interceptive ortho

8/11/2019 interceptive ortho

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Interceptive Corrective

Preventive


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Interceptive

orthodontics


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Definitions

Steps in interceptive orthodontics Serial extraction

Muscle exercises

Removal of soft / hard tissue barriers

Management of ectopic eruption

Management of missing permanent teeth

Resolution of crowding

CONTENTS


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CONTENTS

Correction of midline diastema

Correction of developing crossbite

Functional appliancesOrthopedic appliances

Maxillary intrusive splint

Pre orthodontic trainer

Bent wire systemInvisalign

Conclusion

References.


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DEFINITION - AAO (1969)

That phase of the science & art of orthodont

employed to recognize & eliminate potential

irregularities & malpositions in the developin

dentofacial complex.


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Interceptive orthodontics basically refers measures undertaken to prevent a potent

malocclusion from progressing into a more seveOne.

Is undertaken at a time when the malocclusion h

already developed or still developing.

Procedures, are aimed at elimination of facto

that may lead to malocclusion.


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Serial extraction

Dev. Cross bite

Abnormal habits

Space regaining

Muscle exercises

Removal of ba

eruption

Interception of

skeletal

malrelation


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SERIAL EXTRACTION

Historical review-

Kjellgren (1929) : Serial extraction

Hotz (1970) : Guidance of eruption

Palsson & Bunon: (1743) first ref to the extractio

of deci teeth (Publication- Diseases of Teeth)

Nance (1940) : popularized the technique

Father of serial extraction


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SERIAL EXTRACTION

DEFINITION:

Dewel (1967) : orderly removal of selected prima

& permanent teeth in predetermined sequence

-Tweed :planned & sequential removal of prima

& permanent teeth to intercept & reduce dentalcrowding problems


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I: On the basis of hereditary determined toothsize arch length discrepancy:

Midline line shift of

mandibular Incisorpremature exfoliation

of pri C

INDICATIONS


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2. Gingival recession on a

labially displaced

incisor.

3. Crowded maxillary or

mandibular teeth thatare excessively

inclined labially.


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4. Labially but unerupted

permanent canine that are

extremely prominent.

5. Splayed out perm Max /

Mandi Incisor due to crowded

position of unerupted canines


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6. Unusual shape, size and no of teeth.

7. Ectopic eruption of maxillary 1st molar

8. Premature loss of primary canine

9. Abnormal / pathological root resorption of primary canine.

10. Crowded anteriors


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1. Unusual resorptionpattern of certain

primary teeth.

2. Aberrant eruption

pattern of perm teeth

II : Indications due to loss of

arch length :


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3. Prolonged

retention of

primary teeth /

ankylosis

4. Transposition


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5. Rotation of teeth

6. Suppression of primaryteeth


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CONTRAINDICATIONS

1. Skeletal Class II and Class III malformation.

2. Spaced dentitions

3. Anodontia / oligodontia

4. Open bite & deep bite

5. Midline diastema

6. Class I malocclusions with minimal space def.

7. Unerupted malformed teeth Eg: dilacerations

8. Mild disproportions b /w arch length & tooth materia

that can be treated by proximal stripping.


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DIAGNOSTIC RECORDS

Intra oral radiographs:

Panoramic radiograph

Cephalometric radiographs:

Facial Photographs:

Study models

Model analysis


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IOPA radiographs:

Detection of congenital absences of teeth.

Detection of supernumerary teeth

Calculations of total space analysis.

Determine the root resorption before & after treatment.

Determine size, shape, relative position of perm teeth.

Detection of pathologic conditions in the early stages

Eruptive patterns of the unerupted teeth


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Cephalometric radiographs:

Evaluation of craniofacial relationship before treatment

Assessment of soft tissue matrix.

Classification of facial patterns.

Calculation of toothsize / jaw- size discrepancies.

Prediction of growth & development

Detection pathologic conditions before, during and after treat

Determination of mandibular rest positions

Facial photographs


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Facial photographs

Evaluation of craniofacial (&dental) relationships& proportiobefore treatment.

Assessment of soft tissue profile.

Proportional facial analysis & Total space analysis

Monitoring treatment progress.

