Interceptive Orthodontics

Professor Dr. Sun Sun Win Professor & Head Childrens Dentistry & Orthodontics Department University of Dental Medicine,Yangon

Interceptive Orthodontics
Certain malocclusion need correction at an earlier stage

in order to facilitate normal development of the

occlusion or to reduce the severity of malocclusion.

This kind of early intervention is called interceptive

orthodontics.
( Not all malocclusions can be prevented )

Common malocclusions which need early intervention are 1. Early loss of primary teeth. 2. Retained primary teeth.

3. Anterior cross-bite (with displacement).

4. Posterior cross-bite with displacement

5. Median Diastema
6. Harmful Para-functional habits 7. Supernumerary teeth

1. Early loss of primary teeth.

Unilateral loss centreline shift.

- Delayed eruption of permanent tooth. - Centre line shift. - Localised crowding.

- Including loss of space due to inter - proximal caries

Management
To prevent early loss of primary teeth. Use of fissure sealants. Restore carious teeth. Dietary advice.

Use of fluoride

2. Retained Primary teeth - cross-bite - median diastema - displacement of the permanent teeth.

- rotation
Treatment remove the retained primary teeth.

3. Anterior Crossbite One or more upper incisors occlude lingual to the corresponding lower incisors.

Causes

Class III skeletal pattern

Crowding Retained primary teeth Presence of supernumerary teeth. Trauma.

Management
- Remove etiological factors. - Differentiate skeletal problems from others. (a) Tongue blade correction. (b) Lower inclined bite plane.

(c) Removable appliance with either cantilever spring or

screw.

(a) Tongue blade correction.

- tongue blade correction. ( e.g.: anterior cross-bite
1

- maxillary incisor is still erupting, with no major overtbite

and adequate space for
1

The patient is instructed to insert the tongue blade at an angle between the teeth and bite firmly, maintaining the pressure for 5 sec, then interrupt and repeat for 25 times.

 3 times a day.
if the tongue blade exercise is not successful after 2 wks (or) if tooth eruption is too advanced, a bite

plane is more satisfactory.

(b). Lower inclined bite plane.

have sufficient inclination to produce a definite forward sliding motion of the maxillary incisor on closure. should not impinge on soft tissue of the mandibular teeth.

- the appliance is cemented with a temporary cement. - the posterior teeth will be slightly out of occlusion.

- is used for no longer than two weeks.

(C) Removable appliance with either cantilever

spring or screw
single tooth single or double cantilever spring.

of more teeth are in cross bite crossed

cantilever or a screw.

 E.g. : instructions to the technician on appliance construction. Appliance design for a case with incisor cross-bite on a child in a mixed dentition. Adams clasps on
6 6

D D

or

E E

Double cantilever spring ( Z spring) on 1 Posterior bite plane half molar capping with adequate thickness.

4. Posterior crossbite with displacement

- A unilateral posterior crossbite with displacement is

easily corrected during the mixed dentition,

- But one without an associated displacement is

probably skeletal in origin and correction should not be attempted.

Possible causes Narrow maxilla Deviated path of eruption of maxillary first permanent molar. Clinical features Cross-bite involving one or more posterior teeth Lateral displacement of the mandible.

Design of the appliance

- Adams Clasps on 6D / D6 - Mid line expansion screw - Half molar capping sufficiently thick to relieve occlusal interference.

5. Median Diastema Median Diastema spacing between Common Causes a. Physiological diastema b. Retained primary teeth c. Supernumerary teeth
1 1

d. Missing Lateral incisor

e. Fibrous frenum

f. microdontia

2 2

(a).

Physiological diastema

The diastema which develops between two permanent central incisor is transient abnormality.

Permanent incisors erupt into a more forward and

proclined position than their predecessors.

- Normally this space closes spontaneously as the lateral incisors erupt, but may persist even after the lateral

incisors have erupted, particularly if the primary canines

have been lost and upper incisor become flared to the labial. ( ugly duckling stage of development ). - No need of early correction and close spontaneously

(b). Retained primary teeth Remove the primary tooth and observe spontaneous space closure. If the space is not closing, close the diastema using an appliance. (c). Supernumerary teeth Management of Supernumerary teeth

(d). Missing Lateral incisor

Space closure between

1 1

Replacement (prosthesis) for missing lateral incisor.

(e). Fibrous frenum Due to high frenum attachment ( Presence of fibrous frenum extending from the incisive papilla to the inner surface of the upper lip

(X-ray inverted V shaped notch between central incisor

where the fibrous tissue of the frenum is attached. Frenectomy after eruption of closure,
3 3

and space

(f). Microdontia

Peg shaped lateral incisor 2 2

Space closure, crown build-up of 2 2 up to

normal form and size.

Choice of the appliance

Choice of the appliance depend on the width of the diastema and the inclination of the incisor teeth. If the space is less than 2 mm or teeth are distally inclined simple tipping movement with a removable appliance can move the teeth into a normal alignment.

6. Harmful Parafunctional habits

(a). Thumb sucking

(b). Finger sucking

(c). Nail biting (d). Dummy sucking (e) Lip sucking (f). Prolonged bottle feeding (g). Tongue thrust and mouth breathing habits

- The presence of an oral habit in the 3 to 6 year old child is an important finding during clinical

examination.
- 6 year - is not usually present

> 6 year effect on eruption of permanent teeth

and occlusion. Thus should be eliminated before the permanent incisors erupt.

Thumb and Finger Habits

-Highly specified cause and effect relationship. -Types of dental changes vary with intensity, duration and frequency of the habit as well as the manner in which position of the digit in the mouth. - 4 to 6 hrs of force per day are probably the minimum necessary to cause the movement.

-A child who sucks continuously ( > 6 hrs ) can

cause significant dental changes.

Features of malocclusion
1. proclination of upper incisor

2.retroclination of lower incisor

3.retardation of eruption of upper and lower teeth

4.asymmetric anterior open bite depending on the

side where the finger is held

5. adaptive tongue thrust

6. maxillary constriction posterior cross bite.

Management
-Persuade the child to stop the habit -Identify the child who is willing to stop the habit but unable to do so at night -Fit habit breaking appliance

-Correct adaptive tongue thrust using a tongue guard.

Dummy sucking ( Pacifier Habits )

-similar to changes created by thumb habits

-but ended before 5 years of age

-easy to stop this habits -then start sucking a digit -elimination of the subsequent finger habit may become necessary

Lip Habits ( Lip sucking )

-most lip habits do not cause

dental problems
-can maintain an existing malocclusion

-result is
a proclination of the maxillary incisors

a retroclination of the mandibular incisors

an increased overjet

 Nail Biting
-no evidence it can cause malocclusion or dental change -other than minor enamel fracture

-some reported incisor rotation

Tongue Thrust and Mouth Breathing Habits

-tongue thrust is characteristic of the infantile swallowing -no simple cause and effect relationship

-may be able to sustain and open bite but not create one
( Proffit and Mason, 1975 ) -should be considered a finding and not a problem to be treated

Mouth Breathers
-because of mandibular posture or incompetent lips or a suspected nasal airway obstruction -a weak relationship between mouth breathing and malocclusion characterized by a long lower face and maxillary constriction

End