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INTERCEPTIVE ORTHODONTICS.pptx

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  1. 1. INTERCEPTIVE ORTHODONTICS DR.MUHAMMAD SHARIQ SOHAIL FCPS-II RESIDENT ORTHODONTICS DEPARTMENT PROF.DR.MUHAMMAD IMRAN RAHBAR
  2. 2. CONTENTS • Definition. • When to intervene? • Why to intervene? • Keys of ideal occlusion. • Space maintainence. • Space regainers. • Space supervision. • Serial extraction. • Correction of developing crossbites. • Interception of oral habits. • Interception of skeletal malocclusions. • Interception of eruption problems.
  3. 3. DEFINITION • “ Interceptive orthondontics is defined as the elimination of the existing interferences with key factors involved in the development of the dentition” (PROFFIT). • “ All the simple measures to eliminate to the developing malocclusion”.
  4. 4. WHEN TO INTERVENE? • The American Association of Orthodontics (AAO) recommends that all children should be seen by a specialist no latter than 7 years. • Screening for orthodontics problems seems to be suitable in children between the age 8-11 years.
  5. 5. WHY TO INTERVENE? • Eliminate future center-line, Antero-posterior, vertical or transverse discrepancy. • Space management in the developing dentition. • For decrease treatment time of comprehensive orthodontics phase. • Decrease risk of trauma. • Improve social and psychological well-being . • Recognition of dental pathology or related conditions at early age.
  6. 6. KEYS OF IDEAL OCCLUSION • Molar relation. • Crown angulation. • Crown inclination. • Rotations. • Spaces. • Occlusal plane.
  7. 7. MOLAR RELATION • MB cusp of upper molar occludes in the groove between MB and middle buccal cusp of lower molar.
  8. 8. CROWN ANGULATION • Mesio-distal tip. • The gingival part of the long axis of crown is distal to the occlusal part of axis. • Extent of angulation varies with tooth type.
  9. 9. CROWN INCLINATION • Bucco-lingual • Incisors - labially inclined • Upper posteriors - lingually inclined from canine to molars • Lower posteriors - the lingual tip increases progressively from the canines to the molar.
  10. 10. ROTATIONS • Absent. • Rotated molars and pre molars occupy more space. • Rotated incisors occupy less space. • Rotated canines adversely affects esthetics and lead • to occlusal interferences.
  11. 11. SPACES • If there is no anomaly in tooth shape and mesio-distal position, tight inter- proximal contacts should be present between the teeth
  12. 12. OCCLUSAL PLANE • Normal occlusion should have flat curve of spee, not more than 1.5mm.
  13. 13. SPACE MAINTENANCE
  14. 14. SPACE MAINTENANCE • Defined as premature tooth loss with adequate space available. Indicated : • When all un-erupted tooth are present and at normal stage of development. Unnecessary: • If permanent successor will erupt in 6 months ( i.e if more than one-half to two- third of its root is formed. Noar J. Review: Interceptive Orthodontics (2002). The European Journal of Orthodontics. 2020;24(6):705-705
  15. 15. TYPES OF SPACE MAINTENANCE • Band and loop space. • Partial denture. • Distal shoe. • Lingual arch. •Setia V, Pandit IK, Srivastava N, Gugnani N, Sekhon HK. Space maintainers in dentistry: past to present. J Clin Diagn Res. 2013;7(10):2402-5
  16. 16. BAND AND LOOP • Unilateral fixed appliance. • Indicated in pre-mature loss of “E” , band is given on either 6 or D. • Also indicated when permanent incisors have not erupted, and bilateral loss of primary molar has occurred. • It should be used to hold space for one tooth only. • Should be kept out of chewing forces.
  17. 17. PARTIAL DENTURE • Useful for bilateral space maintenance, when more than one tooth is lost per segment. • Posterior space maintenance in conjunction with replacement of missing primary incisor or delayed permanent incisor.
