Ortho

PREVENTIVE
&
INTERCEPTIVE ORTHODONTICS
www.indiandentalacademy.com

Preventive orthodontics
It means a dynamic,ever-constant vigilance-a
routine,a discipline,for both the dentist and
patient.it is concerned with the patients and parents
education,supervision of the growth and development
of the dentition and the cranio-facial structures,the
diagnostic procedures undertaken to predict the
appearance of malocclusion and the treatment
procedures instituted to prevent the onset of
malocclusion.
(Remove potential causes of developing malocclusion)

Interceptive orthodontic treatment
It refers to measures undertaken to prevent a
potential malocclusion from progressing into a more
severe one. It is carried out when the signs and
symptoms of a malocclusion have appeared.
Examples of this kind of orthodontic treatment
may include correction of thumb- and finger-
sucking habits; or gaining or holding space for
permanent teeth.
(remove incipient malocclusions which develops intowww.indiandentalacademy.com

Comprehensive orthodontic treatment
Comprehensive orthodontic treatment is
undertaken for problems that involve alignmen
of the teeth, how the jaws function and how
the top and bottom teeth fit together. The
goal of comprehensive orthodontic treatment
to correct the identified problem and restore
the occlusion to its optimum. Treatment may
consist of one or more phases, depending on
the nature of the problem being corrected an
the goals for treatment.

INDICATIONS
~In case of delay in emergence of the teeth.
Most children start getting their primary teeth
by 5-7 months of age. In case of delay beyond
1 year of age in the emergence of the teeth it
is advisable to seek opinion of the dentist.
~the milk teeth is shed off and the permanent
teeth do not replace it.
~Teeth that are erupting too close to one
another or are crowded together.
~Teeth that are too far apart or spaced teeth.
.

-Normally the upper teeth are ahead of the
lower teeth. In case the lower teeth are
ahead of the upper it is called cross bite and
should be intercepted -If a space exists
between the upper and the lower teeth when
the teeth are brought together. This is called
open bite and signifies improper bite that
requires orthodontic care.
-Continued presence of habits such as finger
sucking beyond 4 years of age often requires
professional assistance to discontinue the habit
and to rectify the damage done to the bite.

-Presence of a space in the middle between the
two incisors. This is called midline diastema.
-Difficulty in chewing or biting
-Difficulty in pronunciation of certain words or
lisping.
-Children who breathe through the mouth due to
some nasal problem or as a habit.
-In case one or both the parents have had
orthodontic problems in the past.
-In case the child is habituated to the use of
pacifiers for too long.

What happens if the treatment is delayed?
At an early age the braces are less painful
and the treatment duration is shorter.
Advancing age makes the jaws harder and
therefore makes it difficult to mold the
jaws and to move the teeth.
As mentioned in the earlier section, in
younger individuals it is possible to prevent
and intercept the developing problems. But
orthodontic treatment can be carried out at
any age.

Duration of orthodontic treatment
The duration of treatment depends from
person to person and from one orthodontist
to other.
Most jaw molding and jaw corrections
carried out during the growing age takes
1-11/2 years.
Orthodontic treatment with braces often
takes 2 - 2 1/2 years.
The orthodontist would advice you on how
long the treatment is going to take after
studying the case.www.indiandentalacademy.com

-Although orthodontic treatment can be done at any
age they are best carried out in young children of 8
15 years age.
-During this age it is possible for the orthodontist t
foresee any dental problems that are likely to occur
and can take preventive measures. This is called
preventive orthodontics.
-It is also possible to intercept disorders of the bit
at an early stage so that it does not mature to a bi
dental problem. This is called interceptive
orthodontics.