Study relationships before, immediately following & several

treatment.

Detecting & recording facial asymmetry.

Identifying patients

Intra oral photographs


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1. Total space analysis.

2. Dental anatomy.

3. The intercuspation.

4. Arch form.

5. Curves of occlusion

6. Measure progress during

treatment

7. Evaluate occlusion

ABO specificationsStudy models:

S l i


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Space analysis:

Conventional method Space required-four mandibular incisors were measured at MD

diameter by means of boley gauge. The values for unerupted canine and premolars were obtained

measuring their MD on the image on the periapical radiograph.

To reduce the radiographic enlargement the formula recommenby Huckaba is.

(y)(x')

X= y

X-is the estimated size of the permanent tooth.

X the radiographic size of the permanent teeth.

Y-is the size of the primary second molar on the cast.

Y-is the radiographic size of the primary molar.


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Space requiredMD width of mandibular incisors othe cast and canine and premolar on the radiograpwere added.

Space available-obtained by extending brass wirefrom the mesiobuccal of the first permanent molaron one side to mesiobuccal of the molar on theopposite side.

The difference in the value obtained for spacerequired and space available was the amount of thdiscrepancy.


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ADVANTAGES OF SERIAL

EXTRACTION

Removal of deciduous canines.

Extraction of deciduous 1stmolar.

Extraction of first premolar before crowding allows

It lessens the period of future appliance therapy an

cost of treatment.

ADVERSE EFFECTS


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S C S

First (Dewel-1967), tendency of developing

anterior deep bite following loss of posterior teeth.

Second side effect is failure of premolars to reach their normalocclusal level.

Third : Effect of Serial Extraction has on facial esthetics.

The over emphasis on straight profile..

Lip fullness is not a reliable criterion

The straight profile must be viewed with greater concern

because early removal of premolars


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Fourth : Nasal development is another unpredictable ha

Unrestrained extraction will accentuate nose promineby reducing skeletal development in dental area.

Moreover growth of chin is unpredictable. If growth in

and chin exceeds normal range a concave profile is

obtained.

M & d


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Most common & accepted

sequences:-

1. Tweeds method

2. Dewelsmethd

3. Nances method

4. Grewesmethod

D l M th d 1978 (CD4)


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Dewels Method: 1978 (CD4)

There are 3 stages in Serial Extraction Therapy:

Removal of deciduous canines:

Removal of first deciduous molars:

Removal of erupting premolars:


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REMOVAL OF DECIDUOUS

CANINES Extraction 8-9 yrs.

R l f i 1st l


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Removal of primary 1stmolar

REMOVAL OF ERUPTING


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REMOVAL OF ERUPTING

PREMOLARS

TWEEDS SEQUENCE OF


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TWEEDS SEQUENCE OF

EXTRACTION (1966)

Sequence is :DC4 At approx 8 years all deci 1st molars are extracted.

Deciduous canines maintained to retard eruption of

permanent canines.

1st premolarin advanced eruptive stage- crown above

bone. Deciduous canines along with first premolar are extracte

Treatment proced re in class


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Treatment procedure in class

I malocclusion Group A - Anterior discrepancy : crowding

Group B - Anterior discrepancy : Alveolodental protrusion

Group C - Middle discrepancy : impacted canine

Group D - Enucleation in mandible

Group E - Enucleation in mandible & maxilla

Group F - Alternative to enucleation

Group G - Interproximal stripping

Group H- congenital absence

Advantages of


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Closure of Residual Xn spaces

Improvement in axial inclination

Correction of rotation

Correction of Midline discrepancy

Correction of residual overbite and overjet

Correction of cross bites Improvement in arch form

Advantages of

mechanotherapy

MUSCLE EXERCISES


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MUSCLE EXERCISES

The dental tissues are blanketed from all directions

by the muscles

Normal occlusal development depends on normal

oro-facial muscle function.

Muscle exercises helps in improving aberrant musc

function.


