1. Research & Reviews: A Journal of Dentistry
Volume 2, Issue 1, April, 2011, Pages 6-9.
_____________________________________________________________________________________________
Interceptive orthodontics-a short review
Dr. Srinivas. N.Ch
Assistant Professor, Department of Pedodontics and Preventive Dentistry, Panineeya
Mahavidyalaya Institute of Dental Sciences and Research Centre, Hyderabad, Andhra Pradesh,
India - 500060
Abstract
The term interceptive orthodontics used in this paper is defined as the prompt treatment of
unfavorable features of a developing occlusion categorized as local factors, crowding and
displacements of the mandible in closing from the rest position. Interceptive orthodontics
is defines as a – phase of science and art of orthodontics employed to recognize and
eliminate the potential irregularities and malpositions in the developing dentofacial
complex. Guidance of the eruption and development of the primary and permanent
dentitions is an integral part of the care of pediatric patients. Such guidance should
contribute to the development of a permanent dentition that is in a harmonious, functional
and esthetically acceptable occlusion. This article aims to provide a simple guide to the
correct diagnosis of anomalies and to choosing the most suitable treatment for each case.
Keywords – Interceptive orthodontics, crossbite, midline diastema, habits, ectopic
eruption.
Author for Correspondence E-mail: cnudent@gmail.com Tel: 9963002821
Introduction
One of the main functions of the primary with occlusal development; and interceptive
dentition is the maintenance of the arch orthodontics, this is treatment to intercept a
length, so that the permanent dentition, developing problem or to correct existing
which replaces have sufficient space to early malocclusion.
erupt. The three features of primary
dentition that indicate good dental Interceptive orthodontics
development are spacing, anthropoid spaces
mesial to the maxillary canine and distal to Richardson (1982) defined interceptive
mandibular canines, and straight or mesial orthodontics as the prompt treatment of
step primary second molar occlusion(1). unfavorable features of a developing
Early orthodontic intervention is carried out occlusion that may make the difference
to enhance dentoalveolar, skeletal and between achieving a satisfactory result by
muscular development before complete simple mechanics later, thus reducing
eruption of the permanent dentition (2). The overall treatment time and providing better
early orthodontic intervention can be stability and functional and aesthetic results
3
broadly classified as: preventive . The percentage of children who would
orthodontics, which prevents interferences
© STM Journals 2011. All Rights Reserved. 6

2. Research & Reviews: A Journal of Dentistry
Volume 2, Issue 1, April, 2011, Pages 6-9.
_____________________________________________________________________________________________
benefit from interceptive orthodontics has age results in a permanent loss of space due
been reported from 14% to 49% (4-6). to the mesial drifting of the permanent first
molars (11). Using space maintainer can
Intervention seeking abnormalities and prevent this space loss; space maintainers
treatment are passive fixed appliance such as distal
shoe or lingual arch and removable
a. Local factors appliances such as the partial denture. Space
Local factors such as impacted upper first regainer appliances may obtain up to 3 mm
molars, scissor bite of first molars, retained per quadrant of space by making drifted
primary teeth related to malposed permanent teeth upright. It is not indicated for severe
teeth and delayed eruption of permanent crowding or in cases that need extraction
teeth caused by supernumerary teeth need later (12). Unilateral loss of primary canine
interceptive orthodontics for the normal usually requires extraction of the antemere
development of the mixed dentition. to prevent midline shift.
