Interceptive orthodontics

• SEMINAR ON
•INTERCEPTIVE
ORTHODONTICS
www.indiandentalacademy.com

CONTENTS
• INTRODUCTION
• DEFINITION
• INDICATIONS AND BENEFITS
• PATIENT EXAMINATION
• MODERATE NON SKELETAL PROBLEMS IN
PRE ADOLOCENT CHILDREN
• TREATMENT OF SKELETAL PROBLEMS IN
• PRE ADOLOCENT CHILDREN
• CONCLUSION

• INTERCEPTIVE ORTHODONTICS
INTRODUCTION
INTERCEPTION DEFINED
American association of orthodontists defines interceptive orthodontists as
“That phase of the science and art of orthodontics, employed to recognize and
eliminate potential irregularities and appositions in the developing dent facial
complex.”
“Interceptive orthodontics” basically refers to measures undertaken to prevent a
potential malocclusion from progressing into a more severe one and is thus
undertaken at a time when the malocclusion has already developed or procedures,
which are aimed at eliminationof factors, that may lead to malocclusion.

INDICATIONS OF INTERCEPTION
Indications for early interceptive treatment at
university of Pacific (AJO Jan 1998) includes:
• Dental and/or skeletal class II
• Dental and/or skeletal class III
• Posterior or anterior cross bites.
• >6mm of over jet, especially in females.
• Maxillary midface deficiency.
• Moderate incisor crowding.
• Ectopic eruptions.

BENEFITS
reduced incidence of premolar extraction.
Decreased extent or possible elimination of 2nd
phase of treatment.
Reduced need for surgical orthodontics.
Increased stability of transverse and antero-
posterior dimension changes.
Increased long term stability of lower incisor
alignment.
Reduced incidence of root resorption
Reduced incidence of mucogingival problems.
Reduced incidence of ectopic cuspid eruption.

PATIENT EXAMINATION FOR INTERCEPTION
STANDARD CLINCAL EXAMINATION SHOULD
INCLUDE THE FOLLOWING:
The skeletal relationships, axial inclination of incisors,
the profile
• The soft tissues.
• Habits
• The medical history
This is usually followed by impressions and bite
registration, accompanied by radiography and
photographs as required. On a second visit an offer of
treatment can be made. Photographs of appliances are
helpful in explaining appliance therapy.

PROBLEMS MODERATE NON-SKELETAL
IN PREADOLESCENT
CHILDREN
CROWDED AND IRREGULAR TEETH
Irregular and malaligned teeth in the early mixed
dentition rise from two major causes:
1 Lack of adequate space for alignment,
2 Interferences with eruption,
The goal of early treatment is either to prevent
teeth from drifting and reducing the space
available for the permanent teeth or to create some
additional. Space within the dental arch so that
alignment becomes possible.www.indiandentalacademy.com

•MISSING PRIMARY TEETH WITH ADEQUATE
SPACE: SPACE MAINTENANCE
•. A space maintainer to hold space after the loss of a single
tooth is placed only if the following conditions obtain.
•1.The permanent successor is present and developing
normally.
•2 The arch length has not shortened.
•3.The space from which the tooth has been lost has not
diminished.
•4 The molar or cuspid interdigitation has been unaffected by
the loss.
•5. There is a favorable mixed dentition analysis prediction,
There is no reason to insert a space maintainer if the
permanent successor is absent. The type of space-maintainer
to be used depends on the site of the loss and the operator’s
preference. www.indiandentalacademy.com

IRREGULARINCISOR NO SPACE
DISCREPANCY
Up to 2mm of incisor crowding may resolve
spontaneously without treatment..
If exaggerated parental concern creates a problem, or
if slightly more anterior irregularity is present, one
could consider disking the interproximal enamel
surfaces of the primary lateral incisors or canines
as the anterior teeth erupt.

• LOCALIZED SPACE LOSS (3 MM OR
LESS): SPACE REGAINING
• After premature loss of a primary tooth, space
may be lost from drift of other teeth before a
dentist is consulted. Then, repositioning the teeth
to regain space rather than just space maintenance
to stabilize the situation is required.
• Up to 3mm of space can be re-established in a
localized area with relatively simple appliances
and a good prognosis. Space loss greater than that
constitutes a severe problem.

