brief presentation

1. INTERCEPTIVE ORTHODONTICS
AYESHA JABEEN
12BDS0006

2. DEFINITION
 “Interceptive orthodontics includes procedures that are
undertaken at an early stage of a malocclusion to eliminate or
reduce the severity of the same” .
 It is undertaken at a time when signs & symptoms of
malocclusion has already developed or developing.
 It prevent establishment of a full-fledged malocclusion that may
require long-term treatment at a later stage.
 Defined as that phase of the science & art of
orthodontics employed to recognize & eliminate
potential irregularities & malpositions of the developing
dentofacial complex.

3. Preventive orthodontics
(prevent onset )
Interceptive orthodontics
(after onset )
 Dentition & occlusion
are perfectly normal
 Signs & symptoms of
malocclusion appeared
5yroldchildwhoneedspreventivemeasures
7yroldchildneedsinterceptiveprocedures

4. 1. Serial extraction
2. Correction of developing crossbite
3. Control of abnormal habits
4. Space regaining
5. Muscle exercises
6. Interception of skeletal malrelations
7. Removal of soft tissue & bony barrier to eruption of
teeth
Procedures

5. Basic principles
1. Arch length-tooth material
discrepancy
2. Physiologic tooth
movement-tendency to
move towards an extraction
space
SERIAL EXTRACTION
Definition - A procedure
where some deciduous
teeth followed by
permanent teeth were
extracted to guide the
rest of the teeth in
normal occlusion.

6. Indications
1. Class I
(dental)malocclusion
2. Growth is not enough to
overcome discrepancy
3. Straight profile & pleasing
appearance
4. Arch length deficiency
compared to tooth
material
i) Physiological spacing –nt
ii) Unilateral/bilateral premature
loss of 1° canines ê midline
shift
iii) Palatally erupted/impacted
lateral incisors
iv) Marked crowding in U/L
anteriors

7. v. Localized gingival
recession in lower
anterior region*
vi. Ectopic eruption of teeth
vii. Mesial migration of
buccal segment
viii. Abnormal eruption
pattern
ix. Lower anterior flaring
x. Ankylosis of one/more
teeth

8. 1. Class II & III malocclusion ê skeletal abnormalities
2. Spaced dentition
3. Anodontia / oligodontia
4. Open / deep bite
5. Midline diastema
6. Class I malocclusions ê minimal space deficiency
7. Unerupted malformed teeth e.g. dilaceration
8. Extensive caries / heavily filled 1st molars
9. Mild discrepancy which can be treated by proximal
stripping
Contraindications

9. Procedure
 Assessment of dental, skeletal & soft tissues
 Arch length deficiency of 5-7 mm should exist
 Study model analysis
 Mixed dentition analysis
 Opg & cephalometric examination
 Fixed appliance therapy
Methods Dewel’s Tweeds Nance
Age 8-9 yrs 8 yrs 8-9 yrs
Pattern CD4 D4C D4C

10. Advantages Disadvantages
a) Treatment is more physiologic
b) Psychological trauma assoc ê
malocclusion can be avoided
c) Eliminates or reduces duration
of multibanded fixed t/t.
d) Lesser retention period
e) Better oral hygiene thereby
reducing risk of caries
f) Stable results
a) Requires clinical judgement.
No single approach to apply
universally to all patients.
b) Treatment time is prolonged
(2-3 yrs)
c) Multiple visits. Pt cooperation
is needed
d) Tendency of developing
tongue thrust
e) Extraction of buccal teeth can
result in deep bite
f) Risk of arch length reduction
by mesial migration of buccal
segment
g) Ditching / space can exist b/w
canine & premolar
h) Axial inclination of teeth at
termination of procedure
necessitates fixed t/t.

11. Definition - Anterior crossbite is chracterized
by reverse overjet wherein one or more
maxillary anterior teeth are in lingual relation to
mandibular teeth.
Classification – 1. Dental crossbite
(lingual eruption path of maxillary anteriors,
trauma, supernumerary teeth etc)
2. Functional crossbite(occlusal interference)
3. Skeletal crossbites(retrognathic
maxilla/prognathic mandible)
Sequelae - Self perpetuating-manifest in
mixed & permanent as well
Potential of growing into skeletal malocclusion
Poor facial appearance
2.CORRECTION OF DEVELOPING CROSS BITE

12. Tongue blade Catalan’s appliance
Z-spring e. post. Bite plane Reverse pull head gear
Treatment
The best time to treat a crossbite is the first time it is seen
Quad helix

13. Habits refer to certain actions involving teeth &
other oral / perioral structures which are repeated
often enough by some patients to have a profound
& deleterious effect on position of teeth &
occlusion.
(defined as tendency towards an act that has
become a repeated performance, relatively fixed,
consistent & easy to perform )
Classification – 1.[useful & harmful habits]
2.[Empty & meaningful habits]
3.[Pressure- thumb sucking, tongue thrusting etc
Non pressure- mouth breathing
Biting habits- lip & nail biting]
4.[Compulsive(deep rooted) & non-compulsive habits(easily
learned & dropped)]
Sequela – abnormal soft tissue pressure
- Altered muscular contraction
- Altered dentofacial & skeletal growth
3. CONTROL OF ABNORMAL HABITS

