Interceptive Orthodontics

Question 1

What is interceptive treatment?

Answer 1

Any treatment which eliminates or reduces the severity of a developing malocclusion- which may reduce the need for further treatment or simplify it.

Question 2

Issues that may require interceptive treatment

Answer 2

Early loss of primary teeth

Impacted 6’s

Submerged primary molar E’s

Dilaceration

Supernumerary teeth

Unerupted maxillary incisor

Crossbites

Digit habits

Early loss of 6’s

Ectopic canines

Question 3

Early loss of primary teeth

In crowded cases this may result in neighbouring teeth drifting into the space

Thiswill depend on the degree of crowding, patient age and location.

Less likely to to occur in spaced arches

Effect is greater in maxilla

Interceptive treatment????

Answer 3

1) Balancing extraction- extraction of the same tooth on the opposite side of the same arch.
Prevents a centre line shift - suggestion not a rule

2) Space maintenance
Best space maintainer is the tooth!!!
Consider restoration or stainless steel crown.
URA or band and loop

Question 4

Reasons for Interceptive extractions

Answer 4

To guide / permit the eruption of permanent successors

To encourage space closure in hypodontia

To reduce localised gingival recession

Impacted 6’s

Question 5

Impacted 6’s

More common in maxilla

2/3 of cases self correct

Less likely after age of 8

Interception ????

Answer 5

Disimpaction using separation (elastomeric / brass wire)

Extraction of resorbed E

Distalisation of upper 6 with URA / sectional fixed appliance

Question 6

Infracluded primary molars E’s

8-14% of children there is a temporary predominance of repair - leading to temporary ankylosis

Due to continued growth of the surrounding bone and teeth the affected molar appears to “sink down” or becoming submerged.

Interception???

Answer 6

Removal of the submerged molar may be considered if the occlusal surface of the molar as it lies at or below the contact point of adjacent teeth

Root formation of the successor tooth is almost complete

The successor tooth is absent - depending on the condition of the primary tooth.

Question 7

Dilaceration - is a distortion or bend in the crown or root of a tooth - often results in failure of eruption.
Caused by developmental or trauma

Interception ???

Answer 7

Surgical removal or exposure with attempting orthodontic alignments.

Question 8

Supernumerary teeth
Additional tooth
1% occurrence

Effect & management???

Answer 8

Failure of eruption
Remove supernumerary tooth and bond unerupted tooth and create space and bring into alignment

Displacement of adjacent tooth
Remove supernumerary and alignment

Crowding
Remove and align

No effect
Incidental finding and does no interfere with orthodontic tooth movement. Can be left and monitored.

Question 9

Unerupted maxillary incisor
*Unerupted mirrored tooth after 6mths
*Lower incisors erupted more than one year no sign or uppers.
*Deviated from normal sequence

Causes and incidence???

Answer 9

Hereditary: supernumerary tooth, cleft lip / palate, gingival fibromatosis.

Environmental: trauma, early loss, space loss, cyst.

Incidence
0.13% in 5-12 years old
2.6% in population

Question 10

Anterior cossbite
CLASS III negative OJ

Indication for treatment and options??

Answer 10

Labial enamel wear to upper incisors
Labial gingival recession +- mobility
Possible TMD

URA
Upper 2x4 fixed

Question 11

Digit habits

Treatment

Answer 11

Encouragement to stop before permanent dentition or 6 yrs old.

Hayrake bluegrass

Question 12

Early loss of 6’s
Not first choice of extraction in orthodontics

However for poor prognosis you can extract at an appropriate time to encourage spontaneous space closure with the eruption of the second molar.