Interceptive Orthodontics Treatment:

Efficient Early Correction of Malocclusion

Perawatan Ortodonti Interseptif :
Koreksi Awal Maloklusi yang Efisien

Prof. Dr. Ida Bagus Narmada, drg., Sp. Ort. (K)

The problem oriented approach

Question Problem list

Clinical Data =
Classification
examination base Diagnosis
Analysis Dx
ORTHODONTIC CLASSIFICATION SYSTEMS

II/1-2

III
Edward Hartly Angle
1855 - 1930
THE PROBLEM-ORIENTED APPROACH

● Comprehensive way of looking at patient’s

problem
● Involves development of a database
 Patient interview / questionnaire
 Clinical exam
 Diagnostic records : study model,
Rὃ : Panoramic, Lateral Sefalometric, Posterior-
Anterior Sefalometric and CBCT
Orthodontic Diagnosis

Proffit, W.R. (2007) Contemporary Orthodontics. 4th Edition,

Mosby, St. Louis, 107-129 and 689-691.
KELOMPOK USIA
67.3% anak usia 5 tahun memiliki angka pengalaman
karies gigi (dmft) ≥6 (masuk dalam kategori karies anak
usia dini yang parah/Severe Early Childhood Caries (S-
ECC))

HASIL UTAMA RISKESDAS 2018 BLOK GIGI"

 The AAO recommends that children
are first evaluated by an orthodontist
at
Age 7
to determine if they are in need of
early orthodontic treatment.
Some Problems Observed in the Early Mixed
Dentition

● Openbite/Deepbite
● Protrusion
● Crossbites
● Tooth-size/arch size discrepancies
DEVELOPMENT OF
DENTITION

Permanent Dentition

Mixed Dentition

Primary Dentition
ORTHODONTICS TREATMENT

 PREVENTIVE ORTHODONTIC
 INTERCEPTIVE ORTHODONTIC
 CURRATIVE/ COMPREHENSHIP ORTHODONTIC
 MULTIDICIPLINARY
 INTERDICILINARY
 PREVENTIVE ORTHODONTIC

Early orthodontic treatment:

Recognition of future problem is the critical step in
preventive orthodontics
Early diagnosis: Future problem can be identified by 2
ways:
1. Clinical indicators
2. Radiographic indicators
PREVENTIVE ORTHODONTIC

1. Clinical indicators:
 Lack of inter-dental spacing
 Premature loss of primary tooth
 Over retained deciduous tooth
 Delayed eruption of permanent tooth
 Proximal caries in primary molars can reduce the arch
length
 Gingival recession
PREVENTIVE ORTHODONTIC

2. Radiographic indicators:
 Resorption pattern of primary dentition

 Resorption of roots of many primary teeth associated with eruption

of permanent tooth
 Deciduous canines and second molar resorption pattern

 Mesial positioning of maxillary canine buds

 Superimpostioning of proximal surface of teeth

 Presence of supernumerary tooth

Radiographic indicators
PREVENTIVE ORTHODONTIC PROCEDURES

The procedures are of 2 types:

1. Preventive procedures without using
orthodontic appliance
2. Preventive procedures with using orthodontic
appliance
 PREVENTIVE ORTHODONTIC PROCEDURE WITHOUT
USING ORTHODONTIC APPLIANCE
Predental procedures
 Parent education
 Oral hygiene
 Caries prevention and dental caries
 Monitoring of primary dentition and transition stage
 Removal of supernumerary tooth
 Restoration of decayed tooth
 Occlusal equilibration
 Habit correction
 Extraction of retained deciduous tooth
 Management of mucosal barriers and labial fermium
 Tongue-tie management
 Disking
 Locked permanent first molar
Interceptive Orthodontics

What is Interception?

Any procedure that eliminates or reduces the severity

of malocclusion in the developing dentition.
All simple measures that eliminate the developing
malocclusion.
(Proffit, 2007) Contemporary Orthodontics. 4th Edition, Mosby, St. Louis
Interceptive Orthodontics

Although orthodontic screenings are

recommended at age 7, the “Gold Standard” for
:orthodontic treatment timing is
“During the adolescent growth spurt, starting in
the late mixed or early permanent dentition.”
Interceptive Orthodontics

Proffit considers 4 key principles in Early Tx:

● Growth modification
● Facial growth in the three planes of space
● Tooth eruption vs.

Skeletal growth Permanent teeth eruption

location
Proffit. “The timing of early treatment: An Overview.” AJO-DO. Vol 129(4):
S47-S49, 2004.
Early/interceptive
orthodontic treatment
should be limited to
ONE YEAR (max 18
months)
Early Orthodontics Treatment

3 Main Categories:
1. Severe Dental Problems
2. Severe Skeletal Problems
3. Myofunctional/Habit Problems
Severe Dental Problems

 Crossbites of Dental Origin

(Posterior/Anterior)
 Severe Crowding (Tooth Size Arch Length
Discrepancy - TSALD)
 Premature Tooth Loss: Space Maintenance
 Eruption Problems
 There is a limit to the time and cooperation that patients
and parents are willing to devote to treatment.
 It is easy for mixed dentition treatment to extend over

several years and result in one long period of

treatment.
 If mixed dentition treatment takes too long,
there are 2 problems:
1) Patients become “burned out”
2) Chance of damage to teeth increases as treatment
time increases
 AAO Council of Orthodontic Education