Prolonged retained primary teeth can cause
displacement or failure in the eruption of the d. Ectopic eruption of maxillary canine
permanent teeth. The primary teeth should In Class I non-crowded situations where the
be extracted to allow spontaneous permanent canines is impacted or erupting
alignment. Extraction of the supernumerary buccally or palatally, the treatment of choice
teeth and exposure of the permanent teeth is the extraction of the primary canines
will allow spontaneous eruption. Mesially when the patient is 10-13 years old (13).
impacted first permanent molars can be Power and Short (1993) showed that
relieved by using separators, Kesling metal interceptive extraction of the primary canine
springs or brass wire twisted at the contact completely resolves permanent canine
point (7-9). Severe ectopic eruption may impaction in 62% of cases; another 17%
require a fixed appliance to distalize the show some improvement in terms of more
permanent molar. favorable canine positioning (14). The
success of early interceptive treatment for
b. Crowding impacted maxillary canines is influenced by
Management of crowding in the mixed the degree of impaction and age at diagnosis
dentition includes interproximal primary (13).
tooth reduction, extraction of the primary
tooth and/or sectional fixed appliance to e. Midline diastema
align rotated permanent incisors. If there is There are several reasons for midline
no spacing in the primary dentition there is diastema to occur, the development cause is
70% chance of crowding of the permanent due to the pressure exerted by the
teeth, if there is less than 3mm spacing there developing lateral incisor on the distal
is 50% chance of crowding (10). aspect of the central incisor, which cause
median diastema. This stage is called as
c. Early loss of primary teeth “ugly duckling” stage and it corrects with
Early loss of primary first molars before 7.5 the eruption of the maxillary permanent
years of age leads to a temporary lack of canines. The other causes of midline
space, which can be regained, on the diastema are low frenal attachment, presence
eruption of the permanent successor. On the of a supernumerary teeth or cyst in the
contrary, loss of a second molar before this midline of the upper arch, proclination of the
© STM Journals 2011. All Rights Reserved. 7

3. Research & Reviews: A Journal of Dentistry
Volume 2, Issue 1, April, 2011, Pages 6-9.
_____________________________________________________________________________________________
upper incisors, peg shaped laterals and beyond the cessation of the pacifier or digit
microdontia of upper central incisors. The habit (19). Parafunctional habits that are
pathological cause should be identified and detrimental to the occlusion of the
removed early. The midline diastema can be permanent incisors should be stopped before
closed with a removable appliance or the complete eruption of the permanent
sectional fixed appliance. incisors so that malocclusion may self-
correct and less complex orthodontic
f. Anterior cross bite treatment is required later.
Anterior cross bite which is localized must
be treated at an early stage because the Limitation of interceptive orthodontics
upper incisor may be abraded by the lower Barrer reported that limitations of early
and the periodontal support of the incisor interventions are unfavorable craniofacial
may suffer as a result of occlusal trauma. growth, persistent habits, severe ectopic
Cross bite can also result in mandibular eruption and congenitally malformed or
shift; this can produce an undesirable growth missing permanent teeth (20). These factors
pattern, dental compensation leading to a should be considered in the treatment plan.
true prognathism and/or asymmetry at a later Some of the contraindications of early
time and potentially harmful functional treatments are changes that cannot be
patterns (15, 16). Unilateral cross bites can retained by stable occlusion, e.g.
be corrected using an upper removable unfavorable soft tissue/skeletal growth and
appliance with z-spring. persistent habits (21). Patient factors such as
immaturity lack of motivation or parental
g. Mandibular displacement during supervision, small mouth size, low pain
function threshold and poor oral hygiene could
Displacement or deflection of the mandible influence the success of the interceptive
from closing from the rest position occurs orthodontics.
when there is a discrepancy between
muscular positioning and the jaw The goals and objectives of early treatment
relationship determined by the teeth (17). must be established firmly in order to
The displacements may be anterior, lateral prevent unnecessary, prolonged treatment
of posterior; they may lead to that may burn out the patient in the second-
temperomandibular joint dysfunction, pain phase treatment later.
of the masticatory muscles and undesirable
growth modifications. The treatment References –
includes habit counseling, grinding of the
primary canine or expansion appliance. 1. Kurol J. and Koch G. “The deciduous
dentition and occlusion” In: Shaw W. C.
h. Habits Orthodontics and Occlusal Management
Digit or pacifier sucking habits have long Oxford: Wright, Butterworth-Heinemann
been recognized to affect occlusion and Ltd. 1993. 39-41p.
dental characteristics (18). Usually these 2. McNamara J. A. Jr. and Brudon W. L.
habits are rarely seen beyond the age of 6 Orthodontic and Orthopaedic Treatment
years, Warren and Bishara (2002) found that in the Mixed Dentition 3rd edition,
some changes in the dental arch perimeters Michigan: Needham Press. 1993. 1-7p.
and occlusal characteristics persist well
© STM Journals 2011. All Rights Reserved. 8

4. Research & Reviews: A Journal of Dentistry
Volume 2, Issue 1, April, 2011, Pages 6-9.
