This document discusses preventive orthodontics procedures including caries control, care of deciduous dentition, eliminating occlusal interference, education of patients, and space maintenance. It emphasizes the importance of prevention and early intervention to preserve the dental arch and proper eruption of permanent teeth. Space maintenance is especially important after premature loss of primary teeth to prevent drifting and maintain the dental arch width and shape until permanent teeth erupt. Removable and fixed space maintainers are commonly used depending on factors like patient cooperation and eruption status of permanent teeth.

1. 2O20-21

2. PREVENTIVE ORTHODONTICS
Prevention is not only better than cure but more
stable and cheaper as well
GRABER(1996) – has defined preventive orthodontics as the
action taken to preserve the integrity of what appears to
be normal occlusion at the same time

3. PREVENTIVE ORTHODONTICS PROCEDURE
1. CARIES CONTROL
2. CARE OF DECIDUOUS DENTITION
3. ELIMINATING OCCLUSAL INTERFACE
4. EDUCATION OF THE PATIENT
5. MAINTENANCE OF TOOTH SHEDDING TIME TABLE
6. MANAGEMENT OF ANKYLOSED TEETH
7. MANAGEMENT OF ABNORMAL FRENAL ATTACHMENTS
8. ORAL HABITS CHECK UP
9. PREVENTIVE MILKWAUKEE BRACE DAMAGE
10. DEEPLY LOCKED PERMANENT FIRST MOLARs
11. SPACE MAINTENANCE

4. EDUCATION OF THE PATIENT
• It should be ideally begin much before the birth of the
child
• The expecting mother should be educated on matter such
as nutrition , ideal environment
• Soon after birth – Proper nursing and care for the child
• The conventional nipples are not physiologic and donot
permit suckling by movement of the tongue and lower jaw
• The physiological nipple designed to permit suckling

5. • The mother is also advised against prolonged use of
pacifiers
• Prevention of nursing bottle syndrome
• Parents should be educated about maintaining oral
hygiene
• Correct method of brushing technique

6. CARIES CONTROL
• Caries involving the proximal surface of deciduous teeth
if not restored leads to loss of arch length by movement
of adjacent tooth into space
• Bitewing radiograph are valuable aid
• Once caries is detected ,proper restoration of the affected
teeth should be under taken immediately

7. CARE OF DECIDUOUS DENTITION
• Prevention and timely restoration of carious teeth
• The deciduous teeth are natural space maintainer , all
efforts should be taken to prevent any loss of deciduous
teeth
• Simple preventive measures; Application of topical
fluoride and Pit and fissure sealants

8. SUPERNUMERARY TEETH
• Presence of supernumerary teeth can interfere with the
eruption of near by normal teeth
• It should be removed to allow the teeth to erupt normally
• The supernumerary teeth should be identified and
extracted before they cause any crowding or spacing or
displacement of other teeth

9. ELIMINATING OCCLUSAL INTERFERENCE
• All functional prematurities should be detected and
eliminated as they can lead to deviation in the mandibular
path of closure and predispose to bruxism
• Premature contact area is detected , selective grinding is
carried out eg; Enamel pearls, large cingulum on
maxillary central incisor

10. MAINTENANCE 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 caused by presence of supernumerary
teeth improve once the cause is removed

11. MANAGEMENT OF ANKYLOSED TEETH
• It is condition characterized by absence of periodontal
ligament in a small area or whole cementum
• More common in deciduous molars
• Ankylosed deciduoud teeth do not get resorbed and
therefore either prevent the permanent teeth to erupt or
deflect them
• The ankylosed teeth must be diagnosed and surgically
removed at appropriate time

12. MANAGEMENT OF ABNORMAL FRENAL
ATTACHMENTS
• The presence of thick and fleshy maxillary labial frenum
that is present relatively low
• It prevent maxillary central incisor from approximating
each other producing midline diastema
• Blanch test help in diagnosing
• Notching of interdental bone in a periapical radiograph
confirms the test
• Ankyloglossia, results from lingual frenum extending
beyond than toward tip of tongue
• This limits forward and upward mobility of tongue
• It leads to breast feeding problems

13. • Abnormalities in speech and swallowing
• The condition should be surgically treated.

