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INTERCEPTIVE ORTHODONTICS

PRESENTATION BY MODERATED BY
Sanju Pandit Dr. Dashrath Kafle
Roll No. 25 Dr. Ravi Kumar Mahto
BDS 6th batch Dr. Suja Shrestha
Dr. Abhishek Giri

Department of Orthodontics
Kathmandu University School of Medical Sciences, Dhulikhel, Kavre
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CONTENTS
 Introduction
 Procedures
 Serial extraction
 Correction of developing anterior crossbite
 Control of abnormal habits
 Space regaining
 Muscle exercises
 Interception of developing skeletal malocclusions
 Removal of bony and soft tissue barriers
 Conclusion
 References
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INTRODUCTION
Interceptive orthodontics is defined as ”that phase of the science and art of
orthodontics employed to recognize and eliminate potential irregularities and mal
positions in the developing dentofacial complexes”.
-American Association of Orthodontics
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PROCEDURES
Procedures undertaken in Interceptive orthodontics:
• Serial extraction
• Correction of developing anterior crossbite
• Control of abnormal habits
• Space regaining
• Muscle exercises
• Interception of developing skeletal malocclusions
• Removal of bony and soft tissue barriers
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SERIAL EXTRACTION

Serial extraction can be defined as” the planned & sequential removal of primary
&permanent teeth to intercept & reduce dental crowding problems.
-Tweed

Serial extraction can be defined as” the correctly timed removal of certain deciduous and
permanent teeth in mixed dentition cases with dentoalveolar disproportion in order to
alleviate crowding of incisors teeth, allow unerupted teeth guide themselves into improved
positions, lessen(or eliminate) the period of active appliance therapy”.
-Tandon
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INDICATIONS
 Class I malocclusion showing harmony between skeletal & muscular system
 Arch length- tooth material discrepancy (5mm or more per quadrant), indicated by:
-Absence of physiologic spacing
-Unilateral or bilateral premature loss of deciduous canine with midline shift
-Impacted or mal positioned lateral incisors that erupt palatally out of arch
-Ectopic eruption
-Extensive proximal caries
-Tooth ankylosis
 When growth isn’t enough to overcome discrepancy between tooth material & basal bone
 Patients with straight profile & pleasing appearance
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CONTRAINDICATIONS
 Class II & Class III malocclusions with skeletal abnormalities
 Mild to moderate crowding (arch length- tooth material discrepancy <5mm per quadrant)
 Congenital absence (anodontia/ oligodontia)
 Extensive caries involving permanent 1st molars which cannot be conserved
 Spaced dentition
 Open bite & deep bite ( which should be corrected first)
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DIAGNOSIS AND TREATMENT PLANNING

• Diagnosis involves-
-Comprehensive assessment of dental, skeletal & soft tissues.
-A tooth material arch length discrepancy must exist.
-Investigations: Study model, radiographs & photographs

• STUDY MODELS-
-Assess dental anatomy & intercuspation of teeth
-Assess the arch form & evaluate occlusion
-Model analysis: Carey’s analysis, arch perimeter analysis & mixed dentition analysis
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• RADIOGRAPHS-
IOPA, lateral cephalograms & orthopantomogram, for detection of:
-Supernumerary, congenitally missing tooth or any bony pathosis
-Eruption pattern, dental age & stage of root development
-Facial patterns, relationship between craniofacial structures
-Changes in mid & post treatment relationship

• PHOTOGRAPHS-
-Self evaluation of case
-Patient motivation by showing progress in treatment
-To observe any changes extra orally & assess muscular hypo or hyperactivity
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PROCEDURE

Most common & accepted sequence of serial extraction are:

 Tweed’s method
 Dewel’s method
 Nance’s method
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METHOD

Age 8
Deciduous 1st molars Deciduous canines are
extracted maintained

1st premolars in advanced erupting

stage
Deciduous canines
1st premolars extracted
extracted
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METHOD
Age 8.5 years
Deciduous canines extracted

Age 9.5 years

Resolved anterior Root development in 1st
crowding premolars

Deciduous 1st molars extracted

Accelerated eruption of 1st premolar
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NANCE’S METHOD

Age 8 years
Deciduous 1st molars Deciduous canines are
extracted maintained

Extraction of 1st premolars

Extraction of deciduous canines

Permanent canines erupt in good alignment

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CORRECTION OF DEVELOPING
ANTERIOR CROSSBITE
• Anterior crossbite is condition characterized by reverse overjet- where one or more
maxillary anterior teeth are in lingual relation to mandibular teeth.