  18. 18. DISTAL SHOE • When primary molar is lost before eruption of permanent first molar. • It consists of metal or plastic guide plane along which molar erupts. • Guide plane must extend 1mm below the mesial marginal ridge of the permanent first molar
  19. 19. LINGUALARCH • When multiple posterior teeth are missing and permanent incisors have erupted. • Conventional lingual arch consists of band on primary molar or permanent first molar and contacting incisors, hence preventing anterior movement of posterior teeth and posterior movement of anterior teeth.
  20. 20. TRANSPALATALARCH •Setia V, Pandit IK, Srivastava N, Gugnani N, Sekhon HK. Space maintainers in dentistry: past to present. J Clin Diagn Res. 2013;7(10):2402- 5
  21. 21. SPACE REGAINING
  22. 22. SPACE REGAINING • Drift of permanent teeth after early extraction / loss of primary teeth. • Usually occurs during first 6 months after extraction. • Re-positioning the teeth, re gain the space and then give space maintanence to prevent further drift. • Up to 3mm of space can be reestablished.
  23. 23. MAXILLARY SPACE REGAINERS • Distal tipping and de-rotation of molars are satisfactory to regain 2 to 3mm. • Options available: 1. Removable appliance : retained with Adam’s clasps and incorporating fingerspring adjacent to tooth to be moved.
  24. 24.  2. Fixed appliance : coil spring on a segmental arch wire
  25. 25. MANDIBULAR SPACE REGAINERS • Moving teeth distally in mandible is generally quite challenging. • Options available: 1. For unilateral – fixed appliance. 2. For bilateral – lip bumper, lingual arch.
  26. 26. UNILATERAL SPACE REGAINERS • Coil spring on a segmental archwire. • For anchorage, we need to add lingual arch from permanent and primary molars and incisors.
  27. 27. BILATERAL SPACE REGAINERS  Lip bumper : • Indicated when space is lost and incisors have tipped lingually. • Labial appliance fitted to tubes on the molar teeth. • Removing the soft tissue interference of lip, incisors tend to move forward and molars move distally.
  28. 28. • Lingual arch: Active lingual arch pits posterior movement of both molars against anchorage offered by the incisors, significant forward movement of incisors is also expected
  29. 29. SPACE SUPERVISION
  30. 30. SPACE SUPERVISION • Space supervision is the term applied when it is doubtful, according to the mixed dentition analysis, whether there will be room for all the teeth Indicated: • ALD is -3mm to -5mm • Class I Molar relationship or Mesial step • Flush terminal or end to end molar • Skeletally class I • No open bite or deep bite should be present
  31. 31. STEPS OF SPACE SUPERVISION Noar J. Review: Interceptive Orthodontics (2002). The European Journal of Orthodontics. 2020;24(6):705-705
  32. 32. Space supervision and guidance of eruption in management of lower transitional crowding: A non-extraction approach Ronald A. Bell, DDS, MEd, and Andrew Sonis, DMD
  33. 33. SERIAL EXTRACTION
  34. 34. SERIAL EXTRACTION • SERIAL EXTRACTION is the planned extraction of certain deciduous teeth and specific permanent teeth in an orderly sequence and predetermined pattern to guide the erupting permanent teeth into a more favorable position. • It also allows the tooth to erupt over the alveolus and through keratinized tissue, rather than being displaced buccally or lingually.
  35. 35. INDICATIONS • Early mixed dentition. • No skeletal discrepancy. • Severe crowding (ALD of -10mm). • Straight profile. • Minimal overbite. • Flush terminal plane or Mesial step in deciduous dentition.
  36. 36. CONTRAINDICATIONS • Mild to moderate crowding. • Skeletal Class II or Class III discrepancy. • Deep bite or open bite. • Spaced dentition.
  37. 37. STEPS INVOLVED Hotz RP. Guidance of eruption versus serial extraction. Am J Orthod. 2018;58:1–20
  38. 38. CORRECTION OF DEVELOPING CROSSBITES
  39. 39. CORRECTION OF DEVELOPING CROSSBITES • Dentoalveolar anterior crossbites. • Posterior crossbites. • Functional crossbites.
  40. 40. DENTOALVEOLAR ANTERIOR CROSSBITES • When one or more maxillary teeth are lingual in relation to the mandibular anterior teeth. • Treated by using tongue blades, catalan’s appliance and double cantilever springs with posterior bite plate.