• Maxillary space regaining:
• Permanent maxillary first molars can be tipped
distally to regain space with either a fixed or removable
appliance, but bodily movement requires a fixed
appliance.
• A removable appliance retained with Adams’ clasps
and incorporating a helical finger-spring adjacent to the
tooth to be moved is very effective. The spring is
activated approximately 2mm to produce 1mm of
movement per month.
• For bodily movement a lingual arch plus a
segmental archwire from the banded primary molar to
the tooth to be repositioned is used. For bilateral
movement, a palatal button on the lingual arch is
recommended.
• www.indiandentalacademy.com

When bilateral maxillary space regaining is needed,
extra oral force via a face bow to the molars is the
most effective and straight forward method..
To tip the molar crown distally a longer outer bow
with neck strap is used and the resultant of forces
should pass occlusal to the center of resistance.
For bodily movement of a molar, a shorter or
higher outer bow and a combination of head cap
and neck strap is used and the resultant force is
through the center of resistance.
To move the molar roots distally, the outer bow
should be short and high so the resultant force is
above the center or resistance. This requires a
head cap for force application.

Mandibular space regaining:
Because of susceptibility to breakage and tissue
irritation, removable appliance are less satisfactory in
the mandibular arch.
If there is unilateral space loss, ---- removable
lingual arch, incorporating a loop that can be opened
to provide the necessary distal force.
If space has been lost bilaterally, -----lingual arch
Lip bumper, creates a distal force to tip the molars
posteriorly. Here too forward movement of incisors
occurs due to absence of restraint from lip against
these teeth.
A fixed appliance with multiple banded/bonded
attachments, perhaps supported by interarch elastics
and extra oral force, may be required to significantly
move lower molars back bilaterally.www.indiandentalacademy.com

• SPACE PROBLEMS,GREATER SEVERITY
• Severe crowding(greater than 4mm):
• It is seen that in these cases there is no
interdental space during primary dentition or
even a slight crowding.
• These can be corrected by
• Lingual arch
• jackscrew expander
• lip bumper
• molar distalization by headgear

VERY SEVERE CROWDING
SERIAL EXTRACTION
Serial extraction is the planned and sequential
removal of certain primary and permanent
teeth to intercept and reduce dental crowding
problems
It was described by Robert Bunon in 1743
The term coined by Kjellgren in 1929
Hortz referred it as “guidance of eruption”

Davis rules for serial extraction:
In skeletal class I patients.
• When soft tissue profile of lips is concave or when lips
are supported in normal profile.
• When position of lower incisor is well ahead of A-Pog
line.
• When occlusal plane is relatively flat anterior to
mandibular Ist permanent molar.
• When relationship of overbite, overjet and midline of
anterior segment is ideal.
• When dental arch inadequacy is 9-12mm.
• When a favourable eruption sequence of Ist premolar
and canine can be produced to enable the Ist premolar
to erupt before permanent canine.
• Tooth buds should never be enucleated before eruptionwww.indiandentalacademy.com

Pre-Requisites of Serial extraction:
.    Examination and consultation
•   Diagnostic records.
• a)    IOPA/Panoramic radiographs.
• b)   Cephalonmetic rediograph.
• c)    Facial photograph.
• d)   Study model.
• 3.      Diagnosis
  Space analysis related to face and teeth and should be
done if treatment is to be successful and serial
extraction effective.

Treatment:
It can be divided into 4 categories:
.     A period of interceptive guidance (7 ½ - 12 ½
years).
       An initial period of interceptive guidance for 7
½ - 11/2 years and a second period of multibanded
   treatment for 1 year in class I and specific class
II cases.
      An initial period of interceptive treatment from 8
½ to 1 ½ and a second period of multibanded
treatment from 11 ½ to 13.  Class II and Class III
malocclusions fall into this category.
       A period of multibanded treatmentwww.indiandentalacademy.com

Serial extraction in class I treatment:
Group A: Anterior discrepancy: crowding
• Step 1: Primary canines extracted
• Step 2: Extraction of primary first molars .
• Step 3: Extraction of first premolars .
• Step 4: Multibanded treatment.
• Step 5: Retention.

Group B: Anterior discrepancy: alveoplodental
protrusion
• Step 1: Extraction of the primary first molars .
• Step 2: Extraction of primary canines and first
premolars. .
• Step 3: Multibonded treatment.

Group C: Middle discrepancy: impacted
canines
• Step 1: Extraction of primary molars
Step 2: Extraction of first premolars.
• Step 3: Multibonded treatment.
Step 4: Retention

Group D: Enucleation in the mandible
• Step 1: Extraction of primary first molars and
enucleation of mandibular first premolars.done.
• Step 2: Extraction of primary maxillary canines
and maxillary first premolar.
• Step 3: Multibanded treatment.