14. ORAL HABITS CHECKUP
• Habits such as finger and thumb sucking , nail biting and
thursting should be identified and stopped at an early age
• Prevention starts with proper nursing and use of
physiological designed nursing nipples and pacifiers

15. PREVENTING MILKWAUKEE BRACE DAMAGE
• Milkwaukee is an orthodontic appliance used for the
correction of scoliosis
• This appliance exerts tremendous force on the mandible
and developing occlusion
• It leads to mandibular growth
• In such case, occlusion should be protected using
functional appliances

16. MILWAUKEE BRACE

17. DEEPLY LOCKED PERMANENT FIRST MOLARS
• Ocassionally, the deciduous second molar have
prominent distal bulge
• It prevent eruption of permanent first molars
• Slicing these distal surface helps in guiding the eruption
of first permanent molars

18. SPACE MAINTENANCE
• Premature loss of deciduous teeth cause drifting of
adjacent teeth. This cause abnormal axial inclination of
teeth , spacing , and shift in midline
• Premature loss of permanent first molars – shift of
anteriors takes place

19. IDEAL REQUIREMENTS OF SPACE MAINTAINERS
• Maintain entire mesiodistal space created by the loss of
teeth
• Prevent over eruption of opposing teeth
• Simple in construction
• Strong enough to withstand functional force
• Must not restrict normal growth and developments and
normal adjustments which take place during transition
from deciduous to permanent dentition

20. CLASSIFICATION OF SPACE MAINTAINERS
 According to Hitchock
1. Removable or fixed or semifixed
2. With bands or without bands
3. Active or passive
4. Combination of the above
 According to Raymond C. Thurow
1. Removable
2. Complete arch lingual length
3. Individual tooth

21.  According to Hinrichsen
1) Fixed space maintainer
CLASS I
a) Non functional type
Bar type
Loop type
b) Functional type
Pontic type
Lingual arch type
CLASS II – Cantilever type
2) Removable space maintainer
Acrylic partial denture

22. REMOVABLE SPACE MAINTAINER
• Removed and reinserted by patient
• It can be functional or non functional
Functional – teeth provided to aid in mastication,
speech and esthetics
Non functional- only an acrylic extension
INDICATIONS –
• When esthetics is of importance
• Cleft palate patients
• If permanent teeth is not fully erupted
• Multiple loss of deciduous teeth requiring functional type

23. CONTRADICTIONS –
• Allergy to acrylic
• Lack of patient co operation
Some Commonly used Removable Space Maintainer-
Acrylic partial dentures
Full or complete dentures
Removable distal shoe maintainer

24. REMOVABLE SPACE MAINTAINER

25. FIXED SPACE MAINTAINER
They are fixed or fitted into teeth
Advantage –
• Bands and crown are used So, minimum or no tooth
preparation
• Jaw growth is not hampered
• Don not interfere with passive eruption of abutment teeth
• Masticatory function id restored
Disadvantage –
• Elaborate instrumentation
• May result in decalcification of tooth under bands

26. Examples of Fixed Space Maintainer –
Band & Loop Space Maintainer
• The tooth distal to the extraction space is banded & loop
of thick stainless steel are soldered to it
• Band & Loop space maintainer are one of the most
common space controlling appliances use

28. Crown and Loop Space Maintainer -
• Similar to band and loop space maintainer except that
stainless steel crown is used for the abutment
• It is used when abutment tooth is highly carious , exhibits
marked hypoplasia or is pulpotomized

30. Lingual arch space maintainer-
• Two band on the 2 mandibular first molar / second
deciduous molar which are joined by stainless steel were
contacting the lingual surface of 4 mandibular incisor
• Helps in maintaining arch parameter

32. Palatal Arch Appliance -
• They are similar to lingual arch
• They are designed to prevent mesial migration of
maxillary molars
• They are constructed using 0.036 inch diameter stainless
steel wire

34. Trans palatal arch-
• It is recommended for stabilizing maxillary permanent
molars when primary molar require extraction
• The transpalatal arch consists of stainless steel wire that
spans the palatal connecting the first permanent molar
one side with another

36. Distal shoe space maintainer-
• When the primary tooth is removed prior to eruption of
permanent first molar, the intra alveolar appliance guides
greater control of the path of eruption of the unerupted
tooth and provide undesirable migration
• Intraalevolar appliance

38. Esthetic Anterior Space Maintainer
• It consists of plastic tooth fixed into lingual arch that in
turn is attached to molar bond

39. Band & Bar type Space Maintainer
• This is fixed space maintainer in which abutment teeth on
either side of extraction space are connected and
bonded to each other

40. Performed bonded space maintainer
• This is direct bonded space maintainer that consist of
two bondable mesh pad that are bonded to each teeth in
either side of lost tooth

41. PLANNING FOR SPACE MAINTENANCE
• Time elapsed since loss of tooth
• Dental age of the patient
• Thickness of bone covering the unerupted teeth
• Sequence of eruption of teeth
• Congenital absence of permanent teeth