Procedures and counselling undertaken for
prevention are-
Parent education
Caries control
Care of deciduous dentition
Maintainance of quadrant wise tooth shedding
timetable
Checkup for oral habits and habit breaking
appliance if necessary
Prevention of damage to occlusion by extra
orthodontic appliances .eg; milwaukee braces
Extraction of supernumerary teeth
Space maintainance
Management of abnormal frenal attachmentswww.indiandentalacademy.com

1.EDUCATION OF THE PARENTS
a .the expecting mother should be educated on
matters such as nutrition to provide an ideal
environment for the developing foetus.
b. the mother should be educated on proper
nursing and care of the child.
c. in cases of bottle feeding the mother is
advised on the use of physiologic nipple and not
the conventional nipple.

d. she should be advised against the prolonged use
of pacifiers .
e. she should also be advised on prevention of
nursing bottle syndrome.
f The parent should also be educated on the need
for maintaining good oral hygiene.
g. The parent should be taught the correct
method of brushing the child’s teeth.

2. CARIES CONTROL
-caries involving the proximal surface of
deciduous teeth if not restored leads to
loss of arch length by movement of
adjacent teeth into that space which can
result in discrepancies between the arch
length and tooth material when the bigger
permanent teeth erupt into oral cavity.
-Bite wing radiographs and clinical
examination should be done and the
affected teeth should be restored.

3.CARE OF DECIDUOUS DENTITION
The deciduous teeth are excellent natural
space maintainers until the developing
permanent teeth are ready to erupt into the
oral cavity.Thus all efforts should be taken t
prevent early loss of the deciduous teeth .
Topical fluorides and pit and fissure sealants
help in preventing caries.

4 EXTRACTION OF SUPERNUMERARY
TEETH
presence of supernumerary and supplemental
teeth can interfere with the eruption of
nearby normal teeth and deflect adjacent
teeth to erupt in abnormal positions. Eg-
presence of an unerupted mesiodens
prevents the two maxillary central incisors
from approximating each other,so they
should be extracted before they cause the
problem.

5. MAINTAINANCE OF TOOTH SHEDDING TIME
TABLE
there should not be more than 3 months difference
in shedding of deciduous teeth and eruption of
permanent teeth in one quadrant as compared to
other quadrant.delay in eruption may be due to –
a over-retained deciduous teeth
b.unresorbed deciduous root fragment
c.supernumerary tooth
d. cysts and tumours
f.fibrosis of gingiva

7.PREVENTING MILWAUKEE BRACE
DAMAGE
Milwaukee brace is an orthopaedic appliance
used for the correction of scoliosis . It
exerts tremendous force on the mandible
and the developing occlusion leading to
retardation of mandibular growth and
possible deformities.
Whenever such an appliance is used
,occlusion be protected using functional
appliances or positioners made of soft
materials. www.indiandentalacademy.com

8.SPACE MAINTAINERS
It is a device used to maintain the space created by
the loss of a deciduous tooth.

Pediatric Space Management
The best space maintainer is a primary tooth, as yo
see demonstrated in this radiograph. When nature's
best space maintainer is lost prematurely, we need t
intervene and maintain the space for normal
development of the dental arches.

For example, this panoramic radiograph shows the
premature loss of the mandibular right second prima
molar, resulting in the tipping of the first permanen
molar and consequent loss of space. This is an
example of space loss which could have been
prevented if a space maintainer had been placed aft
the primary tooth was removed.

This patient also has a
missing mandibular right
second primary molar, but
a space maintainer if
placed here, keeps the
permanent molar from
drifting mesially. The
critical importance of
maintaining the space of a
prematurely lost primary
molar should be realised.

CLASSIFICATION OF SPACE MAINTAINERS
According to
Hitchcock:
- Removable or fixed
or semifixed
-With or without
bands
-Functional or non-
functional
- Active or passive
-Certain
combinations
According to
Raymond C
Thurow:
-Removable
-Complete arch
Lingual arch
Extra oral
anchorage
-Individual tooth

According to Hinrichsen;
Fixed space maintainers;
Class I
a)Non functional types
-Bar type
-Loop type
b)Functional types
-Pontic type
-Lingual arch type
Class II-Cantilever type (distal shoe,band
and loop)
Removable space maintainers;
Acrylic partial dentureswww.indiandentalacademy.com

REQUIREMENTS FOR SPACE MAINTAINERS
1 should maintain the mesio-distal dimension o
the lost tooth
2 .if possible, they should be functional at
least to the extent of preventing the over
eruption of the opposing tooth
3 .should be as simple and as strong as
possible
4. must not endanger the remaining teeth by
imposing excessive stresses on them.

