Preventive and interceptive orthodontics (basic)

PREVENTIVE AND
INTERCEPTIVE
ORTHODONTICS
DR. MD. KAMAL ABDULLAH
BDS, MS
Assistant Professor
Islami Bank Medical College Dental Unit, Rajshahi

Preventive Orthodontics
Definition:
It is the action taken to preserve the integrity of what
appears to be the normal occlusion at a specific time
(Graber-1966).
Many of the procedures are common in preventive and
interceptive orthodontics but the timings are different.
Preventive procedures are undertaken in anticipation of
development of a problem.Whereas interceptive procedures
are taken when the problem has already manifested.

The following are some of the procedures
undertaken in preventive orthodontics:
1) Parent & patient education
2) Caries control
3) Care of deciduous dentition
4) Management of ankylosed tooth
5) Maintenance of quadrant wise tooth shedding time table
6) Checkup for oral habits and habit breaking appliance if
necessary
7) Occlusal equilibrium if there are any occlusal prematurity
8) Prevention of damage to occlusion.eg:-milwaukee braces

The following are some of the procedures
undertaken in preventive orthodontics: Cont...
9) Extraction of supernumerary teeth
10) Space maintenance
11) Management of deeply locked first permanent molar
12) Management of abnormal frenal attachments

1) Parent & patient education
 Expecting mother- Nutrition, ideal environment for
developing fetus, avoid certain drugs.
 Soon after birth- Proper nursing and care of child.
 If bottle fed- Use physiologic nipple and not conventional
nipple (do not permit suckling by movement of tongue and
lower jaw) leading to various orthodontic problems.
Physiologic NippleConventional Nipple Conventional vs Physiologic Nipple

1) Parent & patient education Cont…
 Do not use pacifiers for a long time.
 Prevention of nursing bottle syndrome: (Bottle feeding
during night-upper teeth caries. But no lower caries)
• Proper nutrition of the child & proper nursing care of the
infant.
• Correct method of brushing teeth
Pacifier Nursing bottle syndrome

2) Caries control
Caries in proximal surface of deciduous teeth if not restored
leads to loss of arch length by movement of adjacent teeth into
the space and thus cause discrepancies between arch length
and tooth material when larger permanent teeth erupt into the
oral cavity.
Fig: SS Crown to prevent further caries as well as prevention of
movement of adjacent teeth to maintain arch integrity

3) Care of deciduous dentition
• Prevention and timely restoration of carious teeth.
• All efforts to prevent early loss of deciduous teeth (they are
natural space maintainers)
• Simple preventive procedures like: Application of topical
fluorides, Pit & fissure sealants etc.
Topical fluorides Pit & fissure sealants

3) Care of deciduous dentition Cont…
• Supernumerary & supplemental teeth can interfere with
eruption of nearby normal teeth.They deflect adjacent teeth
and erupt in abnormal positions.They should be identified
and extracted before they cause displacement of other teeth.
Supernumerary teeth Supplemental teeth

4) Management of ankylosed tooth
Ankylosis is a condition characterized by absence of the
periodontal ligament in small area or whole of the root surface.
They do not resorb → prevent permanent teeth from erupting
→ deflect them to erupt in abnormal positions.
• They should be removed surgically at appropriate time to
allow emergence of the successor.
Fig: Ankylosis of teeth

5) Maintenance of quadrant wise tooth
shedding time table

5) Maintenance of quadrant wise tooth shedding time
table Cont…
After shedding of
deciduous teeth it should
not take more than 3
months for eruption of
permanent teeth.

6) Checkup for oral habits and habit
breaking appliance if necessary
Identify and stop habits such asThumb sucking , nail biting,
tongue thrusting and lip biting.
Prevention starts with proper
nursing nipple and pacifiers to
enhance normal functional and deglutition activity.

7) Occlusal equilibrium if there are any
occlusal prematurity
Cuspal interference should be removed by selective
grinding of the tooth. Abnormal anatomical features
like enamel pearl, may cause premature contact.
Problem:
• Deviation in the mandibular path of closure
• Predispose to bruxism
Dx:
Detected by using articulating paper and premature
contact removed by selective grinding is carried out.