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1. Exercise for the masseter muscle:

2. Exercise for the lips:

Stretching of upper lip to maintain lip seal for

short hypotonic lips

Holding a piece of paper between lips

Holding and pumping of water back and forth

behind the lips. Massaging of lips

Scotch tape

Button pull exercise:


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3. Exercise for the pterygoid muscles:

4. Exercise for the tongue: (5/16 inch intra oral elastic

One elastic swallow:

Tongue hold exercise:

Two elastic swallow:

The hold pull exercise: tongue tie exercise

Limitation of muscle


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Limitation of muscle

exercises Does not drastically alter any growth pattern

Are not substitute for corrective orthodontictreatment

Pt compliance is extremely important

REMOVAL OF SOFT /HARD TISSUE


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Retained deciduous teeth

Supernumerary teeth

Fibrous/ Bony obstruction of the erupting

tooth bud

Impacted teeth

REMOVAL OF SOFT /HARD TISSUE

BARRIERS IN THE PATHWAY OF

ERUPTION

ECTOPIC ERUPTION


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ECTOPIC ERUPTION

Lateral incisors crowding..aberrant tooth positioningLingual arch with spur to.

Already midline shift. BALANCED EXTRACTION

Prevalence 2-3%

Maxi

Boys

2/3rdof.

ECTOPIC ERUPTION OF 1STPERMMOLAR 3-6 month


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MOLAR

waitful watching

3 6 month

pulpo..SS crown on 2ndmolar

supplemented with band material

extending subgingivally

Difficult to do

Orthodontic elastic separators Replacement at 1-2wks..2mn

Brass ligature wire Periodic tightening 3-5 day in

Safety pin spring Gentle forc exrted, distally he

Humphrey appliance-S shaped loop-helical springs Continual forc, easy reactivatbonded composite to engage

Halterman appliance Elastomeric chain, changed

monthly

Removal of 2ndprimary molar extensive resorption..distal s

regain space

MISSING PERMANENT TEETH


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Management:arch length, adjacent tooth morphology andcolour,incisor position and esthetics

Congenitally missing LATERAL

INCISOR

Canine erupts normally

resin bonded bridge,

conventional bridge or imp

Canine erupts in lat incisor position moved backbridge or im

Substitution of canine with lateral

incisor

recontouring to improve

esthetics

Congenitally missing LI transplanted posterior

teeth..premolarsreshapi

Congenitally missing PREMOLAR

substitute primary molar

ankylosis and root

resorptionexn

primary molar removed space closed ortho

resin bonded bridge,

conventional bridge or imp


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Resolution of crowding

Anterior segment- incisal liability

Posterior segment- leeway space of nance

Management:

1. Observation2. Disking of primary teeth-hand held strip, tapered bur in

speed handpiece

3. Extractions and serialextraction

4. Corrective orthodontic referral

MAXILLARY MIDLINEDIASTEMAS


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DIASTEMASFrenum Attachments Diastema should be closed first..Scarred tissue.

Supernumerary teeth Removal without causing injury t

perm teeth..

Early removal..erupt normally..s

closes spontaneously

Faciolingual positioning Active labial bow.. Acrylic remov

from palatal side.. 2mm/mnth

Very protrusive Fixed orthodontic

appliances..rectangular arch wir

Faulty mesiodistal positioning (tipping)Finger spring appliance.

2mm/mnth

Shud not take more than 2 mnth

(bodily) bonded brackets with

elastomeric chain


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Correction of developing

Anterior and Posterior Cross

Bites Eliminates functional shifts and wear on the erupted permanen

Dentoalveolar asymmetry

Increases circumference and provides more room for permanen


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ANTERIOR CROSSBITES

tong e blade therap / i l

20 times before each meal,pt

counting to 5 each time shud b do


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tongue blade therapy/popsiclestick therapy

counting to 5 each time..shud b do

several times, at certain periods o

day

Anterior inclined plane 45degree to the long axis of lower

1/4thinch post.. bite jumping wthn

week.. results wthn 2 wks

Doubl helical spring- activated 2 mm to provide 1 mm o

tooth movmnt per month

Mild rotation..