14. Definition – defined as placement of
thumb or one or more fingers in varying
depths into the mouth.
Normal – till 31/2 – 4 yrs
Clinical features –
a. proclined maxillary incisors
b. Retroclined mandibular incisors
c. Anterior open bite
d. Posterior crossbites
e. Hypotonic upper lip & hyperactive
mentalis
Thumb & digit sucking
Thumb guard & Elbow
bandage
MANAGEMENT
-Pepper dissolved in a volatile medium
-Quinine
- Asafoetida

15. Definition – a condition in which
tongue makes contact with any teeth
anterior to the molars during
swallowing.
Classification – simple & complex
tongue thrust
Clinical features –
a. Proclined anteriors
b. Anterior open bite
c. Bimaxillary protrusion
d. Posterior open bite (lateral tongue
thrust)
e. Posterior cross bite
Tongue thrust
Removable habit breaking appliance
Fixed palatal cribs
Management
-Correct method of
swallowing
-Tongue exercises to adapt to
new swallowing pattern

16. Mouth breathing
Classification
a. Obstructive
(deviated nasal septum, nasal polyps, nasal turbinates,
adenoids etc)
b. Habitual(continues after nasal obstruction removal )
c. Anatomic (short upper lips)
Clinical features – Long & narrow face
Contracted upper arch ê post crossbite
Blank face
Anterior marginal gingivitis
Dryness of mouth
Management
a. Removal of nasal / pharyngeal obstruction
(refer E.N.T)
b. Interception of habit
(vestibular screen, adhesive tapes to establish lip seal)
c. Rapid maxillary expansion (constricted arch)
Increase nasal airflow & decrease resistance

17. 4. SPACE REGAINING
Defined as procedure to regain space that
had been lost to mesial drifting or inclination
of posterior teeth. As permanent molars drift
or incline in to the space after early
extraction.
- Space lost can be regained by distal
movement of 1st molar.
- Prior to eruption of 2nd molar(7-10yrs)
Space regainers
Gerber’s space regainer
Using jack screws
Using cantilever spring

18. EXERCISE FOR MASSETER MUSCLE
Clenching of teeth by patient while counting to
10.
Repeat this for some duration
EXERCISES FOR LIPS(CIRCUM-ORAL MUSCLES)
a. Messaging of the lips
b. Holding & pumping of water back & forth behind the
lips
c. Hold a piece of paper b/w lips
(Short hypotonic upper lips_aids in stretching)
d. Button pull exercise
e. Tug of war exercise
5. MUSCLE EXERCISES
Normal occlusal development depends upon presence of
normal oro-facial muscle functions.
Muscle exercises help in improving aberrant muscle function.

19. • Button of 1½ ” diameter is taken & a thread is passed through button hole.
Button pull exercise
Patient is asked to place
button behind lips & pull thread
, while restricting it by using lip
pressure.
Tug of war exercise
-Similar
- Use of 2 buttons
-One placed behind the lips while
other is held by another person to pull
the thread.

20. Exercises for tongue
1. One elastic swallow
Use – Correction of improper positioning of
tongue.
Method- 5/16” intra-oral elastic is placed on tip of
tongue & patient is asked to raise the tongue and
hold elastic against rugae area & swallow.
2. Two elastic swallow
Method- Two 5/16” elastics are placed
over tongue, one in midline & other on tip
& patient is asked to swallow with the
elastics in position.
3. Tongue hold exercise
Method- 5/16” elastic is positioned over tongue
in a designated spot for a prescribed period of
time with the lips closed. Pt is asked to swallow
with elastic in place & lips apart.
4. The hold pull exercise
Method- Tip of tongue & midpoint are
made to contact palate & mandible is
gradually opened.
Helps in stretching lingual frenum.

21. Class II malocclusion
Occurs as a result of either
excessive maxillary
growth/deficient mandibular
growth or a combination of both .
6. Interception of skeletal malrelations
Maxillary growth- restricted by use of
face bow with head gear.
a. Occipital headgear
b. Cervical headgear
Mandibular growth- restricted by
myofunctional appliances
a. Activator
b. Functional regulator

22. Class III malocclusion
Occurs as a result of mandibular
prognathism, maxillary retrognathism or
a combination of both.
6. Interception of skeletal malrelations
Maxillary retrusion
-Frankel III appliance
- Face mask
Mandibular protrusion
- Chin cup with head gear

23. TREATMENT
Eruption is stimulated by surgically
exposing the crown
Removal of soft tissue and bony barriers
Non eruption of succedaneous teeth
CAUSES
Over retained deciduous tooth
Ankylosed primary tooth
Supernumerary tooth