8) Prevention of damage to occlusion.
Preventing MILWAUKEE Brace damage:
 Orthopedic appliance used for correction of
scoliosis.
• It applies tremendous force on the mandible and the
developing occlusion leading to retardation of
mandibular growth and possible deformities.
• whenever such appliance used, occlusion should be
protected using functional appliance or positioners.
made of soft materials.

9) Extraction of supernumerary teeth
• Supernumerary & supplemental teeth can interfere
with eruption of nearby normal teeth.
• They deflect adjacent teeth and erupt in abnormal
positions.
• They should be identified and extracted before they
cause displacement of other teeth.

10) Space maintenance
Premature loss of deciduous teeth can cause drifting of
the adjacent teeth into the space. Space maintainers
must be inserted in appropriate cases after the loss of
teeth, particularly after the loss of deciduous molars in
inadequate arches.
Space Maintainer: (Definition)
Space maintenance can be defined as the provision of
an appliance (active or passive) which is concerned
only with the control of space loss without taking into
consideration measures to supervise the development
of dentition.

10) Space maintenance Cont…
Ideal Prerequisites of a Space Maintainer
a) It should maintain the entire mesio-distal space created by a
lost tooth.
b) It must restore the function as far as possible & prevent over-
eruption of opposing teeth.
c) It should be simple in construction.
d) It should be strong enough to withstand the functional forces.
e) It should not exert excessive stress on adjoining teeth.
f) It must permit maintenance of oral hygiene.
g) It must not restrict normal growth & development and
natural adjustments which take place during the transition
from deciduous to permanent dentition.

10) Space maintenance Cont…
Fig: Different Type of Space Maintainer

11) Management of deeply locked first
permanent molar
Occasionally the deciduous second molar have a
prominent distal bulge which prevents the eruption of
the first permanent molars. Slicing these distal
surface helps in guiding the eruption of first
permanent molars.

12) Management of abnormal frenal
attachments
A.Thick and fleshy maxillary
labial frenum leads midline
diastema.
Diagnosis → Blanch test.
Treated by Frenectomy at an early stage for prevention.

12) Management of abnormal frenal attachments
Cont…
Ankyloglossia or tongue tie → Abnormal development
of Lingual frenum → Difficulty in speech and swallowing
Surgically treated.

Interceptive Orthodontics
Definition:
“Defined as that phase of the science and art of
orthodontics, employed to recognize and eliminate
potential irregularities and malpositions in the
developing dentofacial complex". (Graber & AAO)
Unlike preventive orthodontic procedures, interceptive
orthodontics is undertaken at a time when the
malocclusion has already developed or is developing.

Procedures undertaken in interceptive
orthodontics:
1) Serial extraction.
2) Correction of developing crossbite.
3) Control of abnormal habits.
4) Space regaining.
5) Muscle exercises .
6) Interception of skeletal malrelation.
7) Removal of soft tissue or bony barrier to enable
eruption of teeth.

1) Serial extraction.
Definition:
Planned and timely Removal od certain deciduous
teeth followed by certain permanent teeth to allow
normal alignment of permanent teeth.
History:
KJELLGREN –1929 → Coined the term
NANCE –1940 → popularized –“Planned & progressive
extraction”

1) Serial extraction. Cont…
Rationale:
Based on 2 basic principles:
A. Arch-length tooth material discrepancy-
Tooth material > Arch length
Hence, teeth extracted → So that rest of tooth
occlude normally.
B. Physiologic tooth movement-
Removal some teeth → let’s the rest of the teeth
(which are erupting) to be guided by natural forces
towards extraction spaces.

Serial extraction protocol:
A. Removal of the upper and lower deciduous canines allows
for an improvement in the alignment of the upper and lower
incisors.
B. The removal of the deciduous first molars encourages the
eruption of the first premolars.
C. The removal of the first premolars encourages the eruption
and posterior movement of the permanent canines.
D. The remaining teeth tend to tip toward the extraction sites.
The lower incisors often tip lingually as well.
E. After the lower second premolars near emergence, fixed
appliances are used to align the teeth and level the occlusal
plane.