RATIONALE:
This type of malocclusion is self perpetuating.
Simple anterior crossbites that are not treated early have potential of developing into skeletal
malocclusion.
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CLASSIFICATION
Anterior crossbites can be broadly classified as:

1. Dentoalveolar anterior crossbite

2. Skeletal anterior crossbite
3. Functional anterior crossbite
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1. Dentoalveolar anterior crossbite

Usually localized condition where one or more maxillary anterior teeth are in lingual relation to
mandibular anterior.
Causes:
~lingual eruption path of maxillary anterior
~over retained deciduous teeth that deflect erupting permanent teeth
~trauma to deciduous dentition
~supernumerary teeth
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TREATMENT
a) Tongue blades:
~They are used if crossbite is seen at the time when permanent teeth are erupting & there
is sufficient space for the tooth to be brought out.
~It is flat wooden stick.
~Placed contacting palatal aspect of tooth in crossbite.
~Blade rest on mandibular tooth in crossbite that act as fulcrum while rotating blade
upward and forward.
~Continued for 1-2 hours for about 2 weeks.
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b) Catlan’s appliance or lower anterior inclined plane:

~Consist of inclined plane cemented on mandibular incisors.
~Lower inclined plane is constructed at an angle 45 degree to maxillary
occlusal plane.
~ Can be made up of acrylic or cast metal.
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PREREQUISITES-
• Enough space in maxillary arch for alignment of teeth.
• The erupting maxillary teeth to be corrected should be retroclined.
• Mandibular incisors should tolerate the forces generated & well aligned.
• Co operative patient.

DISADVANTAGES-
• Problem in speech & chewing.
• Cannot be given in periodontally compromised & mal aligned mandibular incisors.
• Prolonged use can cause anterior open bite.
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c) Double cantilever spring/ Z Spring:

~Consist of double helix between two parallel arms & inferior arm extends as
retentive component to acrylic base plate.
~Spring is effective when there is enough space for alignment of teeth in
crossbite.
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2. Skeletal anterior crossbite

Crossbites due to mal positioning or mal formation of the jaws.
Skeletal discrepancies in growth of maxilla & mandible.
Causes:
~Retarded maxillary growth/ maxillary skeletal retrognathism
~Excessive mandibular growth/ mandibular prognathism
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TREATME
NT
a) Reverse head gear/ protraction face mask:
~Used to treat anterior crossbite due to retro- positioned maxilla
~Protract maxilla & normalize skeletal crossbite
~Growing patients
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b) Chin Cup:
~Used to treat developing anterior crossbite due to prominent mandible
~Redirect the growth of mandible & tends to rotate mandible downward
and backward
~Growing patients
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3. Functional anterior crossbite

 Caused due to presence of occlusal interferences which result in deviation of mandible
during jaw closure
Habitual forward positioning of mandible (pseudo class III) lead to anterior crossbite
Causes:
~Early loss of deciduous teeth
~Decayed teeth
~Ectopic eruption
Treatment:
Eliminating occlusal prematurities
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CONTROL OF ABNORMAL HABITS

Habits refer to certain actions involving teeth & other oral or perioral structures, which are
repeated often enough by some patients to have a profound & deleterious effect on position
of teeth & occlusion.

These includes:
~Thumb sucking
~Tongue thrusting
~Mouth breathing
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THUMB SUCKING

Thumb/ digit sucking is defined as placement of thumb or one or more fingers in varying
depths into the mouth. ( Gellin 1978 )
Considered normal up to 2.5-3 years
 Persistence of this habit beyond 3.5-4 years can cause deleterious effects in dentoalveolar
structures like protruded maxillary incisors and localized open bite.
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MANAGEMENT OF THUMB SUCKING

1. Psychological approach
~Adequate love & affection to the child
~Dunlop’s beta hypothesis
2. Reminder therapy
~ Used in children who desire to quit the habit
~Reminding aids are: thermoplastic thumb guard
adhesive tapes
bandages for elbow to avoid flexing of hand
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MANAGEMENT CONTD..
3. Mechanical aids

i) Removable habit breaking appliances:

These are passive appliances which are retained in the oral cavity by
means of clasp & have one of the following additional component-
~Tongue spike
~Tongue guard
~Spurs/ rake
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MANAGEMENT CONTD..
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MANAGEMENT CONTD..
ii) Fixed habit breaking appliances:
Heavy gauge stainless steel wire can be designed to form a frame that is
soldered to bands on molars.
These includes-
~Quad helix
~Hay rakes
~Maxillary lingual arch with palatal crib
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MANAGEMENT CONTD..
4. Chemical aids

Recommends the use of hot flavored, bitter tasting or foul smelling

preparations placed on thumb or fingers that are sucked.
Medicaments includes-
~Red pepper dissolved in volatile liquid medium
~Quinine
~Asafoetida
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TONGUE THRUSTING
Defined as a condition in which the tongue makes contact with any teeth anterior to molars
during swallowing.
Associated with-
~Proclination on anterior teeth
~Anterior open bite
~Bimaxillary protrusion
~Posterior open bite in lateral tongue thrust
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MANAGEMENT OF TONGUE THRUSTING

Use of habit breakers similar to that used for thumb sucking which may be removeable or
fixed cribs
The child is taught the correct method of swallowing
Muscle exercises of tongue can help in training it to adopt to the new swallowing pattern
like:
~Barnet’s tongue positioning exercise
~Use of sugarless mint
~Single elastic swallow of gardiner
~Double elastic swallow
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MOUTH BREATHING

Defined as habitual respiration through mouth instead of nose

It can result in altered jaw and tongue posture, which could alter the orofacial equilibrium
thereby leading to the mal oclussion.
Causes:
~Obstructive: DNS, nasal polyps, localized benign tumors, chronic
inflammation of nasal mucosa
~Habitual
~Anatomic
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MANAGEMENT OF MOUTH
BREATHING
1. Removal of nasal or pharyngeal obstruction:
Refer patient to an ENT surgeon.
2. Interception of habit:
Use of oral screen, alternatively adhesives tapes can be used to establish lip seal.
3. Rapid maxillary arch expansion:
It helps in increasing nasal airflow & decreasing nasal resistance in patients with narrow
constricted maxillary arch.
4. Lip exercises for patient with short & hypotonic upper lip like-
~Tug of war exercise
~Bottom pull exercise
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MANAGEMENT CONTD..

Oral Screen/ Vestibular Screen/ Oral Shield

~It is a simple functional appliance that takes form of curved shield of

acrylic placed in the labial vestibule.
~It helps to retrain & strengthen action of lips, thus used as a habit breaker.
~Breathing holes can be made initially.
~As child learns to breathe through nose, gradually seal holes with acrylic.
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SPACE REGAINING
If space maintainers are not used after premature loss of deciduous 2nd molar, permanent 1st
molar may tip or move mesially, resulting in loss of arch length.
The space lost can be regained by distal movement of permanent 1st molar.
Preferably undertaken at an early age prior to eruption of 2nd molar.
Other causes for space loss within arch:
~Interproximal caries in primary teeth
~Congenitally missing teeth
~Delayed eruption of permanent teeth
~Premature extraction of primary molars without space maintenance
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SPACE REGAINERS
1. Fixed appliances
~Gerber space regainer
~Jackscrew space regainer
~Open coil space regainer ( Herbst space regainer)
2. Removable appliances
~Hawley’s appliance with cantilever spring
~Hawley’s appliance with split acrylic dumbbell spring
~Hawley’s appliance with palatal spring
~Hawley’s appliance with expansion screws
~Hawley’s appliance with helical spring
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GERBER SPACE REGAINER

Orthodontic band or crown is selected for tooth to be distalized.

Consist ‘U’ shaped hollow tubing & ‘U’ shaped rod that enters the tubing.
Tube is soldered on mesial aspect of tooth to be moved distally.
Rod is fitted into tube such that base of rod contacts the tooth mesial to edentulous area.
Open coil springs are placed around free ends of ‘U’ shaped rod & inserted into tubing.
Forces generated by compression of open coil springs brings distal movement.
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GERBER SPACE REGAINER

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JACKSCREW SPACE REGAINER

The appliance consist of a split acrylic plate with a jackscrew in relation to the edentulous
space.
Retained by using Adam’s clasp.
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SPACE REGAINING WITH CANTILEVER SPRING

Molar can be distalized using removeable appliance that incorporates simple finger springs
to regain space.
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MUSCLE EXERCISES

The development of occlusion depends on nature of facial muscles.

