Interceptive Part One

7/27/2019 Interceptive Part One

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A malocclusion, if detected as soon as possible, can

be eliminated or made less severe, by initiation of

interceptive orthodontic procedures.


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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.


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The procedures undertaken in interceptive orthodontics inc

1. Serial extraction.

2. Space regaining.3. Correction of developing cross bite.

4. Oral habit elimination.

5. Muscle exercises.6. Interception of developing skeletal malocclusion.

7. Removal of soft tissue or bony barrier to enable erup

of teeth.

S i l E i


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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 specificpermanent teeth in orderly sequence.

Pre-determined pattern to guide the erupting perman

teeth into a more favorable position.


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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.


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2 Basic principles:

Arch length-tooth material discrepancy

Physiological tooth movement


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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.


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Ectopic eruption of teeth.

Mesial migration of buccal segment.

Abnormal eruption pattern & sequence.

Lower anterior flaring.

Ankylosis of one or more teeth.


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3. Growth is not enough to overcome thediscrepancy between tooth material & basa

bone.

4.

Patient with straight profile & pleasingappearance.


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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.


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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 proxima

stripping.


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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.


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Good clinical judgment is required. no single appro

can be universally applied.

Treatment time is prolonged over 2-3 years.

Patient cooperation is very important.


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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 & 2

premolar.


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Study models.

Radiographs.

Photographs.


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Three popular methods

Dewels method

Tweeds method

Nance method


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Dewel proposed three step serial extraction

procedure.Extraction of

C,

D,

4 s


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Age : 8-9 yrsProcedure : Extraction of C C

C C

Purpose : To create space for alignment of 2121


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Age : 9 - 10 yrsProcedure : Extraction of D D

D D

Purpose : To facilitate eruption of 4 44 4


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Procedure : Extraction of 4 44 4Purpose : Permit eruption of 3 3

3 3


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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.


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Same as Tweed

D4C


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For correction of axial inclination

And detailing of occlusion


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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


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1. Gerber Space regainer 2. Space regainer using Jack Screw.

3. Space regainer using Cantilever Spring.


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

classified as

1. anterior

2. posterior


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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


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Broadly classified as

Dento alveolar crossbite

Skeletal crossbite

Functional crossbite


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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


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Tongue blade

Developing single tooth anterior crossbite can be

successfully treated with tongue blade

A flat wooden stick resembling an ice cream stickPlaced inside mouth contacting palatal aspect of

tooth in crossbite


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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


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Catalan s 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 whichforces the maxillary teeth in crossbite to a

more labial position


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Disadvantage

Problems in speech

If used more than 6 weeks causesSupraeruption of posteriors and anterior

openbite

May need frequent recementation


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Use of double cantilever spring

( z spring )


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USUALLY A RESULT OF SKELETAL

DISCREPANCIES IN GROWTH OFMAXILLA OR MANDIBLE


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BEST TREATED DURING GROWTH BY

ORTHOPAEDIC APPLIANNCES


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OCCUR BECAUSE OF OCCLUSAL

PREMATURITIES

WHICH CAUSES DEFLECTION OF

MANDIBLE IN FORWARD POSITIONDURING CLOSURE

TREATED BY ELLIMINATING

OCCLUSION PREMATURITIES


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Abnormal transverse relationship between

upper and lower posterior teeth.

Can be unilateral or bilateral

Common appliances used in the correctio


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ppof crossbite are

-Tongue blade therapy

-Inclined planes

-Composite inclines

-Hawleys appliance with Z spring-Quad helix appliance .


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For single tooth correction

crossbite elastics

R id l ill i b d


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Rapid or slow maxillary expansion can be done

with the use of,

Removable acrylic plate with jack screwQuad helix

Coffin spring


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4.Control of abnormal habit: Habit in the orthodontic sense refer to certai

actions involving the teeth & other oral or

perioral structures .

Which are repeated often enough by somepatients to have profound & deleterious effe

position of teeth & occlusion.


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Habit that can affect the oral structures arthumb sucking, tongue thrusting , mouth

breathing, etc.


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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.


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Is defined as a condition in which the tong

makes contact with any teeth anterior to tmolar during swallowing.

Present with open bite & anterior

proclination. Intercepted by using habit breaker.

Trained & educated on the correct

technique of swallowing.


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Mouth breathing:


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Can be obstructive or habitual in nature.

Nasal obstructive such as nasal polyps ,nasa

tumors, chronic nasal inflammatory conditio

deviated nasal septum.

Persistence of habitual oral breathing is an

indication to use a vestibular screen to interc

the habit.


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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.


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b. Exercise for the lip [circum oral muscles]


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Upper lip is stretched in the posteroinfer

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 unti


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S as g o ate bet ee t e ps u t

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:


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i. One elastic swallow.

ii. Two elastic swallow.

iii. Tongue hold exercise.

iv. The hold pull exercise.


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Supernumeary teeth , over-retained &

ankylosed primary teeth are other

possible causes of non eruption.


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Whenever a permanent teeth fails to erupt

at the appropriate time, its eruption may bstimulated by surgically exposing thecrown.

7. Interception of skeletal malrelations


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Interception of Cl-II malocclusions.


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Excessive maxillary growth, deficiency in

mandibular growth or a combination of bot Maxillary growth can be restricted by use o

face bow with head gear.

Mandibular growth is usually treated bymyo-functional appliances.


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Interception of Cl-III malocclusions. Mandibular prognathism, maxillary

retrognathism & combination of both.

Chin cup with head gear helps in restrictionof mandibular growth .

FR III or face mask therapy is used for casesof maxillary deficiency.


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Years ago, most patients were not started in

orthodontic treatment until age 12-14 till alltheir permanent teeth were in.

Interceptive orthodontics is a more recentconcept where certain problems are treated ear

(around age 7-11) to take advantage of growthand better cooperation.

This can result in fewer teeth extracted, betterprofile and facial esthetics, and great full smile


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THANK YOU

Documents

Interceptive Part One