Procedure:
Three popular methods are:
1. Dewel’s method: (CD4)
 3 step- C (8-9yrs); D (9-10yrs); Erupting 4’s
2. Tweed’s method: (D4C)
 D (8yrs); Erupting 4’s & C
3. Nance method: (D4C)
 Similar to tweed’s

Serial extraction protocol (CD4):
A. Removal of the upper and lower deciduous canines allows
for an improvement in the alignment of the upper and lower
incisors.
B. The removal of the deciduous first molars encourages the
eruption of the first premolars.
A B

C. The removal of the first premolars encourages the eruption
and posterior movement of the permanent canines.
D. The remaining teeth tend to tip toward the extraction sites.
The lower incisors often tip lingually as well.
C D

E. After the lower second premolars near emergence, fixed
appliances are used to align the teeth and level the occlusal
plane.
E

Factors to be considered in case selection are:
• Class I malocclusion with normal overbite & overjet
• Moderate crowding
• All Deciduous teeth should be present
• All successor teeth should be present and normal in size, shape,
position & inclination
• No caries untreated
• Where there is no doubt about the long term prognosis of the first
permanent molars.
• Doctor’s knowledge, confidence, timing and selection of methods
of serial extraction.
• Patient should be available for close supervision

Indication:
• Child with potential for moderate to severe crowding
• Arch length deficiency as compared to the tooth material
(8 mm or more of arch discrepancy)
• Where growth is not enough to overcome the discrepancy
between tooth material and basal bone.
• Patients with straight profile and pleasing appearance

Contraindications
• Class II & III malocclusion with skeletal abnormalities.
• Mild disproportion between arch length & tooth material.
• Spacing
• Anodontia / oligodontia.
• Open bite & deep bite.
• Midline diastema.
• Unerupted or malformed teeth. Eg. Dilacerations.
• Extensive caries

2) Correction of developing crossbite.
Definition:
Anterior cross bite is a condition characterized by reverse
overjet wherein 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.as an old maxim states
“The best time to treat a crossbite is the first time it is
seen” Or else it may grow into skeletal malocclusion

2) Correction of developing crossbite. Cont…
Classification:
1. Dento-alveolar
2. Skeletal
3. Functional Dento-alveolar
FunctionalSkeletal

Methods of correction of developing Ant. Crossbite:
TONGUE BLADE

Methods of correction of developing Ant. Crossbite:
Catlan’s
Appliance
Double Cantilever Spring

3) Control of abnormal Oral habits.
Definition:
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.
Deleterious oral habits should be recognized early
and patient should be helped to give up by
motivation or by fitting a suitable habit breaking
appliance.

3) Control of abnormal Oral habits. Cont…
Some common habits:
 Thumb / digit sucking
 Tongue thrusting
 Mouth breathing
 Lip sucking / biting

• Thumb / digit sucking prevention & interception

• Tongue thrusting and Preventing appliance:

• Mouth breathing correction: Intercepted by identifying and
removing the cause (Nasal polyps ,tumors, deviated septum).
If persists,Vestibular Screen / Oral Screen can be used.

• Lip sucking / biting Prevention:
Lip Bumper
OrthodonticTrainer

4) Space regaining.
Premature loss of deciduous teeth causes migration of the
adjacent teeth into the edentulous space and this cause
inadequate space for the eruption of the succedaneous
permanent teeth.
Space regainers in the form of removable appliances or fixed
appliances used to regain the space by moving the drifted
teeth back to their original position.

4) Space regaining. Cont…
Types Space Regainer:
A. Fixed appliances
i. Gerber space regainer (most commonly used)
ii. Open coil / herbst space regainer
iii. Jackscrew space regainer
B. Removable appliance
 Hawley’s appliance
a) With helical spring
b) Split acrylic dumb‐bell spring
c) With sling shot elastic
d) Palatal spring
e) Expansion screws

Preventive and interceptive orthodontics (basic)

Preventive and interceptive orthodontics (basic)

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