POSTERIOR CROSSBITESCross arch elastics Isolated molars in 4-8 weeks

Fixed palatal wire designs

W arch

Quad helix

Slow expansion

4-5 mm of buccal expansion in 4-6

wks..left behind for 3 months

Fixed jackscrew expanders

HYRAX, RPE

1-2 turns per day for 4 weeks(1

turn=0.25mm)


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FUNCTIONAL APPLIANCES


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FUNCTIONAL APPLIANCES

Myofunctional appliances -harness the musclepressure

Functional appliances- elicit certain natural

functions of the orofacial region

BACKGROUND


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Functional appliances are conceptually based

on Mossfunctional matrix theory

orm follows function

These appliances either transmit, eliminate or

guide the natural forces of the masculature


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guide the natural forces of the masculature.

Are used for growth modification procedures that

are aimed at intercepting and treating jaw

discrepancies

They bring about following changes:

An increase or decrease in jaw size.

A change in spatial relationship of the jaws

Change in direction of growth of the jaws

Acceleration of desirable growth

classifications


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I) Tom Graber, when functionals were removable:

Group A-teeth supported appliances eg.Catalans, inclined planes, etc.

Group b- teeth/tissues supported appliances.

Eg. Activator, bionator, etc.

Group c- vestibular positioned appliances.

With isolated support from tooth / tissue eg. Oral

Screens, frankel, lip bumpers.

classification


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II) With the advent of fixed functionals another classifica

evolved:A)Removable functionals eg. Activator, Frankel etc.

B)semi fixed functionals eg. Den holtz, Bass appliances.

C)fixed functionals eg. Herbst, Jasper jumper, MARA, etc

classification


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III) With the awareness & acceptance of the concept o

hybridism by Peter Vig, functionals could be furtheclassified as

A)classic functional appliances like

Activator, Catalans, Frankel etc.

B)hybrid appliances like Propulsor, Double Oral

screen, Hybrid bionators, bass appliance.

classification


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IV)

1) Tooth borne passive appliances- myotonic appliances

Eg. Andresen/Haupl activator, Herren activator, Woodside activat

Balters bionator etc.

2) Tooth borne active appliances- myodynamic appliances

Eg. Elastic open activator (EOA), Bimler appliances, Modified bion

Stockfish appliances, Kinetor,etc.

3) Tissue borne passive appliances.

Eg. Oral screens, Lip plumpers

4) Tissue borne active appliances

Eg. Frankels appliances

5) Functional orthopedic magnetic appliances (FOMA)

ORAL SCREEN (NEWELL


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(

1912)MODE OF ACTION

both the principles of force application n elimination

Indications : i f h bi lik


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Interception of habits like Correction of mild disto-occlusion Muscle exercises for correction of hypotonic lip & cheek

muscles.

Correction of mild anterior proclination.

Fabrication : Impression Sealing of cast in occlusion Covering of labial surfaces of teeth & alveolar process with

wax of 2-3mm thickness. Fabrication of appliance with self cure or heat cure resin.

Patient is asked to wear the appliance in the night & 2-3 hrsduring the day time.Seen about once every 3 weeks or a month

Modification of vestibular


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screen1. Hotz modification- metal ring- muscle

exercises2. Double oral screen- tongue thrust

3. With holes- mouth breathers

LIP BUMPER


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Combined removable fixed appliance

Muscular force application or force elimination

Both maxilla and mandible

USES:

o Lip sucking

o Hyperactive mentalis- crowding of lower ant

o Distalization of first molars

Maxillary arch- Denholtz appliance

Appliance design


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Fabrication of appliance


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Impression

Bite registration

Articulation of the model

Preparation of wire element- labial bow-0.8 or

0.9mm wire

Fabrication of acrylic portiono Maxillary part

o Mandibular part

o Interocclusal part

CONSTRUCTION BITE


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Mandible is advanced by 4-5 mm and bite opened

2-3 mm

General considerations-

Trimming of the activator


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For vertical control

Intrusion of teeth-

Extrusion of teeth-

For sagittal control


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Class II correction

Protrusion & retrusion of incisors

For transverse control - Jack screw is incorpora


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Management:

1

st

week: 2-3 hrs during day 2ndweek: full night + 1-3 hr each day

3rdweek: appliance is checked to evaluate the trimm

Every 6 weeek: check up appointment

MODIFICATIONS


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Bow activator of Schwarz

Wunderersmodification

Propulsor

Reduced activator or cybernator of Schmuth

Cutout or palate free activator

Karwetzky modification

Herrensmodification

BIONATOR (BALTER 1950)


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Philosophy of bionator


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Does not activate the muscle

ACTIONS OF THE BIONATOR


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Causes sagittal repositioning of mandible thereby increasing

the oro functional space.