Group E: Enucleation in the maxilla and
mandible
• Step 1: Extraction of primary canines and
primary first molars and enculeation of the first
premolars.
• Step 2: Multibandend treatment.
Step 3: Retention

Group F: Alternative to enculeation
• Step 1: Extraction of primary first molars.
• Step 2: Extraction of primary maxillary canines,
maxillary first premolars and primary
mandibular second molars.
• Step 3: Extraction of mandibular first premolars.
• Step 4: Multibandend treatment.

Serial extraction in class II treatment:
Group A: Anterior discrepancy: maxillary
protrusion.
• Step 1: Extraction of primary maxillary first
molars
• Step 2: Extraction of primary maxillary canines
and maxillary first premolars.
• Step 3: Extraction of primary second molars.

Group B: Middle discrepancy: impacted
maxillary canines
• Step 1: Extraction of primary maxillary first
molars.
Step 2: Extraction of maxillary first premolars

Group C:Posterior discrepancy: ectopic eruption in
the maxilla
• Step 1: Extraction of the primary maxillary second
molars.
• Step 2: Extraction of the primary maxillary first molars
.
• Step 3: Extraction of the primary maxillary canines if
still present and the maxillary first premolars.
• Step 4: Multibonded edgewise appliance.

Group D: Anterior discrepancy: maxillary protrusion,
mandibular incisor crowding.
• Step 1: Extraction of primary maxillary first molars and
primary mandibular canines.
• Step 2: Extraction of primary maxillary canines, maxillary
first premolars, and primary mandibular first molars with
extraction of maxillary first premolars, space has now been
provided for retraction of maxillary incisors.
• Step 3: Extraction of mandibular first premolars.
• Step 4: Multibanded edgewise appliance.
Step 5: Retention.

Group E: Middle discrepancy: maxillary and
mandibular canine and premolar crowding.
• Step 1:   Extraction of primary maxillary first molars
• Step 2: Extraction of primary of primary maxillary
canines, maxillary first premolars and primary
mandibular first molars.  The extraction of the primary
first molars, more likely than not, will encourage the
eruption of permanent mandibular canines.
• Step 3: Extraction of primary maxillary second molars
and mandibular second premolars.
• Step 4: Multibonded edgewise appliance.
    Step 5: Retention.

SUPERNUMERARY TEETH:
Supernumerary teeth can disrupt both the normal
eruption of the other teeth and their alignment if
eruption does occur and hence need to be extracted.
The most common location for supernumerary teeth is
in the anterior maxilla. In the simple cases, if the
tooth is not inverted, will often erupt before the
normal tooth and can be extracted before it interferes
with the adjacent teeth.
As a general rule, the more supernumeraries present,
the more abnormal their shape, and the higher their
position, the harder it will be to manage the situation.
Extractions should be completed as soon as
supernumerary teeth can be removed without harming
the developing normal teeth, to allow for normal teeth
to erupt.

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 resportion of an adjacent
permanent tooth.
Several methods can be helpful for intervention. The
basic approach is to move the ectopically erupting
tooth away from the tooth it is resorbing. A 0.020
inch brass wire can be looped and tightened around
the contact between the primary second molar and
permanent molar and tightened every 2 weeks.
Steel spring clip separator is available
commercially and can be used. Elastomeric separators
are also used. www.indiandentalacademy.com

• MUSLCE EXERCISES
It is a rather common occurrence for a child of 7 or 8
years of age to have mildly protruding and spaced
maxillary incisor teeth.  To prevent the establishment of
abnormal lip and tongue habits, simple lip exercises
should be recommended.  Hypotonicity and flaccidity of
upper lip are the most obvious characteristics of this kind
of problem.
This child is instructed to extend his upper lip as far as
possible, curving the vermilion border under and behind
the maxillary incisors.  This exercise should be done for
15-30 minutes/day for a period of 4-5 months when a
child has a short upper lip.
When protrusion of maxillary incisors is also a factor,
vermilion border of lower lip is placed against the outside
of extended upper lip and pressed as hard as possible
against the upper lip to exert a strong retracting influence.

• EQUILIBRATION OF OCCLUSAL
DISHARMONIES:
• Premature contacts that have not been
eliminated in their incipiency can develop into
tooth guidance problems, with both the mandible
and individual teeth reflecting the abnormal
functions. The path of closure should be observed
from the postural rest position to full occlusion.

