Interceptive orthodontics serial extraction first molar extraction hypodontia delayed eruption retained deciduous infra occlusion retained deciduous canine gemination fusion diastema ectopic upper canine thumb sucking transposition

1. Shahzad Hussain
Final year BDS

2. Definition
 Any procedure that eliminates or reduces the severity of
malocclusion in the developing dentition
Or
 All simple measures that eliminate the developing
malocclusion.

3. Etiology of malocclusion
1- Skeletal discrepancy
2- Soft tissue
3- local factors
4- Crowding and spacing
5- Displacements

4. 1) DELAYED ERUPTION OF UPPERPERMANENT CENTRAL INCISOR.
 Definition: It is considered to be delayed if the contra-lateral
tooth was fully erupted or if teeth later in the usual
eruption sequence were present.
 Interceptive treatment: removal of supernumerary with or
without tooth exposure.
 Treatment timing: as soon as the supernumerary tooth is
detected.

5. 2) RETAINED DECIDUOUS TEETH.
 Definition: the deciduous tooth is considered to be
over retained if it made enamel contact with its
successor.
 Interceptive treatment: extraction.

6. 3) INFRA OCCLUSION
 Definition: the tooth loses its vertical position relative to
the adjacent teeth and assumes a position below the
occlusal plane
 Frequent site: lower 2nd and 1st primary molars.
 Interceptive treatment: nothing unless the permanent
successor was absent or the infra occluded tooth is likely to
disappear .

8. 4) UNILATERAL RETAINEDDECIDUOUS CANINE.
 Definition: premature loss of one deciduous canine as
a result of early root resorption by a crowded lateral
incisor.
 Interceptive treatment: extraction of the primary
canine on the opposite side of the arch to preserve the
midline.

9. 5) DOUBLE TEETH
 Definitions:
Gemination: the attempt of a single tooth bud to form two
distinct morphological entities.
Fusion: the result of joining two adjacent tooth buds.
 Treatment:
1. In the deciduous dentition double teeth are usually associated
with absent permanent successor, or ectopic or delayed
eruption of the permanent successor if it was present.
Treatment therefore involve the extraction of the malformed
tooth.
2. In the permanent dentition treatment options are: Mask, Split
and Extract

11. 6) Hypodontia
 Definition: Absent teeth.
 Common teeth: lower 2nd premolar & upper lateral
incisor.
 Treatment: space closure or space maintenance for
future prosthesis.

12. 6) HYPODONTIA:

13. 7) DIASTEMA
 Definition: space between the two upper central
incisors.
 Treatment if indicated: removal of pathology
(supernumerary, odontoma, frenum….)

14. 7) DIASTEMA

15. 8) ECTOPIC UPPER CANINE
 Definition: the canine erupts out of its normal
eruption path.
 Diagnosis: If the 3 was not palpable in the buccal
sulcus after the age of 10 years.
 Treatment: Extraction of the deciduous canine. And
look for the prognosis of permanent canine eruption.

17. 8) ECTOPIC UPPPER CANINE
Rate of eruption of the permanent canine after the
extraction of the deciduous canine depends on the
amount by which the permanent canine overlap the
lateral incisor:
overlap < 12 of lateral root: success rate 91%
overlap > 12 of lateral root: success rate 64%

18. 9) THUMB SUCKING
 Effect: no malocclusion 14.6%
anterior open bite 48.1%
posterior cross bite 07.2%
ant OB +post X-bite 30.1%
 At what age should treatment be started?
Proffit “before the eruption of permanent incisors”
 Treatment:
1. Appliance therapy (crib appliance)
2. Behavioral modification(remind therapy, reward
therapy)

19. 10) TRANSPOSITION
 Definition: unusual type of ectopic eruption were two
permanent teeth have interchanged their location in the
dental arch.
 Frequent sites: upper canine and first premolar
lower canine and lateral incisor.
 Interceptive treatment: extract transposed tooth.
align before canine eruption
 Treatment timing: before eruption of canine.

21. 11) Crowding
 Treatment:
1-Space management.
2-Molar distalisation.
3-Serial extraction.
4-Premolar extraction.
5-First molar extraction.
6-lower incisor extraction.
7-Second molar extraction.

22. 11) Crowding
 SPACE MANAGEMENT:
Definition: utilization of Lee Way space to relieve
anterior crowding.
Indications
1. Class I molar relation ship
2. E,s are still present in the crowded side(s).
3. Mild crowding

23. 11) Crowding
 SPACE MANAGEMENT
Methods:
1. Space maintainer
2. extract Es
3. Slice the mesial surface of the deciduous canine and
molars before the eruption of permanent canine and
premolars.

24. 11) Crowding
 SERIAL EXTRACTION
 Definition: ”.. The early recognition or anticipation of a
deformity that will occur unless teeth are removed at a
strategic interval to relieve in intensity the developing
malocclusion.”
 Indications:
 The incisors are substantially crowded.(ALD greater than 10 mm)
 Age 8-9 years.
 Normal arch relation ship.
 Reduced or normal overbite.
 All permanent teeth are present.
 The first molars should have a good prognosis.
 The first premolars should be closer to eruption than canines.

25. 11) CROWDING
 SERIAL EXTRACTION
 Disadvantages:
 Increasing the overbite.
 Lingual tipping of lower incisors
Retarding future development in arches.
Lack of aesthetic fullness of the lips.
Rotated incisors do not align spontaneously.

26.  SERIAL EXTRACTION
 Methods:
1-When the lateral are erupting in a crowded position, all
deciduous canines are removed.
2-When the roots of the first deciduous molars are half
resorbed. They are removed.
3-As soon as the first premolars erupt they are removed.

27. As an interceptive orthodontic measure

28. FIRST MOLAR EXTRACTION
 Indications:
1. At least one permanent first molar have poor
prognosis.
2. Crowding in the relevant quadrant.
3. The development of second molar roots did not
reach more than half way.
4. No other missing teeth in the same quadrant.
5. Normal arch relation ship.
6. The overbite is not deep.
7. The second premolar is contained within the E
roots

29. FIRST MOLAR EXTRACTION
 Advantages:
 No need for future prosthesis
 Reduce incisor crowding
 Eliminate buccal segment crowding
 Less chance for third molar impaction.
 Disadvantages:
 The uncertainty of the final contact point between the
second molar and second premolar.

30. FIRST MOLAR EXTRACTION
 Compensatory extraction:
 Extraction of upper first molar does not
necessitate the compensatory extraction
of lower first molar
 Extraction of lower first molar
necessitates the compensatory extraction
of upper first molar

31. THANK YOU