Interceptive Orthodontics

1. Interceptive Orthodontics
DR CHANDRIKA KATTI
READER, DEPT OF ORTHODONTICS
NAVODAYA DENTAL COLLEGE, RAICHUR

2. Definition
• It is defined as that phase of the science & art
of orthodontics employed to recognize &
eliminate potential irregularities &
malpositions of the developing dento-facial
complex.

3. Procedures undertaken in Interceptive
orthodontics
• Serial extractions
• Correction of developing cross bites
• Control of oral habits
• Space regaining
• Muscle exercises
• Removal of soft tissue or bony barrier to
enable eruption of teeth.

4. SERIAL EXTRACTION
 Term coined by Kjellgren (1929)
 Father of serial extraction Nance (1940)
 Definition :
correctly timed, planned removal of certain
deciduous and permanent teeth in mixed dentition
cases with dento-alveolar disproportion in order to :
• Alleviate crowding of incisor teeth
• Allow unerupted teeth to guide themselves into
improved positions
• Lessen the period of active appliance therapy or
eliminate it

5. Indications
Class I with anterior crowding ( >10mm
space loss)
Lingual eruption of lateral incisors
Midline shift potential due to unilateral
canine loss
Crowded arches accompanied with extreme
proclination
Abnormal primary canine root resorption
Lack of developmental spacing
Anomalies such as ankylosis, ectopic
eruption

6. Contraindications
Mild to moderate crowding (8mm or less)
Congenital absence of teeth
Extensive caries of first permanent molars
requires their removal
Deep or open bites without correction
Severe class II, III of dental / skeletal origin
Cleft lip and palate cases

7. Dewel’s method (1978)
CD4

8. Tweed (1966)
DC4

9. Anterior crossbite in primary and mixed
dentition
Etiology :
 Labially positioned supernumerary tooth
 Trauma to anterior primary tooth
 Prolonged retention
 Arch length deficiency
May lead to :
 Developing Cl.III malocclusion
 Traumatic occlusion
 Stripping of gingival tissue & pocket formation
labially
 Wear facets on incisal & labial surfaces

10. • Treatment :
Occlusal equilibration Tongue blade therapy
Composite inclines
Fixed appliances
Acrylic lower inclined plane Palatal appliances
Anterior crossbite in primary and mixed dentition Interceptive
orthodontics

11. Posterior crossbite in primary and mixed dentition
• 3 types :
•SKELETAL
• Etiology –discrepancy in width of arches
• RX : palatal expansion appliance ,RME
•DENTAL
• Etiology – faulty eruption pattern
• RX : W-arch or Quad helix or Cross elastics
•FUNCTIONAL
• Etiology – shift of mandible into abnormal position
• RX : occlusal equilibration , comprehensive ortho RX
Interceptive
orthodontics

12. Problems related to eruption of teeth
1. Ectopic Eruption of First / Second Permanent
Molars :
RX :
• Early stage -- Distal shoe appliance
• Band and S-shaped loop ( Humphrey )
Interceptive
orthodontics

13. 2. Ectopic Eruption of Permanent Lateral Incisors :
RX :
Unilateral loss & no midline shift –
band and loop or lingual arch
Unilateral loss , crowding & midline shift –
Xn of opposite side canine & lingual arch
placed
3. Impaction & delayed eruption of Permanent canines:
RX :
Primary canine present– Extracted
Impacted permanent canine – surgical exposure /
orthodontic movement
Interceptive
orthodontics

14. 4. Supernumerary teeth and accompanying occlusion
Etiology : continued budding of enamel organ
Maxilla : mandible – 8:1
Maxillary Incisor region - common
RX :
Does not interfere – observation
Delayed eruption of adjacent teeth – surgical removal
5. Anterior diastemas
Etiology : heavy labial frenum, supernumerary teeth,
habits..
RX postponed until complete eruption of canines.
Interceptive
orthodontics

15. 6. Congenitally missing teeth
RX :
One or both maxillary lateral incisors missing:
prosthetic replacement, implants or
drifting canine mesially and reshaping it to resemble
the lateral
One premolar missing :
prosthetic replacement, implants
3 or 4 premolars missing :
Orthodontic RX and prosthetic replacement
Interceptive
orthodontics

16. 7. Crowding
• Dependent on several Factors :
• Inter dental spacing
• Inter canine arch width
• Inclinations of permanent incisors
• Ratio of size b/w perm and primary teeth
• Management :
• Observe
• Disking
• Extraction

17. Regaining Space….
Diagnostic considerations:
- Alignment and space needs of the other teeth in
the arch
- Relationship of the teeth with the denture base
- Transverse and sagittal relationship
- Vertical denture relationships
- Skeletal relationship of the denture base to the
cranium
- Profile of the tissues

18. Diagnostic aids:
- Study models
- Radiograph of all the periapical structures
- Clinical assessment of the facial symmetry
and proportions
- Possibly cephalometric analysis
Regaining Space….

19. Radiographs and study models:
- To Assess space needs and tooth alignment
- Proximity of the adjacent erupting teeth
- Estimation of rotation. Slipped contacts, facial –
lingual displacement of teeth from arch circumference
- Permit visualization of vertical, transverse, and sagittal
dental relationships.
RegainingSpace….

20. Classification
Space Regainer
Removable Fixed
Free endloop
Splitsaddle
Jack screw
Sling shot
Open coil SR
Gerber SM
Hotz L Arch
Sectional arch
Lip bumper
Anterior SR

21. Fixed space regainers
Open Coil Space Regainer
•Reciprocal active fixed regainer
•Spaced coil spring 2-3 mm longer
than distance from anterior stop to
molar tube.
•Wire and spring replaced with longer
sections at 4 week intervals

22. Anterior Space Maintainer And
Regainer
- Standard labial tubes are bonded
- .014” wire inserted into Lateral incisor tube,
- Wire then inserted into open coil Spring passed
through central incisor tube

23. Split Saddle Space Regainer
- Formed of .028” wire
- In 2 segments
- Most successful for
regaining 1 – 2 mm lost
space
- Appliance is sturdy,
durable

24. Sling Shot Space Regainer :
- Consists of an S bend
in a continuous 0.036”
wire on both buccal and
lingual sides
- Top curve of S bend is
used as elastic hook
- Hook is placed adjacent
to the developmental
groove on lingual side
- Distal to the
developmental groove
on buccal side

25. Space Regainer Utilizing Jack-screw :
- Open the jack screw ¼
turn (0.25 mm) twice a
day until the appliance
is difficult to seat
- ¼ turn every 2nd or 3rd
day

26. INTERCEPTION OF HABITS
THUMB SUCKING
Normal till 3 yrs
TONGUE THRUST
MOUTH BREATHING
Identification and removal of cause
If habitual then vestibular screen to intercept

27. MUSCLE EXERCISES
Exercise for masseter
Exercise for the lips
1streching of upper lip
2holding and pumping water back and forth behind the lips
3button pull exercise
Exercise for tongue
1 one elastic swallow
2. Two elastic swallow
3 tongue hold exercise
4 tongue hold pull exercise

28. Removal of soft tissue and bony barriers
Eruption stimulated by surgical exposure of crown

29. THANK YOU