Causes anterior positioning of the tongue

prevents the external unfavorable muscle forces by means

vestibular arch and its buccal extension.

Intrusion and extrusion of teeth


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OPEN BITE APPLIANCE


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The interocclusal bite blocks prevent the extrusion

posterior teeth.

prevents thrusting of tongue


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FUNCTIONAL REGULATOR


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FRANKELS PHILOSOPHY AND MODE OF

ACTION1. VESTIBULAR ARENA OF OPERATION

Dentition is influenced by peri-oral muscle function.

Abnormal peri-oral muscle function creates a barrier

the optimal growth of the dento-alveolar complex.


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Frankel-IcTypes of Frankel appliances


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Cl - II division 1 malocclusion

overjet >7mm.

Frankel-II

CL-II and division 1 & 2

Is modified by adding a stainless

steel protrusion bow behind the

maxillary incisors.

Frankel-III - CL-III malocclusion

Types of Frankel appliances


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Frankel III CL III malocclusion.

lip pads are situated in the maxillary vestibular labial sulcus

Labial bow rests against the mandibular teeth

There is a protrusive bow similar to that of Frankel-II

FRANKEL-IV


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correction of open bite & to a lesser extent

bimaxillary protrusion.

redirect the mandibular growth from a downward

backward growth rotation to a upper and forwa

rotation.

Frankle V

Used along with headgears

TWIN BLOCK APPLIANCE


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Occlusal inclined plane is the fundamental functionmechanism of the natural dentition.

Class I Class II

MODE OF ACTION OF TWIN

BLOCK


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BLOCK The unfavourable cuspal contacts of the distal occlusion

replaced by favourable proprioceptive contact on the inclin

plane of Twin block

Due to the inclined plane effect a mesial component of fo

is created

Case Selection

Angles class II div I with good arch form


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Angles class II div I with good arch form

Arches that uncrowded or decrowded

overjet10-12mm & a deep overbite

VTO positive

Actively growing individual

Angulation of inclined plane

70 degree- more horizontal

component of force- encourage

fwd mand growth

Stages of treatment


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Active phase 6-9 months

Support phase- 3-6 months Retention phase- 9 months

avg- 18 months

8-10 hours a day

2-3 months

Emil Herbst (1900s)

HERBST APPLIANCE


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Emil Herbst (1900s).

Pancherz 1982 & McNamara 1990 - both skeletal and den

adaptations This was previously used in the mixed dentition period b

now primarily used as an appliance in permanent dentition

holds lower jaw in a forward position

while pushing the upper jaw backward.


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INDICATIONS

In class II due to retrognathic mandible As an anterior repositioning splint in pt

having TMJ disorders

Uncooperative pts

Post adolescent

TREATMENT EFFECTS


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Class II to class I molar relation

Increase in mand growth

Distal driving of max molars

Overjet reduction

An inhibitory influence on sagittal max growth


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Acc Sassouni et al 1972

ORTHOPEDIC APPLIANCES


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Acc Sassouni et al- 1972

Orthodontic therapy- aimed at correction of

dentoalveolar malocclusion

Orthopedic therapy- correction skeletal imbalance

with correction of any dentoalveolar malocclusion

being of less importance

Orthopedic forces are heavier (400gm) when

compared to orthodontic forces( 50-100gm)

Basis for orthopedicappliances


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pp Makes use of teeth as a handle to transmit forces

to the underlying skeletal structures.

1. Amount of force -400-600gm/side

2. Duration of force- 12-14hrs /day

3. Direction of force- posteriorly &superiorly through

the centre of resistance of the maxilla.4. Age of the patient-

5. Timing of force application-


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HEAD GEARS


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Distalize the maxillary dentition or maxilla it self.