If the oro-maxillofacial musculature were in a state of balance, good occlusion would
develop.
Muscles exercises help in improving aberrant muscle function.
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1) Exercise for lips ( Circum- oral muscles)

~Stretching of upper lips to maintain lip seal in patients with short hypotonic
lips
~Holding & pumping of water back & forth behind lips
~Massaging of lips
~Button pull exercise
~Tug of war exercise
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2) Exercise for tongue:

~One elastic swallow- An orthodontic elastic, usually 5/16th of inch, is
placed on the tip of tongue & patient is asked to raise the tongue to
rugae area & swallow.

~Two elastic swallow- Two 5/16th inch elastics are used, one placed on tip
of tongue while the other on dorsum of tongue in midline & asked to
swallow.
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~The hold pull exercise- The tip of tongue is made to contact palate in the
midline & mandible is gradually opened. This allows stretching of the frenum
to relieve mild tongue tie.

~Tongue hold exercise- A 5/16th inch elastic is used & patient is asked to
place the same on a designated spot over a definite period of time with
lips closed. The patient is asked to swallow with the elastic in designated
position and lips apart.
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3) Exercise for masseter muscle:

~The patient is asked to clench his teeth, count up to 10 in his mind & then
relax them.
~This has to be repeated over a period of time, until the masseter muscles
feel tired.
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INTERCEPTION OF DEVELOPING
SKELETAL MALOCCLUSIONS
Skeletal malocclusion diagnosed at an early age can be intercepted to reduce the severity of
malocclusion that may occur.
The growth modulations are aimed at normalizing the skeletal relationship.
These changes are brought about by myofunctional therapy.
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INTERCEPTION OF CLASS II MALOCCLUSION

Class II skeletal malocclusion occurs either due to excessive maxillary growth or deficient
mandibular growth or due to combination.
Malocclusion due to excessive maxillary growth is treated by use of face bow along with
head gear.
Malocclusion due to deficient mandibular growth is treated by myo- functional appliances.
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INTERCEPTION OF CLASS III MALOCCLUSION

Class III skeletal malocclusion occurs as a result of excessive mandibular growth, deficient
maxillary growth or combination of both.
Malocclusion due to excessive mandibular growth can be treated by using chin cup therapy
that restrict clockwise growth of mandible.
Malocclusion due to maxillary retrognathism can be treated by using reverse pull head hear/
protraction face mask or FR III appliance that promote growth of deficient maxilla.
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REMOVAL OF BONY AND SOFT

TISSUE BARRIERS
Whenever a permanent tooth fails to erupt in oral cavity, its eruption may be stimulated by
surgically exposing the crown.
Causes of non- eruption of succedaneous teeth should be ruled out prior to this procedure,
which includes:
~Over retained primary teeth
~Supernumerary teeth
~Fibrous/ bony obstructions of the erupting tooth bud
The surgical procedure involves excision of soft tissue & any bone overlying the crown of
unerupted tooth such that the greatest diameter of crown is exposed.
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CONCLUSION
The best treatment for any malocclusion is prevention. So if at the preventive stage we are
able to evade malocclusion, it is less traumatic and also cost effective to the patient.
 In case we are not able to prevent the malocclusion, we must intervene to avoid adverse
dental and occlusal consequences.
In conclusion, the interceptive & preventive orthodontic procedures enable the clinician to
treat &/or make a developing malocclusion less severe so as to allow the corrective
orthodontist to deliver a stable and more conservative (non-extraction) treatment plan
benefiting the patient
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REFERENCE
S
 Bhalajhi S.I. Orthodontics: The Art And Sciences. 7th edition. 2018
Gurkeerat Singh. Textbook of Orthodontics. 2nd edition. Jaypee, 2007
Nikhil Marwah. Textbook of Pediatric Dentistry. 4th edition. New Delhi : Jaypee Brothers
Medical Publishers, 2019
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