Interceptive Orthodontics-
“The science and art of orthodontics employed to
recognize and eliminate potential irregularities
and malpositions in the developing dentofacial
complex.”
Orthodontics: Council on Orthodontic Education. St Louis; AAO1971.
CLINICAL CONSIDERATION

Management of orthodontic treatment

Biomechanical of tooth movement

Control of anchorage during mixed

dentition

Development of dentition

Management of space closure

Retention Phase
CLINICAL CONSIDERATION
 Early treatment rendered during mixed dentition
(Phase I)
● Improve the overall oral environment
● Correct problems that are easier to fix early
● Reduce the complexity of treatment in the
permanen dentition
Treatment Management of
:
Malocclusion
 SPACE
ANALYSIS

Proffit, 2019
Treatment Phases for Early Age /Interceptive Orthodontics

Phase I Active
Treatment

Maintenance

Phase II Active
Treatment
 Anterior Crowding
Tooth-size/arch size discrepancies
unilateral posterior crossbite
 POSTERIOR CROSSBITE

Rapid Palatal Exspansion Quad Helix or W-arch

Orthopedic Appliances:

Bionator (Removable) Herbst - Fixed

A Quadhelix appliance
Serial Extraction/ Crowding
Serial Extraction
DELAYED ERUPTION
Anterior Crowding
Retention
Incline Biteplane
Incline Biteplane

Pre treatment During Treatment

Incline Biteplane

Pre Treatment Post Treatment

Incline Biteplane
 Incline bite plane

Nanda, 2005.
Anterior crossbite correction in primary and mixed
dentition
with removable inclined plane (Bruckl appliance)

Irena Jirgensone, Andra Liepa, Andris Abeltins, 2008.

CLINICAL CASE REPORTS
Stomatologija, Baltic Dental and Maxillofacial Journal, 10:140-144, 2008
Management of Sagittal
Problems
Management of Sagittal Problems(Class II/1)

To correct
protrusion of the
upper or lower jaw
class II/1
malocclusion

Management of severe overjet, impinging deep bite, and mandibular retrognathism

in a 9-
year-old girl. (a to c) Pretreatment occlusion. (d to f) Posttreatment occlusion
 DISTALIZATION PROCEDURES

● To correct
protrusion of the
upper or lower jaw
class II/1
malocclusion

HEADGEAR
Headgear
Orthopedic Appliances:

Bionator (Removable) Herbst - Fixed

Pendulum/Pendex appliance

Pendulum/Pendex appliance
bite jumping appliance
BITE JUMPING APPLIANCE
 Anterior Dental Crossbite and Class III
Malocclusion

● Early treatment of Class III

malocclusion
Early class III treatment decision-making
Orthopedic facial mask

Nanda, 2005
 ANTERIOR CROSSBITE

Anterior Crossbite Removeable Appliances Post treatment

Early treatment of Class III malocclusion: 10-year
clinical follow-up
 Chin cup therapy

Marcio Rodrigues de ALMEIDA1 , Renato Rodrigues de ALMEIDA2 , 2010

Chin cup therapy

Marcio Rodrigues de ALMEIDA1 , Renato Rodrigues de ALMEIDA2 , 2010

Chin cup therapy
Orthopedic facial mask

Orthopedic facial mask

Nanda, 2005
Growth modification Class III malocclusion
Growth modification Class III malocclusion should be recognized and
treated early due to the following reasons

The reasons for early treatment :

1. To correct the anterior displacement of the mandible
before the ERUPTION of the CANINES and PREMOLARS
so that they can be guided into a Class 1 Relationship

2.To provide space for the eruption of the BUCCAL

segments as a result of Proclination of the upper incisor
3.To provide a normal environment for the growth of the maxilla
by Elimination the Anterior Crossbite

4. Psychological benefits resulting from improved dental and

facial appearance.
Corrections in the Anteroposterior Dimension

The use of TADs is a compliance‐free alternative to

traditional
forms of anchorage control in orthodontic treatment.
Of the three dimensions, TADs have been used most
frequently to correct problems in the anteroposterior
dimension. Typical treatment objectives include
mesialization
or distalization of a single tooth, multiple teeth, or
maxillary/mandibular total arches.
Temporary Anchorage Devices in Clinical Orthodontics
Jae Hyun Park, DMD, MSD, MS, PhD
Diplomate, American Board of Orthodontics,2020
 CLASS III MALOCCLUSION

DEEP OVERBITE
MAXIMUM INTERCUSPATION
CLASS III MALOCCLUSION

LATE MIXED DENTITION

CLASS III MALOCCLUSION
ANTERIOR CROSSBITE
CLASS III MALOCCLUSION

INITIAL CONTACT POSITION

RESULTS IN SOME
ANTERIOR FUNCTIONAL SHIFT
CLASS III MALOCCLUSION

AVAILABLE LEEWAY SPACE

Class III Elastic
Class III Malocclusion

POST-TREATMENT
Class III Malocclusion

POST-TREATMENT
NORMAL OCCLUSION
CONCLUSIONS

● Before treatment it is necessary to consider the

proper orthodontic diagnosis in early age
● Choosing the appliances for correction of
malocclusion in early age have to consider the
amount of vertical, sagital and tranversal
consideration
● Only a few spontaneous corrective changes can be
expected without active intervention
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