INTERCEPTIVE ORTHODONTICS.pptx

this presentation has basic concepts of interceptive procedures which can be carried out in a child during mixed dentition stage

1. INTERCEPTIVE ORTHODONTICS Dr.MUHAMMAD SHARIQ SOHAIL FCPS-II Resident Orthodontics department Prof.Dr.Muhammad Imran rahbar

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. 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. 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. 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. KEYS OF IDEAL OCCLUSION Molar relation. Crown angulation. Crown inclination. Rotations. Spaces. Occlusal plane.

7. MOLAR RELATION MB cusp of upper molar occludes in the groove between MB and middle buccal cusp of lower molar.

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. 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. 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. SPACES If there is no anomaly in tooth shape and mesio -distal position, tight inter-proximal contacts should be present between the teeth

12. OCCLUSAL PLANE Normal occlusion should have flat curve of spee , not more than 1.5mm.

13. SPACE MAINTENANCE

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. 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. 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. 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. 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. LINGUAL ARCH 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. TRANSPALATAL 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

21. SPACE REGAINING

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. MAXILLARY SPACE REGAINERS Distal tipping and de-rotation of molars are satisfactory to regain 2 to 3mm. Options available: Removable appliance : retained with Adam’s clasps and incorporating fingerspring adjacent to tooth to be moved.

24. 2. Fixed appliance : coil spring on a segmental arch wire

25. MANDIBULAR SPACE REGAINERS Moving teeth distally in mandible is generally quite challenging. Options available: For unilateral – fixed appliance. For bilateral – lip bumper, lingual arch.

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. BILATERAL SPACE REGAINERS Lip bumper : I ndicated 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. 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. SPACE SUPERVISION

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. STEPS OF SPACE SUPERVISION Noar J. Review: Interceptive Orthodontics (2002). The European Journal of Orthodontics. 2020;24(6):705-705

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. SERIAL EXTRACTION

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. 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. CONTRAINDICATIONS Mild to moderate crowding. Skeletal Class II or Class III discrepancy. Deep bite or open bite. Spaced dentition.

37. STEPS INVOLVED Hotz RP. Guidance of eruption versus serial extraction. Am J Orthod . 2018;58:1–20

38. CORRECTION OF DEVELOPING CROSSBITES

39. CORRECTION OF DEVELOPING CROSSBITES Dentoalveolar anterior crossbites . Posterior crossbites . Functional crossbites .

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. 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. POSTERIOR CROSSBITE Bilateral posterior crossbite with constricted maxillary arch. Treated with the help of W-Arch, quad helix.

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. INTERCEPTION OF ORAL HABITS

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. INTERCEPTION OF SKELETAL MALOCCLUSION

47. INTERCEPTION OF SKELETAL MALOCCLUSION Skeletal Class II Malocclusion : Excessive maxillary growth. (Treated by headgear) Deficient mandibular growth. ( Myofunctional appliance) Combination.

48. Skeletal Class III Malocclusion: Deficient maxillary growth. (Facemask) Excessive mandibular growth.(Chin cup) Combination.

49. INTERCEPTION OF ERUPTION PROBLEMS

50. DELAYED ERUPTION OF UPPER PERMANENT INCISORS

51. RETAINED DECIDUOUS TEETH

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. Noar J. Review: Interceptive Orthodontics (2002). The European Journal of Orthodontics. 2020;24(6):705-705

54. UNILATERAL RETAINED DECIDUOUS CANINE Premature loss of one deciduous canine as a result of early resorption by a crowded lateral incisor.

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. 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. TRANSPOSITION Transposition is a positional interchange of two adjacent teeth. The teeth most likely to be transposed are: M andibular 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. 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. 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