PREVENTIVE AND INTERCEPTIVE ORTHODONTICS Group 1

PREVENTIVE ORTHODONTIC Definition : It is an action taken to presrve the integrity of what appears to be a normal occlusion at a specific time. Aim : To prevent develoment of malocclusion.

PROCEDURES Parent education : Caries control : Physiologic nipples, proper toothbrushing technique, maintain good OH Caries control : Monitor caries progression, prevent early loss Monitoring of primary dentition and transition stage : Monitor eruption and exfoliation time, application of preventive procedures

Extraction of retained deciduous or supernumerary teeth : Can interfere with eruption of permanent and cause displacement or erupt abnormally. Habit correction : Thumb sucking habit, tongue thrusting. Can cause anterior open bite. Use habit breaker appliances. Space maintainer : To maintain space created by premature loss of deciduous teeth.

PHYSIOLOGIC NIPPLE, PACIFIER SPACE MAINTAINER HABIT BREAKER

INTERCEPTIVE ORTHODONTICS

Definitions. 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 malocclusion (Ackerman and Profit 1980).

Indications. Impacted canine Impacted molars Hypodontia Supernumerary teeth. Correction of anterior and posterior crossbite Sagittal problems- class II Sagittal problems- class III

Treatment involved Serial extraction Correction of developing cross bite Control of abnormal habits Space regaining Muscle exercises Interception of skeletal mal relation Removal of soft tissue or bony barrier to enable eruption of teeth

1. Serial extractions 1940s to treat Class I malocclusion complicated by severe labial segment crowding Aim: to spontaneously guide the developing dentition into good alignment w/o use of appliance treatment by selectively timing deciduous and permanent tooth extractions

should allow spontaneous alignment of the incisors Extraction of four deciduous canines ~ 8 years in a child of average dental development, at the time of eruption of the maxillary lateral incisors. should allow spontaneous alignment of the incisors at the expense of canine space Extraction of the first deciduous molars ~ 9 years when the roots of the first premolars are half formed. Aim: to encourage the first premolars to erupt before the canines, which is often not the case in the lower arch Extraction of the first premolars ~ time of eruption of the canines after confirming that they are buccaly palpable and mesially angulated if there is sufficient crowding to warrant premolar extractions and if all other teeth are present and sound.

Disadvantages serial Xn • Multiple Extractions under GA > a stressful experience for the patient. • Early loss of the 1st deciduous molar > mesial drift of the buccal segments with further space loss. • The lower canine may still erupt into the first deciduous molar space before the first premolar resulting in first premolar impaction. • No spontaneous correction of an incorrect incisor relationship, hence it is only useful in Class I cases. • A risk of lower incisor retroclination and deepening of the overbite. • Patients may still require later appliance treatment.

Current approach Serial xn rarely practice due current wide availability of fixed appliances a modified version of the procedure may be carried out (e.g. extraction of deciduous canines to allow alignment of the incisors or for interceptive treatment of palatal maxillary canines) to simplify later appliance treatment

2. Treatment for crossbites Quad helix Micro screws

3. Control of abnormal habits Thumb / digit sucking Mouth breathing Tongue thrusting Lip sucking / biting

Treatments for thumb sucking Tongue crib Lip bumper

4. Space regaining Mesial tipping or drifting of permanent first molars on premature loss of deciduous second molar , reducing the arch length Extensive caries Ecotopic eruption Premature extraction of primary molars

Treatments Timing of distalization 7-10 yrs of age Incomplete root formation Second molars are not erupted

Treatment procedures Fixed appliances Removable appliance Open coil / herbst space regainer Jackscrew space regainer Gerber space regainer Removable appliance Hawley’s appliance With helical spring\ Split acrylic dumb bell spring With sling shot elastic Palatal spring Expansion screws

6. Interception of skeletal malocclusion Class II Class III Functional appliances Tooth borne Active Passive Tissue borne

7. Removal of soft tissue / bony barrier Retained deciduous teeth Supernumerary teeth Fibrous / bony obstruction of the erupting tooth bud