INTERCEPTIVE ORTHODONTICSDefinitions: Any procedure that eliminates or reduces the

severity of malocclusion in the developing dentition.(Popovich and Thompson 1979, Hiles 1985.)

All simple measures that eliminate the developing

mal occlusion. (Ackerman and Proffit 1980)

INTERCEPTIVE ORTHODONTICS

Unlike preventive orthodontic procedures, interceptive orthodontics is undertaken at a time when the malocclusion has already developed or is developing.

Thus interceptive orthodontics basically refers to measures undertaken to prevent a potential malocclusion from progressing into a more severe one.

Some of the procedures carried out in preventive

orthodontics can also be carried out in interceptive orthodontics but the timings are different.

Procedures undertaken in interceptive orthodontics

Serial extraction.Correction of developing crossbite.Control of abnormal habits.Space regaining.Interception of skeletal malrelationship.Removal of soft tissue or bony barrier to enable eruption of

teeth. Etc etc

SERIAL EXTRACTION:Planned extraction of certain deciduous teeth and later

specific permanent teeth in an orderly sequence and pre-determined pattern to guide the erupting permanent teeth into a more favourable position…….when one can recognize and anticipate potential irregularities in the dento-facial complex.

History:-Kjellgren 1929 first used the term “serial extraction”….Nance(USA) 1940’s popularized the technique

Indications:

Class I malocclusions showing harmony between skeletal and muscular systems

Arch length deficiency.Where growth is not enough to overcome the discrepancy

between tooth material and basal bone.

Contraindications:Class II & III malocclusion with skeletal abnormalitiesSpaced dentitionAnodontia/OligodontiaOpen bite and deep biteMidline diastemaClass I malocclusion with minimal space deficiencyUnerupted malformed teeth. E.g.dilacerationExtensive caries or heavily filled first permanent

molarsMild disproportion between arch length and tooth

material that can be treated by proximal stripping.

INTERCEPTIVE ORTHODONTICSSERIAL EXTRACTION………Disadvantages:1- Increasing the overbite.2- Lingual tipping of lower incisors3-Retarding future development in arches.4-Lack of aesthetic fullness of the lips.5-Rotated incisors do not align spontaneously.

INTERCEPTIVE ORTHODONTICSSERIAL EXTRACTIONMethod: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.

DEVELOPING ANTERIOR CROSSBITE:

Anterior cross bite is a condition characterized by reverse overjet where one or more maxillary anterior teeth are in lingual relation to the mandibular teeth.

Should be intercepted and treated at an early stage to prevent a minor orthodontic problem from progressing into a major dento-facial anomaly.

“The best time to treat a crossbite is the first time it is seen” Or else it may grow into skeletal malocclusion

INTERCEPTIVE ORTHODONTIC TREATMENT

Anterior Crossbite

INTERCEPTION OF HABITS:

Habit’s refers to certain actions involving the teeth and other oral or perioral structures which are repeated often enough by some patients to have a profound and deleterious effect on the positions of teeth and occlusion.

Some such habits are:Thumb suckingTongue thrustingMouth breathing

Thumb sucking: Most frequently practiced by children. Causes damaging effect on dento-alveolar structures. It’s presence upto2-1/2 to 3 years age is considered normal. Persistence beyond 3-1/2 to 4 years have damaging effect.& should be intercepted Intercepted by use of HABIT BREAKERS that could be removable or fixed. Tongue thrusting: Condition in which tongue makes contact with any teeth anterior to the molars

during swallowing. Deleterious habit , can clinically present along with open bite and anterior

proclination. Intercepted using HABIT BREAKERS

Mouth breathing: Obstructive-nasal polyps ,tumors ,inflammations ,deviated septum Habitual –persistence of habit after removal of the obstruction. It affects the orofacial equilibrium due to lowered mandible & tongue posture.

And hence cause malocclusion. Intercepted by identifying and removing the cause.If persists , VESTIBULAR

SCREEN can be used.

Habit Breakers

SPACE REGAINING:

Early loss of primary molar and failure to use space maintainers may lead to reduction in arch length by mesial movement of 1st molars.

Space regained by distal movement of first molar. Which is undertaken at an early age prior to eruption of second molar.

INTERCEPTION OF SKELETAL MALRELATIONS:

Interception of class II malocclusions: Causes: Excess maxillary growth. (Restricted by facebow with headgear) Defficient mandibular growth. (Myofunctional appliances) Combination of both.

Interception of class III malocclusions: Causes: Mandibular prognathism.(Chin cap with head gear) Maxillary retrognathism ( Face mask therapy ) Combination of both

Chin cap,Face mask

REMOVAL OF SOFT TISSUE & BONY BARRIERS: Failure of teeth to erupt in appropriate time should be

intercepted by surgically exposing the crown.

Over retained primary teeth,ankylosed primary teeth & supernumerary teeth are possible causesof non-eruption of succedaneous teeth . The soft tissue and any bone overlying it are

INTERCEPTIVE ORTHODONTICSLocal factors: DELAYED ERUPTION OF UPPER PERMANENT CENTRAL INCISOR.Definition: 1 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.

INTERCEPTIVE ORTHODONTICSLocal factors:RETAINED DECIDUOUS TEETH.

Interceptive treatment: extraction.

INTERCEPTIVE ORTHODONTICSLocal factors: INFRAOCCLUSIONDefinition: 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 infraoccluded tooth is likely to disappear .

INTERCEPTIVE ORTHODONTICSLocal factors: UNILATERAL RETAINED DECIDUOUS 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.

INTERCEPTIVE ORTHODONTICSLocal factors: DOUBLE TEETHDefinitions: Gemination: the attempt of a single tooth bud to form

two distinct morphological entities. Fusion: the result of joining two adjacent tooth buds.

INTERCEPTIVE ORTHODONTICSLocal factors: ECTOPIC ERUPTION OF THE

PERMANENT FIRST MOLAR.Definition: the molar erupts at an angle mesial to its

normal path of eruption.Types : reversible and irreversible Treatment: extraction of E or distalisation of

permanent molar

INTERCEPTIVE ORTHODONTICSLocal factors: HypodontiaDefinition: Absent teeth.Common teeth: lower 2nd premolar & upper lateral

incisor.Treatment: space closure or space maintenance for

future prosthesis.

INTERCEPTIVE ORTHODONTICSLocal factors:DIASTEMADefinition: space between the two upper central

incisors.

Treatment if indicated: removal of pathology (supernumerary, frenum?….)

INTERCEPTIVE ORTHODONTICSLocal factors: ECTOPIC UPPER CANINEDefinition: 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.

INTERCEPTIVE ORTHODONTICSLocal factors: TRANSPOSITIONDefinition: 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

-accept the transpositionTreatment timing: before eruption of canine.

INTERCEPTIVE ORTHODONTICSCrowding:Treatment:1-Space management.2-Molar distalisation.3-Serial extraction.4-Extractions

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