  41. 41. •Melink S, Vagner MV, Hocevar-Boltezar I, et al. Posterior crossbite in the deciduous dentition period: its relation with sucking habits, irregular orofacial functions, and otolaryngological findings. Am J Orthod Dentofacial Orthop. 2010;138:32–40
  42. 42. POSTERIOR CROSSBITE • Bilateral posterior crossbite with constricted maxillary arch. • Treated with the help of W-Arch, quad helix.
  43. 43. FUNCTIONAL CROSSBITE • Occurs as a result of occlusal prematurities that cause a deflection of the mandible into a forward position during closure. • Treated by eliminating the occlusal interferences.
  44. 44. INTERCEPTION OF ORAL HABITS
  45. 45. INTERCEPTION OF ORAL HABITS • Habits refer to certain actions involving the teeth and other perioral structures, which are often repeated enough by the patients to have profound and deleterious effects on the position of teeth and occlusion. • Habits commonly seen are: • Thumb sucking. • Tongue thrusting. • Mouth breathing.
  46. 46. INTERCEPTION OF SKELETAL MALOCCLUSION
  47. 47. INTERCEPTION OF SKELETAL MALOCCLUSION • Skeletal Class II Malocclusion: • Excessive maxillary growth. (Treated by headgear) • Deficient mandibular growth. ( Myofunctional appliance) • Combination.
  48. 48. • Skeletal Class III Malocclusion: • Deficient maxillary growth. (Facemask) • Excessive mandibular growth.(Chin cup) • Combination.
  49. 49. INTERCEPTION OF ERUPTION PROBLEMS
  50. 50. DELAYED ERUPTION OF UPPER PERMANENT INCISORS
  51. 51. RETAINED DECIDUOUS TEETH
  52. 52. ANKYLOSIS OF PRIMARY TOOTH • The tooth loses its vertical position relative to the adjacent teeth and assumes a position below the occlusal plane. • Most commonly ankylosed teeth: Primary second molars.
  53. 53. Noar J. Review: Interceptive Orthodontics (2002). The European Journal of Orthodontics. 2020;24(6):705-705
  54. 54. UNILATERAL RETAINED DECIDUOUS CANINE • Premature loss of one deciduous canine as a result of early resorption by a crowded lateral incisor.
  55. 55. ECTOPIC ERUPTION OF PERMANENT FIRST MOLARS • Ectopic eruption of the first permanent molar is a local eruption disturbance characterized by the abnormal eruptive pathway of molar causing the permanent tooth to be locked under the distal undercut of the second primary molar and failure to erupt into normal occlusal plane. •Sharma PS, Rypel TS. Ectopic eruption of permanent molars and their management. Quint Int. 2019;9:47–52
  56. 56. DIASTEMA • Space between the upper central incisors. • Causes: • Supernumerary teeth • High frenal attachment • ugly duckling stage. • Pathologies i.e, cyst, odontomes,etc. • Generalized spacing.
