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Preventive and

interceptive orthodontics

Courtesy Of:
Orthodontic procedures can be divided as:
• Preventive
• Interceptive
• comprehensive
Preventive orthodontics
• Anticipation of development of a problem
– Patient and parent education ,
– supervision of growth and development of
dentition and craniofacial structures ,
• the diagnostic procedures  predict the
malocclusion  treatment procedures 
prevent malocclusion
Interceptive orthodontics
• Procedure are undertaken when the problem
has already manifested.
Orthodontic problems in children :
- non skeletal (dental)
- skeletal problems
Preventive orthodontics
• Natal teeth
• Occlusal relationship problems
• Eruption Problems
• Space maintainence
Natal teeth
• Present at birth or erupt shortly after birth
• Most frequent in lower incisor region
• Only 10% are supernumerary  removed only
when interfere with feeding or causing tongue
Occlusal relationship problems
a)Cross bites of Dental Origin
b) Oral Habits and Open Bites
Occlusal relationship problems
Cross bites of Dental Origin:
Correction of dental crossbites in the mixed
dentition is recommended because it
eliminates functional shifts
Minor canine interference leading to
mandibular shift
Non skeletal anterior Crossbites
The most common etiologic factor for non skeletal
anterior Crossbites is lack of space for the
permanent incisors, and it is important to focus
the treatment plan on management of the total
space situation, not just the crossbite.
If the developing crossbite is discovered before
eruption is complete and overbite has not been
established the adjacent primary teeth can be
extracted to provide the necessary space
Non skeletal anterior Crossbites
Dental anterior crossbites typically develop as
the permanent incisors erupt.
The first concern is adequate space for tooth
movement, which usually requires:
1: Bilateral disking,
2: Extraction of the adjacent primary teeth,
3: Or opening space for tooth movement.
Non skeletal anterior Crossbites
Non skeletal anterior Crossbites
Dental posterior cross
• early loss of a second deciduous molar causing
a second premolar to erupt palatally/lingually
• retention of a primary tooth can deflect the
eruption of the permanent successor leading
to a cross bite.
Dental posterior cross bite
Dental posterior cross bite
Dental posterior cross bite
Oral Habits and Open Bites
Open bite in a preadolescent child has several
possible causes:
1: The normal transition as primary teeth are
replaced by the permanent teeth
2: A habit like finger sucking
3: Tooth displacement by resting soft tissues
Open bite observed during the
transitional dentition years
Effects of Sucking Habits
The effect of such a habit on the hard and soft
tissues depends on its :
1: Frequency(hours per day)
2: Duration (months/years)
• With frequent and prolonged sucking,
maxillary incisors are tipped facially,
mandibular incisors are tipped lingually , and
eruption of some incisors is impeded
Effects of Sucking Habits
Effects of Sucking Habits
As long as the habit stops before the eruption
of the permanent incisor, most of the changes
resolve spontaneously.
Eruption problems
• Over-Retained Primary Teeth
• Supernumerary teeth
• Delayed Incisor eruption
• Ankylosed Primary Teeth
• Ectopic eruptions
• Transposition
• Primary failure of eruption
• Roots shortened by radiation therapy
Over-Retained Primary Teeth

A permanent tooth should replace its primary predecessor

when approximately three fourths of the root of the
permanent tooth has formed, whether or not resorption of
the primary roots is to the point of spontaneous
A primary tooth that is retained beyond this point should be
An over-retained primary tooth leads to:
• Gingival inflammation
• Hyperplasia that causes pain and bleeding
• And sets the stage for deflected eruption paths that can
result in:
(a) irregularity, (b) crowding, (c) crossbite
Over-Retained Primary Teeth

Once the primary tooth is out,

if space is adequate,
moderately abnormal facial or
lingual positioning will
usually be corrected by the
equilibrium forces of the lip,
cheeks and tongue
Supernumerary teeth
Supernumerary teeth can disrupt both the normal
eruption of other teeth and their alignment and
The most common location for supernumerary teeth
is the anterior maxilla .
Treatment is aimed at:
• Extraction of the supernumeraries before problems
• OR at minimizing the effect if other teeth have
already been displaced
Supernumerary teeth
Delayed Incisor Eruption
Sometimes incisors fail to erupt even when there is no
retained or overlying primary tooth or supernumerary
teeth present.
Changes in the overlying keratinized tissue occur in long-
standing edentulous region
If the delayed incisor is located superficially it can
be exposed with a simple soft tissue excision
and usually will erupt rapidly .
When the tooth is more deeply positioned, the
overlying and adjacent tissue can be repositioned apically and
the crown exposed, which usually leads to normal eruption or
the tooth can have an attachment placed and repositioned
Delayed Incisor Eruption
Delayed Incisor Eruption
Ankylosed Primary Teeth
Appropriate management of an ankylosed primary
molar consists of:
maintaining it until an interference with eruption or
drift of other teeth begins to occur, then
extracting it and placing a lingual arch or other
appropriate fixed appliance if needed
Ectopic eruption
Eruption is ectopic when a permanent tooth
causes either:
Resorption of a primary tooth other than the
one it is supposed to replace
OR resorption of an adjacent permanent
Space maintenance
• Early loss of a primary tooth presents a
potential alignment problem because drift of
permanent or other primary teeth is likely
unless it is prevented
• Should maintain the desired mesiodistal
dimensions of the space.
• Should not interfere with the eruption of the
permanent teeth.
• Maintenance of functional movement
(physiological) of the teeth.
• Should allow for space regainence, when
Different types of space maintainers
• Band and Loop Space Maintainers
• Partial Denture Space Maintainers
• Distal Shoe Space Maintainers
• Lingual Arch Space Maintainers
Different types of space maintainers
Different types of space maintainers
Interceptive orthodontics