Anterior Mandibular displacement:
At point of initial contact, there is edge to edge
relationship due to lingual malposition of maxillary
incisors of incipient mandibular prognathism. Then the
condyle slides forward on the articular eminence and
posterior teeth make occlusal contact as the labio incisal
margin of maxillary incisors glides down the lingual
surface of mandibular incisors. By beveling the labial
incisal of mandibular incisor and lingual incisal of
maxillary incisors, a more nearly correct overjet is
established. However, correct diagnosis is very
significant.

Crossbite conditions: Bilateral maxillary
constriction can lead to unilateral cross bite.
As a result of asymmetry of dental arches,
an actual asymmetry can result in adults if
cross bites are not eliminated. Judicious
occlusal grinding to eliminate the guiding
forces can correct some of these cross-bites.

OCCLUSAL RELATIONSHIP PROBLEMS
Transverse: Posterior cross bite:
Bilateral constriction of maxilla can give rise to
functional shift of mandible leading to unilateral cross
bite. More severe condition leads to bilateral cross bite.
Sometimes minor interferences caused by primary
canines can lead to cross bite.
These should be treated as soon as they are discovered to
prevent undesirable growth modification, dental
compensation leading to a true asymmetry at a later time.
There are 3 basic approaches to the treatment of posterior
cross bites in children:
• 1. Equilibration to eliminate mandibular shift.
• 2. Expansion of constricted maxilla.
• 3. Repositioning of individual teeth to deal with intra-
arch asymmetries.

Expansion of the constricted maxilla can be
brought about by expansion plates, fixed jack
screws, w-arch appliance and quad helix.
In cases of canine interference, equilibration corrects
the cross bite.
In children with true unilateral cross bite without a
mandibular shift, ideal treatment would be to
move selected teeth on the constricted side of
upper arch by either a removable appliance that
has been sectioned asymmetrically or using
different length arms on a w-arch or quad helix.
An alternative method is to use a mandibular
lingual arch to stabilize the lower teeth and attach
cross-elastics to the maxillary teeth that are at
fault. If both arches are at fault cross elastics
between bonded attachments in both arches can be
helpful.

ANTEROPOSTERIOR PROBLEMS
Anterior Crossbite:
The most common etiologic factor of
nonskeletal anterior crossbites is lack of
space for the permanent incisors. If the
developing cross bite is discovered before
eruption is complete, the adjacent primary
teeth can be extracted to provide the
necessary space. A tongue blade therapy
can be used.

Anterior cross bites diagnosed after the incisors have
erupted require appliance therapy for correction.
Bilateral disking of extraction of adjacent primary
teeth is done for space. Finger spring of Z-spring
is used in a appliance with multiple clasps for
retention. Anterior or posterior bite plate can be
used to reduce overbite wile the cross bite is being
corrected.
Fixed appliance like maxillary lingual arch with
finger springs can also be used..
Fixed appliance using posterior bands and anterior
bonded attachments with round wires can be used
as well.

• MAXILLARY DENTAL PROTRUSION:
• Treatment for maxillary dental protrusion in
early mixed dentition is indicated only when they
are esthetically objectionable or in danger of
traumatic injury.
• If there is vertical clearance and space within
the arch, Hawley type appliance with activated
labial bow is used.
• A fixed appliance consisting of bonded
molars, bonded incisors and archwires also can be
used. The force to retract the incisors can be
provided by a closing loop in the archwire or a

VERTICAL PROBLEMS
Habits and open bites:
Most children indulge in no-nutritive sucking habits.
Intervention is not usually indicated until 5 years of
age. As long as the habits stop before eruption of
permanent incisors, most of the dental changes
resolve spontaneously. “Adult” approach of straight
forward discussion between the child and dentist can
be very beneficial. If this approach fails, a inward
system can be implemented. Pleasure of sucking can
be removed by plancing a cotton glove on the hand
or a band-aid on thumb or finger. A maxillary
lingual arch, especially quad-helix has the neminder
effect when used for maxillary expansion.
A cemented reminder appliance comprising of a
maxillary lingual arch and a crib can be used

Deep bite:
It is necessary to establish the cause of a deep bite
before treating it.
If the posterior teeth are infraerupted, an anterior
bite plate which will prevent the posterior from
occluding and encourages their eruption is used.
Utility arches which in corporate molar incisor
teeth can be used during mixed dentition to
intrude, tip or repositition both molars and
incisors.