5. must be easily cleaned and not serve as
traps or debris which might enhance dental
caries and soft tissue pathology
6.Their construction must be such that they do not
restrict normal growth and developmental processes
or interfere with such functions such as
mastication,speech or deglutition.

Removable space maintainers-can be
removed or reinserted into the oral
cavity by the patient
Advantages
Easy to clean n permit maintainance of
proper oral hygiene
Maintain or restore the vertical dimension
Worn part time-allows circulation of
blood to soft tissues
Serve important functions like
mastication, esthetics n phonetics
Dental check-up for caries detection is
easy www.indiandentalacademy.com

Disadvantages:
May be lost or broken
Uncooperative patients may not wear the
appliance
Lateral jaw growth may be restricted,if
clasps are incorporated.
May cause irritation of underlying soft
tissues

Indications
When aesthetics is of importance
The abutment teeth cannot support a fixed
appliance
In cleft palate patients who require obturation
Multiple loss of deciduous teeth which may
require functional replacement in the form of
either partial or complete denture

CONTRAINDICATIONS
1. lack of patient cooperation.
2. in patients who are allergic to
acrylic materials
3. epileptic patients who have
uncontrolled seizures.

COMMONLY USED REMOVABLE SPACE
MAINTAINERS
1.acrylic partial dentures
-indicated in multiple extractions
-can be readily adjusted to allow the eruption of
teeth
-the inclusion of artificial teeth in the denture
restores masticatory function
-clasps can be fabricated on deciduous canines and
molars for retention.

2. COMPLETE DENTURE
Sometimes all the primary teeth of a pre-school chi
may require extraction due to rampant caries.so
dentures are used not only to restore masticatory
function and esthetics,but also to guide the first
permanent molars into their correct position.
-the posterior border of the denture should be
placed over a area approximating the mesial surface
of the unerupted first permanent molar.
-the denture will have to be adjusted and a portion
of it cut away as the permanent incisors erupt.
-on eruption of few teeth a partial denture space
maintainer can be used.www.indiandentalacademy.com

3.DISTAL SHOE SPACE MAINTAINER
An immediate acrylic partial denture with an
acrylic distal shoe extension can be used to guide
the first permanent molar into position when the
deciduous second molar is lost shortly before the
eruption of the first permanent molar. The
extension may be removed after the eruption of
the permanent tooth.

FIXED SPACE MAINTAINERS
-these are fitted onto the teeth and the patient
cannot remove it.
ADVANTAGES
1.bands and crowns are used which require minimum
no tooth preparation.
2.they do not interfere with passive eruption of
abutment teeth.
3.jaw growth is not hampered
4.the succedaneous permanent teeth are free to eru
into oral cavity
5.they can be used in uncooperative patients
6.masticatory function is restored if pontics are
placed. www.indiandentalacademy.com

DISADVANTAGES
1Elaborate instrumentation with expert skill is
needed.
2. They may result in decalcification of tooth
material under the bands
3. Supraeruption of opposing teeth can take
place if pontics are not used.
4. If pontics are used it can interfere with
vertical eruption of the abutment tooth and
may prevent eruption of replacing permanent
teeth if the patient fails to report.

TYPES –
1Band and loop space maintainer-
-most commonly used
-the tooth distal to the extraction space is
banded and a loop of thick stainless steel wire is
soldered to it with its mesial end touching the
tooth mesial to the extraction space
-unilateral appliance indicated in posterior
segments when a single tooth is lost.