• Procedure are undertaken when the problem

has already manifested.
Traumatic displacement of teeth
Prior to treatment, multiple radiographs
at numerous vertical and horizontal
angulations should be obtained to rule out
vertical, and horizontal root fractures that may
make it impossible to save the tooth.
• Vertical displacement of teeth is a major
indication for post-trauma orthodontics
All severely intruded teeth with mature apices
become nonvital and fail to erupt.
Early repositioning is critical to reduce the
chance of ankylosis, improve access for
Traumatic displacement of teeth
Vertical displacement of teeth is a major
indication for post-trauma orthodontics .
All severely intruded teeth with mature apices
become nonvital and fail
to erupt.
Early repositioning is critical to reduce the
chance of ankylosis, improve access for
Traumatic displacement of teeth
Within 2 weeks of the injury, the intruded tooth
should have been moved enough to allow
access-ideally, it would be at or near the pre-
trauma position.
Traumatic displacement of teeth
Space related problems
Excess space:
Midline diastema:
A small maxillary midline diastema, which is present in many
children, is not necessarily an indication for orthodontic
treatment.The unerupted permanent canines often lie
superior and distal to the lateral incisor roots, which forces
the lateral and central incisor roots toward the midline of
dental development
Ugly duckling stage
The spaces between the incisors, including the
midline diastema, decrease and often completely
disappear when the canines erupt .
while their crowns diverge distally this condition
of flared and spaced incisors is called the "ugly
duckling" stage of development
These spaces tend to close spontaneously when
the canines erupt and the incisor root and crown
positions change
The ugly duckling phase
Midline diastema
A small but unesthetic diastema (2 mm or less)
can be closed in the early mixed dentition by
tipping the central incisors together.
Midline diastema(2mm/less)
When a larger diastema (>2mm) is
Causes can be:
1. A midline supernumerary tooth
2. Missing permanent lateral incisors
3. digit-sucking habits
What to do:
• Maxillary occlusal or periapical radiograph
• Bodily mesiodistal movement, an anterior
segmental archwire from central to central incisor
or the classic 2 x 4 appliance
Permanent retention

A fixed retainer to maintain diastema closure.

A bonded 17.5mil multistrand wire with loops bent into the ends
is bonded to the lingual surfaces of anterior teeth to serve as a
Permanent retainer. This flexible wire allows physiologic mobility
Of the teeth and reduces bond failure but can be used onlv when
the overbite is not excessive.
Maxillary Dental Protrusion and
• Treatment for maxillary dental protrusion
during the early mixed dentition is indicated
only when the maxillary incisors protrude with
spaces between
them and are esthetically objectionable or in
danger of traumatic injury
: it is often a sequel to prolonged thumb
Maxillary Dental Protrusion and
• If there is adequate vertical clearance and
space within the arch, maxillary incisors that
have been displaced by a sucking habit can be
tipped lingually with a removable or a fixed
Maxillary Dental Protrusion and
Missing Permanent Teeth
Missing Second Premolars:
• If the patient has an ideal or an acceptable
occlusion, maintaining the primary second
molars is a reasonable plan
• if the space profile and jaw Relationships are
good or some what protrusive,i t is possible to
extract primary second molars that have no
successor at age 7 to 9 and allow the first
molars to drift mesially
Space Regaining
• After premature loss of a primary tooth, space
may be lost from drift of other teeth
• Up to 3 mm of space can be reestablished in a
localized area with relatively simple appliances
and a good prognosis
Maxillary Space Regaining
• Generally, space is easier to regain in the
maxillary than in the mandibular arch,
because of the increased anchorage for
removable appliances afforded by the palatal
vault and the possibility for use of extraoral
force (headgear)
Maxillary Space Regaining
Maxillary Space Regaining
• A removable appliance retained with Adams'
clasps and incorporating a helical fingerspring
adjacent to the tooth to be moved is very
effective. This appliance is the ideal design for
tipping one molar .
• One posterior tooth can be moved up to 3 mm
distally during 3 to 4 months of
full-time appliance wear. The spring is activated
2 mm to produce I mm of movement per month
• For unilateral bodily space regaining, a fixed
intra-arch appliance is preferred
Maxillary Space Regaining
• If bodily movement of both permanent maxillary
first molars is necessary in regaining space this
can be accomplished by using a banded and
bonded fixed appliance or headgear
• Sometimes both molars need to be moved
distally but one requires substantially more
movement than the other. To accomplish this, an
asymmetric facebow with a neckstrap attachment
can be used
Maxillary Space Regaining
Mandibular Space Regaining
• For unilateral mandibular space regaining, the
best choice is a fixed appliance and an
• a lingual arch can be used to support the
tooth movement and provide anchorage when
used in conjunction
with a segmental archwire and coil spring
Mandibular Space Regaining
Mandibular Space Regaining
• If space has been lost bilaterally there
are two choice:
1) an adjustable lingual arch and
2) a lip bumper.
Mandibular Space Regaining
Mandibular Space Regaining
Serial extraction
1.Straight profile
2.Class I malocclusion
3.Arch length discrepency in maxilla should be
11 mm while in mandibular arch 10.5 mm
Serial extraction
1. Convex profile
2. Class II malocclusion
3. Low angle case
4. High angle case
Advantages of serial extraction
• Reduces the severity of malocclusion
• Reduces the extent of mechanotherapy
• Reduces the duration of treatment
Disadvantages of serial extraction
• Chances of increasing overbite
• Canines may fail to migrate distally
• Anterior teeth may tip lingually
Methods of serial extraction
Dewel’s method (cd4)
Tweed’s method (d4c)
Skeletal Problems
• Class I
– Bimax
• Class II
– Maxilla
– Mandibula
• Class III
– Maxilla
– Mandibula