TREATMENT OF SKELETAL PROBLEMS IN
PRE-ADOLESCENT CHILDREN:
Correction of jaw discrepancy in a growing child
is possible by growth modification. Growth
modification through either a functional appliance
or extra oral force, usually is aimed at mandibular
condyles and/or the maxillary sutures by applying
forces directly to the teeth, and secondarily and
indirectly to the skeletal structures, instead of
applying direct pressure to the bones.
Ideally the treatment should begin 1-3 yeas before
the peak of adolescent growth spurt.

Treatment of mandibular deficiency:
Many children with a skeletal class II relationship
have a component of mandibular deficiency
caused by either a small mandible or a normal
mandible in a posterior position. One possibility
for treatment is to restrain growth of maxilla with
extra oral force and let the mandible continue to
grow.
The treatment of choice would be enhancement of
mandibular skeletal growth using functional
appliances which hold the mandible forward.
When the mandible is held forward, the elasticity
of the soft tissues produce a reactive force against
the maxilla and restraint of maxillary growth often
occurs. www.indiandentalacademy.com

Functional appliances often place a distal force
against the upper incisors that tends to tip them
lingually. They also exert a protrusive effect on the
mandibular dentition becauses the appliance
contacts the lower teeth. The combination of
maxillary dental retraction and mandibular dental
protrusion is similar to “class II elastics effect”.
Class II dental relationship can also be corrected
by allowing lower posterior teeth free to erupt up
and forward. However excessive posterior eruption
causes mandibular growth to be projected more
downwards thereby increasing lower facial height
especially in patients with vertical growth pattern.
Bass appliance is a removable bite jumping
appliance in combination with high pull heavy
force headgear fixed to appliance in premolar area.

Treatment of vertical deficiency (short face):
Skeletal vertical deficiency occurs usually in
conjunction with an anterior deep bite, a class II,
division 2 malocclusion, and some degree of
mandibular deficiency. The challenge in
correcting these problems is to increase eruption
of posterior teeth and influence mandible to rotate
downward.
Cervical headgear produces more eruption or the
upper molars, while eruption can be manipulated
with a functional appliance so that either the upper
or lower molar erupts more class II correction,
however, is easier if the lower molar erupts more
than the upper, which means that, all other factors
being equal, the functional appliance would be
preferred. www.indiandentalacademy.com

MAXILLARY EXCESS:
Here the goal of treatment is to restrict growth
of the maxilla while the mandible grows
into a more prominent and normal
relationship, and the application of extra
oral force is the obvious approach.
Extra oral force decreases the amount of
forward and/or downward growth, by
changing the pattern of apposition of bone
at the sutures. Extra oral force is almost
always applied to the first molars via a face
bow with head cap or neck strap for
anchorage. The recommended force is 12-
16 ounces per side, with 12-14 hours of
wearing time per day.

The direction of force must be compatible
with the vertical relationship of the patient.
Distal and superior headgear force
(headcap) will limit vertical maxillary
development and cannot be used in short
faced patients. Distal and inferior direction
of force (cervical strap) will accentuate
downward growth required in short faced
patients.

Selection of headgear: There are 3 major decisions to be
made in the selection of headgear.
• 1 Anchorage location to provide a correct vertical
component of force to the skeletal and dental structure.
• 2 How the headgear is attached to the dentition..
• 3Decision on whether bodily movement or tipping of
teeth or maxilla is desired.

VERTICAL EXCESS:
The ideal treatment for these patients would
be to control all subsequent vertical growth
so that mandible would rotate in an upward
and forward direction.
In order of increasing effectiveness following
could be used

High pull headgear to the molars:
This would inhibit eruption of the maxillary
posterior teeth and maintain vertical position of
maxilla. This is worn 14 hours a day with a force
greater than 14 ounces per side.
2. High pull headgear to a maxillary splint:
Addition of anterior plate to the inner bow (cervera
headgear) or the use of a plastic occlusal splint
attached to the facebow would be useful for a
child with excessive vertical development of the
entire maxillary arch. This allows vertical force to
be directed against all the maxillary teeth, not just
the molars.

Functional appliance with bite blocks:
This will inhabit eruption of posterior teeth and vertical
descent of maxilla. Moreover the anterior teeth are allowed
to erupt which reduces open bite. However the child may
exhibit a posterior open bite when appliance is not in place.
The posterior bite block which is usually constructed of plastic
can be relieved at that point so that slow eruption of posterior
teeth into occlusion can occur.
4. High pull headgear to a functional appliance with bite block:
Functional appliances will anteriorly reposition the mandible in patient
with class II relationship. The high pull headgear provides head gear
force and improved retention of the functional appliance and produces a
force direction near the estimated center of resistance of maxilla.