  57. 57. TRANSPOSITION • Transposition is a positional interchange of two adjacent teeth. • The teeth most likely to be transposed are: • Mandibular incisors and mandibular canine. • Maxillary canine and maxillary premolars. Peck S, Peck L. Classification of maxillary tooth transpositions. Am J Orthod Dent Orthop. 1995;107:505–517
  58. 58. REFERENCES • William R. Proffit. Textbook Contemporary Orthodontics. Sixth Edition. • Graber. Textbook of Orthodontics:Current principles and techniques. Vol 1 Sixth edition • Lentini-Oliveira DA, Carvalho FR, Rodrigues CG, et al. Orthodontic and orthopaedic treatment for anterior open bite in children. Cochrane Database Syst Rev. 2014;CD005515. • Peck S, Peck L. Classification of maxillary tooth transpositions. Am J Orthod Dent Orthop. 2019;107:505–517. • Hotz RP. Guidance of eruption versus serial extraction. Am J Orthod. 2018;58:1–20. • Setia V, Pandit IK, Srivastava N, Gugnani N, Sekhon HK. Space maintainers in dentistry: past to present. J Clin Diagn Res. 2013;7(10):2402-5
  59. 59. • Noar J. Review: Interceptive Orthodontics (2002). The European Journal of Orthodontics. 2020;24(6):705-705. • Rubin RL, Baccetti T, McNamara JA Jr. Mandibular second molar eruption difficulties related to the maintenance of arch perimeter in the mixed dentition. Am J Orthod Dentofacial Orthop. 2012;141:146–152 • Sharma PS, Rypel TS. Ectopic eruption of permanent molars and their management. Quint Int. 2019;9:47–52 • Melink S, Vagner MV, Hocevar-Boltezar I, et al. Posterior crossbite in the deciduous dentition period: its relation with sucking habits, irregular orofacial functions, and otolaryngological findings. Am J Orthod Dentofacial Orthop. 2010;138:32–40

Hinweis der Redaktion

  • MB cusp of upper molar occludes in the groove between MB and middle buccal cusp of lower molar
    DB cusp of upper molar contacts the MB cusp of lower second molar
  • The angulation of the crown is defined as the angle which tooth forms with a line drawn perpendicular to occlusal plane
  • If the upper teeth are too up-right, occlusion will be unstable, the canine guidance will be in-significant, risk that posterior teeth will drift mesial
  • Excessive curve of spee will prevent normal development of occlusion
  • Carfully contoured to abutment tooth without restricting lateral movement of primary canine
    Loop is contoured 1,5mm within alveolar ridge to bring it out of occlusal forces
    Soldr joints should fill the angle between band and wire to avoid food debris
  • Replace anterior teeth for aesthetics
    Maintain space posteriorly for pre mature loss of primary molars
    But it needs frequent adjustments of clasps and acrylic to prevent interference during eruption of permanent teeth
  • Instead of band, crown can be given also with a guide plane, this provides some occlusal function as well
    But after the eruption of molar, re placing this maintener would be a problem
  • It should rest on cingula
    1.5mm off soft tissue, stepped to lingual in canine region to remain away from primary molars and uneruppted pre molars, so tat their eruption is not interferd
  • TPA prevents mesial rotation of molar into the extraction space
    A lingual holding arch usually is the best choice to maintain space for premolars after premature loss of the primary molars when the permanent incisors have erupted.
    TPA nance, to prevent rotation and in such cases where there is deep bite, nance will correct deep bite
  • When ALD is -3 mm
  • Removable: ideal design for distally tipping one molar, post teeth can be moved up to 3mm during 3-4 months of full time wear
    Activation: 2mm will produce 1mm movement
  • Quite challenging in lower arch due to less support as we have palate in upper arch fir support
  • Soft tissue pressure is giving the force to distallize the molars
    Activation/ adjustments can be done by opening the loop

  • Expansion can also be ahieved with lingual arch by slightly opening the loops located mesial to banded molars
    It can also serve as a passive retainer

  • Distal surface of mand primary 2 molar is mesial to distal surface of max molar
  • Dewels method: CD4
    Tweeds method: D4c
    Nance method:
  • Serial extraction is used to relieve severe arch length discrepancies. (A) The initial diagnosis is made when a severe space deficiency is documented and there is marked incisor crowding. (B) The primary canines are extracted to provide space for alignment of the incisors. (C) The primary first molars are extracted when one-half to two-thirds of the first premolar root is formed, to speed eruption of the first premolars. (D) When the first premolars have erupted they are extracted and the canines erupt into the remaining extraction space. The residual space is closed by drifting and tipping of the posterior teeth unless full appliance therapy is implemented.
  • It must be correcte at an early stage in order to prevent the minor orthodontic problem from progressing into major dento facial anomaly.
  • Tongue blades
    Catalan’s appliance ( the bite plate covering the anteriors)
    Z spring with posterior bite plate
  • The W-arch appliance is ideal for bilateral maxillary expansion. (A) The appliance is fabricated from 36-mil wire and soldered to the bands. The lingual wire should contact the teeth involved in the crossbite and should not extend than 1 to 2 mm distal to the banded molars to eliminate soft tissue irritation. Activation at point 1 produces posterior expansion and activation at point 2 produces anterior expansion. (B) The lingual wire should remain 1 to 1.5 mm away from the marginal gingiva and the palatal tissue.