Design of Band Loop Space MaintainerDesign of Band Loop Space Maintainer
The central portion of the loop is shaped wide enoughThe central portion of the loop is shaped wide enough
to allow the full eruption of the permanent tooth theto allow the full eruption of the permanent tooth the
bucco-lingual width of a maxillary premolar is 9mmbucco-lingual width of a maxillary premolar is 9mm
The loop should be contoured to follow the edentulousThe loop should be contoured to follow the edentulous
ridge, but 1mm off the tissueridge, but 1mm off the tissue
The anterior curve of the loop is shaped toThe anterior curve of the loop is shaped to
approximate the shape of the distal surface of theapproximate the shape of the distal surface of the
abutment tooth and to match its widthabutment tooth and to match its width

2.BAND AND BAR TYPE
abutment teeth on either side of the
extraction space are banded and
connected to each other by a wire.
3.CROWN AND LOOP APPLIANCE
it is used in preference to the band when
the abutment tooth is highly
carious,exhibits marked hypoplasia or is
pulpotomised.

4.LINGUAL ARCH SPACE MAINTAINER
-most effective appliance in the lower arch
-it consists of two bands cemented on the
first permanent molars or on the second
deciduous molars,which are joined by a
stainless steel wire contacting the lingual
surface of the four mandibular incisors
-it is usually indicated to preserve the
spaces created by multiple loss of primary
molars
-it helps in maintaining the arch perimeter
by preventing both mesial drifting of the
molars and also lingual collapse of anteriorwww.indiandentalacademy.com

Lingual holding arch

5.PALATAL ARCH APPLIANCES
-similar to the lingual arch
-designed to prevent mesial migration of the maxillary
molars
-constructed using 0.036inch diameter hard stainless s
wire
-the NANCE HOLDING ARCH is maxillary lingual arch
that does not contact the anterior teeth ,but
approximates the anterior palate.
-it incorporates an acrylic button in the anterior region
that contacts the palatal tissue.

The Nance
Bilateral UPPER space maintainer

6.TRANSPALATAL ARCH
-recommended for stabilising the maxillary first
permanent molars when the primary molars require
extraction.
-it is indicated when one side of arch is intact and
several primary teeth on the other side are missing.
-it consists of wire that spans the palate connecting
first permanent molar of one side with the other

7.DISTAL SHOE SPACE MAINTAINER
also known as intra-alveolar appliance
-it provides greater control of the path of
eruption of the unerupted tooth and
prevents undesirable mesial migration
-appliance used in practice now is roche’s
distal shoe or its modifications using crown
and band appliances with a distal intra
gingival extension.

Distal shoe space maintainer at insertion and after
eruption.
A conventional space maintainer should now be
constructed.

8.ESTHETIC ANTERIOR SPACE
MAINTAINERS
described by Steffen, Miller and Johnson
-it consists of a plastic tooth fixed onto a
lingual arch which, inturn,is attached to
molar bands

INTERCEPTIVE ORTHODONTICS
-It basically refers to measures undertaken to
prevent a potential malocclusion from progressing
into a more severe one.
-It is defined as that phase of the science and
art of orthodontics employed to recognise and
eliminate potential irregularities and malposition
of the developing dentofacial complex.
-The main difference between preventive and
interceptive orthodontics lies in the timing of the
services rendered.

Before undertaking any type of interceptive
procedure following should be thoroughly analysed
1. Case history
2. Study models
3. Full dental radiograph or panoramic radiographs
procedures undertaken in interceptive orthodontics
1. Equilibration of occlusal dysharmonies.
2. Correction of developing cross bites
3.correction of anterior diastema
4. Control of abnormal habits.
5. Space regaining
6. Muscle excercises
7. Interception of skeletal malrelations
8. Serial extractionwww.indiandentalacademy.com

1. EQUILIBERATION OF OCCLUSAL
DISHARMONIES
to check on occlusion harmony the patient should
be observed carefully as he closes from wide
open mouth to postural resting position and then
to full occlusion.
Postural resting position is a balanced, unstrained
relationship of mandibular condyle, articular disc,
articular eminence, articular capsular structures
and ligaments and of the controlling musculature.
This balanced relation should not be disturbed as
the mandibles moves into full occlusal contact.