When a headgear activator combination is
used, torquing springs can be incorporated
to the activator to reduce the tipping effect
on maxillary anterior teeth.
The headgear tubes are incorporated into the
bite blocks in the premolar region.

• MAXILLARY DEFICIENCY:
Transverse maxillary constriction:
This can be corrected by opening the mid palatal
suture.
• Primary and early mixed dentition:
• Opening of the midpalatal suture is relatively
easy and less force will be required. W-arch or
quad helix appliances generally deliver less that 2
pounds of force. Jackscrew appliances can also be
used for maxillary expansion in the early mixe
dentition.
Functional appliances incorporating springs and
jackscrews can be used buccal shields to relieve
buccal soft tissue pressure.

In late mixed dentition:
With increasing age, the suture becomes more and
more tightly interdigitated.
In late mixed dentition, sutural expansion requires
placing a relatively heavy force directed across the
suture to move he halves of maxilla apart. A fixed
appliance is required because the necessary force
magnitude is large enough to displace removable
appliances. Vertical opening during expansion
can be controlled by posterior bite blocks.
In rapid palatal expansion (RPE) atleast 0.5mm
activation is required per day. After
expansion a minimum of 3 months retention
period is required for the bone to fill in.

mixed dentition.
• - Slow maxillary expansion was done using a
quad helix and equal skeletal and dental results
were obtained at the end of treatment.
• - Semirapid expansion using removable plates
with a midline screw gave most remarkable dental
and skeletal effects in the transverse plane and
none in sagittal plane.
• - RME using hyrax showed significant skeletal
and dental results in all planes.

Anteroposterior and vertical maxillary
deficiency:
The preferred treatment is to move maxilla into a
more anterior and inferior position, which also
increases its size as bone is added at the posterior
sutures. In children under age 8, this treatment
can be accomplished with a facemask that obtains
anchorage from the forehead and chin and exerts
force on the maxilla via elastics that attach to a
maxillary splint producing both tooth movement
and displacement of the maxilla. In olden children
(above 9 years) the same treatment produces more
dental movement and usually very little skeletal
change.

MANDIBULAR EXCESS
These cases are relatively difficult to treat and the treatment
of choice is to inhibit the growth of mandible.
Class III Functional appliances:
These are designed to rotate the mandible down and back
and to produce proper occlusal relationships by allowing the
upper posterior teeth to erupt down and forward while
restraining eruption of mandibular teeth.
These appliances also introduce an element of dental
camouflage by tipping the mandibular incisors lingually and
maxillary incisors facially.
The sum total of these changes can produce an acceptable
result in a child who has a class I skeletal pattern and mild
skeletal discrepancy, or a pseudo-class III problem because
a anterior shift, but not in a patient who had severe
mandibular excess. www.indiandentalacademy.com

Extraoral force to mandible: chin cup treatment:
Another approach to treat mandibular skeletal excess is
a chin cup attached to a headcap for anchorage.
Extraoral force directed against the mandibular condyle
would restrain growth at that location.
Chin cup accomplishes lingual tipping of the lower
incisors as a result of the pressure of the appliance on
the lower lip and dentition, and a change in the
direction of mandibular growth, rotating the chin down
and back.
The headcap includes the spring mechanism and it is
adjusted in the same manner as the headgear to direct a
force of approximately 16 to 24 ounces per side. For
child with severe prognathism, orthognathic surgery
remains treatment of choice.

FACIAL ASYMMETRY:
Facial asymmetry in children arises mainly due to
injury, typically a fracture of the condylar process of
mandible, but also may be due to congenital anamolies
such as hemifacial microsomia or hemimandibular
hypertrophy.
Facial asymmetry following traumatic injury to
mandible is best avoided by maintaining the function
of mandible.
If asymmetry does develop in the post injury period,
these patients can be treated with an asymmetric
functional appliance to restore symmetry through
better growth and function on affected side.

CONCLUSION:-
The mal occulusion may be accepted or be treated in a
variety of ways . The natural growth change which
follows the completion of the treatment may spoil a
fine results.
Interceptive procedures can to some extent prevent or
reduce the severity of mal occulision .
In the treatment at early ages the orthodontist can
reasonably become “ Re director” of growth pattern
rather than solely concerned about tooth position.

Interceptive orthodontics

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