Interceptive orthodontics: A short review

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Interceptive orthodontics: A short review

  1. 1. Research & Reviews: A Journal of DentistryVolume 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: 9963002821IntroductionOne of the main functions of the primary with occlusal development; and interceptivedentition is the maintenance of the arch orthodontics, this is treatment to intercept alength, so that the permanent dentition, developing problem or to correct existingwhich replaces have sufficient space to early malocclusion.erupt. The three features of primarydentition that indicate good dental Interceptive orthodonticsdevelopment are spacing, anthropoid spacesmesial to the maxillary canine and distal to Richardson (1982) defined interceptivemandibular canines, and straight or mesial orthodontics as the prompt treatment ofstep primary second molar occlusion(1). unfavorable features of a developingEarly orthodontic intervention is carried out occlusion that may make the differenceto enhance dentoalveolar, skeletal and between achieving a satisfactory result bymuscular development before complete simple mechanics later, thus reducingeruption of the permanent dentition (2). The overall treatment time and providing betterearly orthodontic intervention can be stability and functional and aesthetic results 3broadly classified as: preventive . The percentage of children who wouldorthodontics, which prevents interferences© STM Journals 2011. All Rights Reserved. 6
  2. 2. Research & Reviews: A Journal of DentistryVolume 2, Issue 1, April, 2011, Pages 6-9._____________________________________________________________________________________________benefit from interceptive orthodontics has age results in a permanent loss of space duebeen reported from 14% to 49% (4-6). to the mesial drifting of the permanent first molars (11). Using space maintainer canIntervention seeking abnormalities and prevent this space loss; space maintainerstreatment are passive fixed appliance such as distal shoe or lingual arch and removablea. Local factors appliances such as the partial denture. SpaceLocal factors such as impacted upper first regainer appliances may obtain up to 3 mmmolars, scissor bite of first molars, retained per quadrant of space by making driftedprimary teeth related to malposed permanent teeth upright. It is not indicated for severeteeth and delayed eruption of permanent crowding or in cases that need extractionteeth caused by supernumerary teeth need later (12). Unilateral loss of primary canineinterceptive orthodontics for the normal usually requires extraction of the antemeredevelopment of the mixed dentition. to prevent midline shift.Prolonged retained primary teeth can causedisplacement or failure in the eruption of the d. Ectopic eruption of maxillary caninepermanent teeth. The primary teeth should In Class I non-crowded situations where thebe extracted to allow spontaneous permanent canines is impacted or eruptingalignment. Extraction of the supernumerary buccally or palatally, the treatment of choiceteeth and exposure of the permanent teeth is the extraction of the primary canineswill allow spontaneous eruption. Mesially when the patient is 10-13 years old (13).impacted first permanent molars can be Power and Short (1993) showed thatrelieved by using separators, Kesling metal interceptive extraction of the primary caninesprings or brass wire twisted at the contact completely resolves permanent caninepoint (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 morepermanent molar. favorable canine positioning (14). The success of early interceptive treatment forb. Crowding impacted maxillary canines is influenced byManagement of crowding in the mixed the degree of impaction and age at diagnosisdentition includes interproximal primary (13).tooth reduction, extraction of the primarytooth and/or sectional fixed appliance to e. Midline diastemaalign rotated permanent incisors. If there is There are several reasons for midlineno spacing in the primary dentition there is diastema to occur, the development cause is70% chance of crowding of the permanent due to the pressure exerted by theteeth, if there is less than 3mm spacing there developing lateral incisor on the distalis 50% chance of crowding (10). aspect of the central incisor, which cause median diastema. This stage is called asc. Early loss of primary teeth “ugly duckling” stage and it corrects withEarly loss of primary first molars before 7.5 the eruption of the maxillary permanentyears of age leads to a temporary lack of canines. The other causes of midlinespace, which can be regained, on the diastema are low frenal attachment, presenceeruption of the permanent successor. On the of a supernumerary teeth or cyst in thecontrary, loss of a second molar before this midline of the upper arch, proclination of the© STM Journals 2011. All Rights Reserved. 7
  3. 3. Research & Reviews: A Journal of DentistryVolume 2, Issue 1, April, 2011, Pages 6-9._____________________________________________________________________________________________upper incisors, peg shaped laterals and beyond the cessation of the pacifier or digitmicrodontia of upper central incisors. The habit (19). Parafunctional habits that arepathological cause should be identified and detrimental to the occlusion of theremoved early. The midline diastema can be permanent incisors should be stopped beforeclosed with a removable appliance or the complete eruption of the permanentsectional fixed appliance. incisors so that malocclusion may self- correct and less complex orthodonticf. Anterior cross bite treatment is required later.Anterior cross bite which is localized mustbe treated at an early stage because the Limitation of interceptive orthodonticsupper incisor may be abraded by the lower Barrer reported that limitations of earlyand the periodontal support of the incisor interventions are unfavorable craniofacialmay suffer as a result of occlusal trauma. growth, persistent habits, severe ectopicCross bite can also result in mandibular eruption and congenitally malformed orshift; this can produce an undesirable growth missing permanent teeth (20). These factorspattern, 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 earlytime and potentially harmful functional treatments are changes that cannot bepatterns (15, 16). Unilateral cross bites can retained by stable occlusion, e.g.be corrected using an upper removable unfavorable soft tissue/skeletal growth andappliance with z-spring. persistent habits (21). Patient factors such as immaturity lack of motivation or parentalg. Mandibular displacement during supervision, small mouth size, low painfunction threshold and poor oral hygiene couldDisplacement or deflection of the mandible influence the success of the interceptivefrom closing from the rest position occurs orthodontics.when there is a discrepancy betweenmuscular positioning and the jaw The goals and objectives of early treatmentrelationship determined by the teeth (17). must be established firmly in order toThe displacements may be anterior, lateral prevent unnecessary, prolonged treatmentof 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 undesirablegrowth modifications. The treatment References –includes habit counseling, grinding of theprimary canine or expansion appliance. 1. Kurol J. and Koch G. “The deciduous dentition and occlusion” In: Shaw W. C.h. Habits Orthodontics and Occlusal ManagementDigit or pacifier sucking habits have long Oxford: Wright, Butterworth-Heinemannbeen 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 Treatmentyears, 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. 4. Research & Reviews: A Journal of DentistryVolume 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

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