  • by the primary canines or (less frequently) primary molars. These patients can be diagnosed by carefully positioning the mandible in centric occlusion; then it can be seen that the width of the maxilla is adequate and that there would be no crossbite without the shift
    Minor canine interferences leading to a mandibular shift. (A) Initial contact; (B) shift into centric occlusion. The slight lingual position of the primary canines can lead to occlusal interferences and an apparent posterior crossbite. This sole cause of posterior crossbite is infrequent and is best treated by occlusal adjustment of the primary canines
  • Thumb sucking can lead to open bite. If it persists it can change the pattern of growth and cause malalignment of teeth.( reminder ( adhesive bandage covered over thumb,elastic bandage wrapped around the arm the preventthe arm to flex , appliance therapy)
    Mouth breathing: retrognathic mandible, open bite, high angle cases. Proclined of the anteriors.
  • Considered to be delayed if the contralateral tooth was fully erupted or if the teeth later in the eruption sequence is present.
    Removal of supernumerary teeth with or without exposure of tooth
    Treatment timing: as soon as supernumerary is detected.
  • Interception involves the extraction of deciduous teeth to allow the normal eruption of teeth
    Prevents crowding and malalignment
    A permanent tooth should replace its primary predecessor when approximately three-fourths of the root of the permanent tooth has formed, whether resorption of the primary roots is or is not to the point of spontaneous exfoliation.
    primary tooth that is retained beyond this point should be removed.
  • Appropriate management of an ankylosed primary molar consists of maintaining it until an interference with eruption or drift of other teeth begins to occur (Fig. 11.46), then extracting it and placing a lingual arch or other appropriate fixed appliance if needed.
  • If they have no successors, ankylosed primary teeth can be carefully removed when vertical discrepancies begin to develop. It is better to allow permanent teeth to drift into the edentulous space and bring bone with them, and then reposition the teeth before implant or prosthetic replacement, so that large periodontal defects such as those adjacent to the primary molars in this patient do not develop. Another approach is to decoronate the primary molar
  • Extraction of the primary canine on the contralateral side to preserve the midline.
  • Ectopic eruption of the permanent first molar is usually diagnosed from routine bitewing radiographs. If the resorption is limited, immediate treatment is not required. (A) The distal root of the primary maxillary second molar shows minor resorption from ectopic eruption. (B) This radiograph taken approximately 18 months later illustrates that the permanent molar was able to erupt without treatment .
  • Moderately advanced resorption from ectopic eruption of the permanent maxillary first molar requires active intervention. (A) This distal root of the primary maxillary second molar shows enough resorption that self-correction is highly unlikely. (B) A 22-mil dead soft brass wire is guided under the contact (starting from either the facial or lingual surface and proceeding with the most advantageous approach) and then looped around the contact between the teeth and tightened at approximately 2-week intervals; (C) the permanent tooth is dislodged distally and erupts past the primary tooth that is retained.

    An Arkansas spring (Arkansas Dental Products Co, West Plains, MO), a scissors-like spring that extends below the contact point, can be effective in tipping a permanent first molar distally so that it can erupt. The posterior bow is crimped to bring the subgingival legs together and apply pressure to separate the teeth
  • Ugly duckling stage: before eruption of canine. The crown of canine impinge on the lateral incisors root causing the roots to move medially and lateral flaring of crowns.
    A small diastema (2 mm or less) can be closed in the early mixed dentition by tipping the central incisors together .
    Diastema greater than 2 mm iss due to pathology, supernumerary teeth. Extraction of supernumerary teeth, frenectomies, etc required.
  • (A) Closure of a midline diastema can be accomplished with a removable appliance and fingersprings to tip the teeth mesially. (B) The 28-mil helical fingersprings are activated to tip the incisors together. (C) The final position can be maintained with the same appliance.
  • Interception: extract the transposed teeth, align before canine erupts, accept the transposition.

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