-I malocclusion showing harmony between skeletal & muscular system.

2.

Arch length deficiency-following factors Absence of physiologic spacing.

Unilateral / bilateral premature loss of deciduous

canine with mid-line shift.

Malpositioned or impacted lateral incisors that erupt palatally out of the arch.

Localized gingival recession in the lower anterior region is a characteristics feature of arch length deficiency .

Ectopic eruption of teeth.

Mesial migration of buccal segment. Abnormal eruption pattern & sequence. Lower anterior flaring. Ankylosis of one or more teeth.

3.

4.

Growth is not enough to overcome the discrepancy between tooth material & basal bone. Patient with straight profile & pleasing appearance.

Cl-II & CI-III malocclusion with skeletal abnormalities. Spaced dentition. Anodontia / Oligodontia. Open bite & Deep bite. Middle diaestema. Cl-I malocclusion with minimal space deficiency.

Unerupted malformed teeth e.g. dilaceration. Extensive caries or heavily filled first permanent molar. Mild disproportion between arch length & tooth material that can be treated by proximal stripping.

More physiologic treatment as teeth are guided into

normal position using physiologic forces.

Duration of fixed treatment is reduced.

Health of investing tissues is preserved.

Lesser retention period is required. Result are more stable.

Good clinical judgment is required. no single approach

can be universally applied.

Treatment time is prolonged over 2-3 years. Patient cooperation is very important.

Tendency to develop tongue thrust as extraction spaces gradually.

Extraction of buccal teeth causes deepening of the bite.

Residual spaces can remain between the canine & 2nd

premolar.

Study models.

Radiographs.
Photographs.

Three popular methods Dewels method

Tweeds method Nance method

Dewel proposed three step serial extraction procedure. Extraction of C, D, 4s

Age : 8-9 yrs

Procedure : Extraction of C C C C Purpose : To create space for alignment of 21 12 21 12

Age : 9 - 10 yrs

Procedure : Extraction of D D D D Purpose : To facilitate eruption of 4 4 4 4

Procedure : Extraction of

4 4 4 4 Purpose : Permit eruption of 3 3 3 3

extraction of the D around 8-years of age.

followed by the extraction of 4 & the C

simultaneously 4-6 months prior to eruption of

permanent canines.

Same as Tweed
D4C

For correction of axial inclination

And detailing of occlusion

Not all patients who have lost arch length

by mesial molar movement are ideal

candidates for space regaining.

Space regaining is undertaken at an early

age, prior to the eruption of second molar.

1. Gerber Space regainer 2. Space regainer using Jack Screw. 3. Space regainer using Cantilever Spring.

Crossbite is a term used to describe abnormal occlusion in the transverse plane.

classified as 1. anterior 2. posterior

This type of malocclusion is self perpetuating if present in deciduous may manifest in mixed & permanent dentition as well Simple anterior cross-bite that are not treated early have the potential of growing into skeletal malocclusion

Broadly classified as Dento alveolar crossbite Skeletal crossbite Functional crossbite

Localised condition where one or more teeth are abnormally related to that of opposing arch Causes tooth material-arch length discrepancy over retained deciduous teeth supernumerary tooth trauma

Tongue blade Developing single tooth anterior crossbite can be successfully treated with tongue blade A flat wooden stick resembling an ice cream stick Placed inside mouth contacting palatal aspect of tooth in crossbite

Blade is made to rest on mandibular tooth in crossbite Patient is asked to rotate oral part of blade upwards and forwards Continued for 1-2 hours for about 2 weeks

Catalans appliance
Construted on lower anteriors(made of acrylic or cast metal) For single tooth crossbite or segment of upper arch in crossbite

Inclined plane have 45 angulation which forces the maxillary teeth in crossbite to a more labial position

Disadvantage Problems in speech If used more than 6 weeks causes Supraeruption of posteriors and anterior openbite May need frequent recementation

Use of double cantilever spring ( z spring )

USUALLY A RESULT OF SKELETAL

DISCREPANCIES IN GROWTH OF
MAXILLA OR MANDIBLE

BEST TREATED DURING GROWTH BY ORTHOPAEDIC APPLIANNCES

OCCUR BECAUSE OF OCCLUSAL PREMATURITIES WHICH CAUSES DEFLECTION OF MANDIBLE IN FORWARD POSITION DURING CLOSURE TREATED BY ELLIMINATING OCCLUSION PREMATURITIES

Abnormal transverse relationship between upper and lower posterior teeth.

Can be unilateral or bilateral

Common appliances used in the correction of crossbite are

Tongue blade therapy

-Inclined planes

-Composite inclines
-Hawleys appliance with Z spring

-Quad helix appliance .

For single tooth correction crossbite elastics

Rapid or slow maxillary expansion can be done with the use of, Removable acrylic plate with jack screw Quad helix Coffin spring

4.Control of abnormal habit:

Habit in the orthodontic sense refer to certain actions involving the teeth & other oral or perioral structures . Which are repeated often enough by some

patients to have profound & deleterious effect on

position of teeth & occlusion.

Habit that can affect the oral structures are, thumb sucking, tongue thrusting , mouth breathing, etc.

Thumb

sucking:

Presence of this habit upto 2-3years is consider quite normal. Beyond 3 years of age can have a damaging influence on the dentoalveolar structure.

Is defined as a condition in which the tongue makes contact with any teeth anterior to the molar during swallowing.

Present with open bite & anterior proclination. Intercepted by using habit breaker. Trained & educated on the correct technique of swallowing.

Mouth

breathing

Can be obstructive or habitual in nature. Nasal obstructive such as nasal polyps ,nasal tumors, chronic nasal inflammatory conditions &

deviated nasal septum.

Persistence of habitual oral breathing is an

indication to use a vestibular screen to intercept

the habit.

a. Exercise for the masseter muscle:

To strengthen the masseter muscle . Clenching of teeth by the patient while counting to ten.

Repeat the exercise for some duration of

time.

b. Exercise for the lip [circum oral muscles]

Upper lip is stretched in the posteroinferior

direction by overlapping the lower lip .

Hypotonic lips can also be exercised by holding a piece of paper between the lips. Parent can stretch the lips of the child in the posteroinferior direction at regular interval.

Swashing of water between the lips until

they get tired .

Massaging of the lips.

Use of oral screen with a holder-to

exercise the lips.

Button pull exercise.

Tug of war exercise.

c. Exercise for the tongue:

i.

One elastic swallow.

ii.
iii.

Two elastic swallow.

Tongue hold exercise.

iv.

The hold pull exercise.

Supernumeary teeth , over-retained & ankylosed primary teeth are other possible causes of non eruption.

Whenever a permanent teeth fails to erupt at the appropriate time, its eruption may be stimulated by surgically exposing the crown.

7. Interception of skeletal malrelations Interception of Cl-II malocclusions.

Excessive maxillary growth, deficiency in mandibular growth or a combination of both. Maxillary growth can be restricted by use of face bow with head gear. Mandibular growth is usually treated by myo-functional appliances.

Interception of Cl-III malocclusions. Mandibular prognathism, maxillary retrognathism & combination of both. Chin cup with head gear helps in restriction of mandibular growth . FR III or face mask therapy is used for cases of maxillary deficiency.

Years ago, most patients were not started in orthodontic treatment until age 12-14 till all their permanent teeth were in. Interceptive orthodontics is a more recent concept where certain problems are treated early (around age 7-11) to take advantage of growth and better cooperation. This can result in fewer teeth extracted, better profile and facial esthetics, and great full smiles.

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