Treatment- beveling the labial incisal of the mandibular
incisors and the lingual incisal of the maxillary incisors
creates a nearly correct overjet. One must make sure
that he is not dealing with a true class III malocclusion
and to remove premature contacts.
B) crossbite condition- prolonged crossbite conditions
leads to asymmetry of the dental arches and may also
lead to actual facial asymmetry. Tooth guided occlusion
may deflect mandible into cross bite conditions. As an
interceptive procedure judicious occlusal grinding can
be don’t to eliminate the guiding force leading to
correction of cross bite.

2. DEVELOPING ANTERIOR CROSS BITE
anterior cross bite is a condition characterised by
reverse overjet where in one or more maxillary
anterior teeth are in lingual relation to the
mandibular teeth.
Anterior cross bite should be treated early
because:
a) it is self perpetuating condition which may
manifest in the mixed and permanent dentition as
well.
b) if not treated early they have the potential of
growing into skeletal malocclusion.

Anterior cross bites are classified as:
a. dentoalveolar
b. skeletal
c. functional

A. Dentoalveolar : in this one or more maxillary
anterior teeth are in lingual relation to the
mandibular anteriors. This type is often manifested
as single tooth cross bite and usually occurs due t
over retained deciduous teeth.
Treated by- tongue blades, catalan’s appliance and
double cantilever springs with posterior bite plate.
B. functional : this type is the so called pseudo
class III malocclusion. It is a result of occlusal
prematurities.
Treated by- eliminating occlusal prematurities.
C. skeletal: they are the result of skeletal
discrepancies in growth of maxilla and mandible.
Treated by – growth modification using myofunction
or orthopaedic appliances.www.indiandentalacademy.com

3. CORRECTION OF ANTERIOR DIASTEMA
A. In the mixed dentition period a transient
anterior diastema develops in the form of “ugly
duckling” stage which is self correcting. One should
not try to give any kind of mechanical assistance
during the stage.
B. sometimes labial frenum is responsible for
spacing between the maxillary incisors. Clipping
this attachment may then allow the normal mesial
migration of the incisors into proper proximal
contact.
C. frequently maxillary central incisors erupt with
a 2 to 3 mm space between them encroaching
necessory space for the maxillary lateral incisors.
This condition should be corrected early as it may
lead to severe malocclusion.

4. CONTROL OF ABNORMAL HABITS
habits referred to certain actions involving the teeth and oth
oral or perioral structures which are repeated often enough
some patients to have a profound and deleterious effect on t
position of the teeth and occlusion.
A. thumb sucking – frequently practiced by children. Presenc
of this habit is considered normal upto 2-3 years of age. A
thorough case history should be obtained before initiating an
sort of treatment .
Treated by: removable or fixed habit breakers. The optima
time for appliance placement is between the ages of 3 12 t
4 12 years of age. The appliance serves several purposes-
- it renders the finger habit meaningless.
- the appliance prevent finger pressure from displacing the
maxillary incisor farther labially.www.indiandentalacademy.com

-It forces the tongue backward changing its shape
during postural resting position from an elongated
mass to a wider, more nearly normal tongue.
The habit appliance is worn for 4-6 months in
most cases. A period of three months of total
absence of this habit is good insurance against a
relapse.
B.TONGUE THRUSTING- it is defined as the
condition in which the tongue makes contact with
any teeth anterior to the molars during swallowing.
This habit may clinically present with open bite
and anterior proclination.
Treated by: habit breaking appliances like tongue
crib – removable or fixed.www.indiandentalacademy.com