_____________________________________________________________________________________________
3. Richardson A. “Interceptive 12. Proffit W. R. et al. Contemporary
Orthodontics” 2nd edition, London. Orthodontics 3rd edition, St.Louis:
British Dental Journal 1989. 48-50p. Mosby. 2000. 422-427p.
4. Ackerman J. L. and Proffit W. R. 13. Jacobs S. G. “Reducing the incidences of
“Preventive and interceptive palatally impacted maxillary canines by
orthodontics: a strong theory process extraction of deciduous canines: a useful
weak in practice” Angle Orthodontist preventive/interceptive orthodontic
1980. 50. 75-87p. procedure, Case reports” Australian
5. Popovich F. Thompson G. W. Dental Journal 1992. 37. 6-11p.
Evaluation of preventive and 14. Power S. M. and Short M. B. “An
interceptive orthodontic treatment investigation into the response of
between 3 and 18 years of age (In: palatally displaced canines to the removal
Cook J. T. Ed.) Transactions of the of deciduous canines and an assessment
Third International Orthodontic of factors contributing to favourable
Congress London, Crosby Lockwood eruption” British Journal of Orthodontics
Staples. 1975. 26-33p. 1993. 20. 217-223p.
6. Al Nimri K. and Richardson A. “The 15. Bishara S. E. et al. “Dental and facial
applicability of interceptive asymmetries: a review” Angle
orthodontics in the community” British Orthodontist 1994. 64. 89-98p.
Journal of Orthodontics 1997. 24. 223- 16. Pirttiniemi P. M. “Associations of
228p. mandibular and facial asymmetries- a
7. Humphrey W. P. “A simple technique review” American Journal of
for correcting an ectopically erupting Orthodontics and Dentofacial
first permanent molar” Journal of Orthopedics 1994. 106. 191-200p.
Dentistry for Children 1962. 29. 176- 17. Richardson A. “Interceptive orthodontics
178p. in general dental practice. Part I. Early
8. Levitas T. C. “A simple technique for interceptive treatment” British Journal of
correcting an ectopically erupting first Orthodontics 1982. 152. 85-89.
permanent molar” Journal of Dentistry 18. Larsson E. “The effect of finger sucking
for Children 1964. 31. 16-18p. on the occlusion” European Journal of
9. Garcia-Godoy F. “Correction of Orthodontics1987. 9. 279-282p.
ectopically erupting maxillary 19. Warren J. J. and Bishara S. E. “Duration
permanent first molars” The Journal of of nutritive and nonnutritive sucking
the American Dental Association 1982. behaviours and their effects on the dental
105. 244-246p. arches in the primary dentition” American
10. Leighton B. C. “The early signs of Journal of Orthodontics and Dentofacial
malocclusion” Transactions European Orthopedics 2002. 121. 347-356p.
Orthodontic Society 1969. 353-368p. 20. Barrer H. G. “Treatment timing onset or
11. Rönnerman A. “The effect of early loss onslaught?” Journal of Clinical
of primary molars on the tooth eruption Orthodontics 1971. 5. 191-199p.
and space conditions: A longitudinal 21. White L. “Early orthodontic intervention”
study” Acta Odontologica Scandinavica American Journal of Orthodontics and
1977. 35. 229-239p. Dentofacial Orthopedics 1998. 113. 24-
28p.
© STM Journals 2011. All Rights Reserved. 9