350 -450 gms on each side for 12-14 hrs / day.

COMPONENTS :

Force delivering unit- Face bow, J hook

Force generating unit ( elastic / springs )

Anchorage unit ( head strap/ cervical strap )

Types


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1. Cervical headgear-

2. Occipital headgear3. High pull(parietal )

4. Combination pull

CHIN CUP THERAPY


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Objective - to provide growth inhibition or redirection

& posterior positioning of mandible.


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Ideal patient for chin cup-

Acc to T M Graber


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A mild skeletal problem with the ability to bring incisors

edge to edge or nearly so

Short vertical facial height

normally positioned or protrusive , but not retrusive lower

incisors

Types of chin cup1. Occipital pull chin cup-

Classs III with mild to moderate prognathism

pt with short facial height also benefits from yhis type

2. Vetical pull chin cup- high angle cases or long face patients

PROTRACTION FACE MASK


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Hickham 1972.. Reverse head gear

Mainly used to pull the max ahead simultaneously pushingthe mandible distally.

250gm per side for 13 months

12-24 hrs/day.

MAXILLARY INTRUSIVESPLINT


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Indicationsevere gummy class II div 1

malocclusion

It reduces the visibility & vulnerability of the

maxillary incisors by

Achieving intrusion of max teeth

Restraining the max growth

Forward mandibular rotation

MAXILLARY INTRUSIVE SPLINT

FABRICATION-


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PRE ORTHODONTICTRAINER


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Technical Features


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1.Tooth channels

2. Labial bows

3.Tongue tag

4.Tongue guard

5. Lip bumpers

6. Jaw repositioning

Tooth guidance

system

Myofunctional

Training

Jaw positioning /

Functional appliance


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Phase 2


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Duration :612 months

much stiffer

same principle as orthodontic arch wire

Made of polyurethane

The TRAINER System

T4K The Pre orthodontic TRAINER
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T4K - The Pre-orthodontic TRAINER.

Improves facial & dental development in the growing

child (mixed dentition).

T4A - Aligns and retains anterior teeth in the

permanent dentition.

INFANT TRAINER - For habit correction.

To assist development of teeth & jaws in the

growing child.

The TRAINER System cont.,
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T4B - The TRAINER for Braces.

Shields the soft tissue from brackets.

T4CII - The TRAINER for Class II Correction.

Jaw alignment in combination with fixed

orthodontics.

LINGUA - Train the Tongue Day & Night.

tongue retraining.

The FARRELL BENT WIRESystem

The BWS allows arch development and anterior dental alignmen
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The BWS allows arch development and anterior dental alignmen

combined without encroaching on the natural position of the tong

Therefore the force of the.. allowing the BWS to use very ligh

Fabrication:


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THE MYOBRACE SYSTEMFeatures 2 main elements-

A soft flexible outer , &


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A soft flexible outer , &

Dynamicore- a hard

inner core- producespositive arch

development & tooth

alignment

Used in late mixed &

early permanent

dentition


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Interceptive series- i-3


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1:A Frankel cage for maxillary development, with an offset

Class I/II incisor preset.

2:High extended reflex sides to discourage anterior

mandibular posture.

3:Positive tongue position elevator to raise tongue position

conjunction with the tongue tag used in the Pre-Orthodont

TRAINER (T4K)..


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Correction of anterior crossbitPrarthana 7/F.. Tongue blade theray


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Chitra 9/F.. Hawleys with expansion screw

Kavana 8/F.. Anterior inclined plane


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Management of Class I malocclusion with crowding us

Trainer

Usha 12F


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Pre op

Post op

Arch expansion using Bent Wire System for management of cr

Brunda 11/F


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CONCLUSION

The earlier treatment begins, the more the


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g ,

face will adapt to your standards, the later

treatment begins the more your standards whave to adapt to the face.

C.Gugino


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Clinical Pedodontics: 4theditionFinn

REFERENCES


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Textbook of pedodontics:2ndedition- Tandon

Occlusal guidance in pediatric dentistryNakata

Pediatric dentistry .infancy through adolescence: 4theditio

Pinkham

Google search

Myobrace.com


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interceptive ortho

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