A tongue thrust appliance does two things-
1. Eliminates the strong anterior thrust and plunger
like action during deglutition.
2. Re educate tongue posture so that the dorsum of
the tongue approximate the palatal vault and the tip
of the tongue contacts the palatal rugae during
deglutition.
Depending on the severity of the open bite problem
4-9 months may be required for correction. Optimum
age for placement of this appliance is between 5-10
years.
Higher incidences of this habit is seen in class II Div
2 malocclusion and this habit should be intercepted
along with treatment of malocclusion.www.indiandentalacademy.com

C. LIP BITING AND SUCKING
this habit is a compensatory activity that results from
an excessive overjet and the relative difficulty of
closing the lips properly during deglutition. There is a
presence of abnormal mentalis activity.
Clinically the habit manifests as protrusion of maxillary
incisors and a marked flattening and crowding of lower
anteriors.in severe cases vermillion border of lip
becomes hypertrophic and redundant.

D. MOUTH BREATHING
it can be obstructive or habitual in nature and should
be intercepted as soon as the obstruction ia removed.
Treated by: vestibular or oral screen.
If patient cooperation is not assured fixed appliance
are indicated.
This habit may be associated with class II Div 1
malocclusion or an excessive overjet problem. The
first service to be rendered in these cases is the
establishment of normal occlusion.
Treated by: lip habit appliance like lip plumper. The
appliance is worn for 8-9 months

. SPACE REGAINING
if a primary molar is lost early and space maintainers
are not used, a reduction in arch length by mesial
movement of the first molar is expected. In such
cases the space lost by mesial movement can be
regained by distal movement of the first molar.
The space regaining procedures are preferably
undertaken at an early age prior to the eruption of
second molar. Following are the commonly used space
regainers:
a. Gerber space regainers: it consist of a U shaped
hollow tubing and a U shaped rod that enters the
tubing. Open coil spring inserted into the tubing
assembly generates forces to bring about distal
movement of the first molar.

b.space regainers using jack screws-these are
placed in such a way that distalisation of the
molar is achieved using a split acrylic plate with a
jack screw.
c.Space regaining using cantilever spring.
6.MUSCLE EXERCICES
these help in improving aberrant muscle.
EXERCISES FOR THE LIPS-
-stretching if the upper lip to maintain lip seal .
-holding and pumping of water back and forth
behind the lips.
-for a developing class II div 1 malocclusion, the
playing of a wind instrument may be an
interceptive procedure.

EXCERCISES FOR THE TONGUE-
one elastic swallow- a 516 inch intra oral elastic is
positioned on the tip of the tongue and the patient i
asked to raise the tongue and hold the elastic
against rugae area and swallow.
Two elastic swallow- to 516 inch elastics are place
on the tongue, one in the midline and the other at
the tip. And the patient is asked to swallow with th
elastics to swallow.
The hold pull exercise- the tip of the tongue and
the mid point are made contact the palate and the
mandible is gradually opened. This helps in stretchin
the lingual frenum.

7. INTERCEPTION OF THE SKELETAL
MALRELATIONS
class II and class III malocclusion are largely
maxillomandibular basal malrelationship .
- for class II malocclusion head gears to restrict
maxillary growth and myofunctional appliances to
promote mandibular growth are used.
- for class III chin cut therapy to restrict
mandibular growth and myofuctional appliance to
promote to maxillary growth are given.

-Early treatment (age 9) to reduce severe
protrusion of teeth and reduce risk of trauma.

8. SERIAL EXTRACTION
it involves the planned extraction of certain
deciduous teeth and later specific permanent teeth
in an orderly sequence and predetermined pattern to
guide the erupting permanent teeth in to a more
favourable position .
Certain surgical procedures like removal of soft
tissue and bony barriers to surgically expose the
crown for stimulation of eruption can also be
considered to be an interceptive procedure.

A Final Word...
There are many other examples of preventive and
interceptive orthodontic strategies that are too
numerous to mention here. However, it is
important to remember three things when
considering preventive/interceptive care:
-timing of preventive/interceptive treatment is
critical
-a thorough knowledge of craniofacial growth and
development is necessary
-the proposed treatment should be of benefit

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