PREVENTIVEPREVENTIVE&&

INTERCEPTIVE INTERCEPTIVE ORTHODONTICSORTHODONTICS

By:By:

Dr shabeel pnDr shabeel pn

Preventive and Interceptive Preventive and Interceptive OrthodonticsOrthodontics

"An Ounce of Prevention is Worth a Pound of Cure""An Ounce of Prevention is Worth a Pound of Cure"

This axiom may be applied to many facets of This axiom may be applied to many facets of life... your house, your car, your health, and life... your house, your car, your health, and your teeth. A comprehensive oral hygiene your teeth. A comprehensive oral hygiene program that includes good brushing and program that includes good brushing and

flossing, fluorides, and limiting frequent sugary flossing, fluorides, and limiting frequent sugary or starchy snacks will help prevent cavities or starchy snacks will help prevent cavities and periodontal disease. Many orthodontic and periodontal disease. Many orthodontic

problems can be prevented.problems can be prevented.

Preventive OrthodonticsPreventive Orthodontics Preventive orthodontics is that part of Preventive orthodontics is that part of

orthodontic practice which is concerned with orthodontic practice which is concerned with patient’s and parents education,supervision of patient’s and parents education,supervision of the growth and development of the dentition the growth and development of the dentition and the cranio-facial structures,the diagnostic and the cranio-facial structures,the diagnostic procedures undertaken to predict the procedures undertaken to predict the appearance of malocclusion and the treatment appearance of malocclusion and the treatment procedures instituted to prevent the onset of procedures instituted to prevent the onset of malocclusion.malocclusion.

Many of the procedures are common in Many of the procedures are common in preventive and interceptive orthodontics but preventive and interceptive orthodontics but the timings are different.the timings are different.

Preventive procedures are undertaken in Preventive procedures are undertaken in anticipation of developmentof a anticipation of developmentof a problem.whereas interceptive procedures are problem.whereas interceptive procedures are taken when the problem has already taken when the problem has already manifested.manifested.

The following are some of the procedures The following are some of the procedures undertaken in preventive orthodontics:undertaken in preventive orthodontics:

Parent educationParent education Caries controlCaries control Care of deciduous dentitionCare of deciduous dentition Management of ankylosed toothManagement of ankylosed tooth Maintenance of quadrant wise tooth shedding time Maintenance of quadrant wise tooth shedding time

tabletable Checkup for oral habits and habit breaking appliance if Checkup for oral habits and habit breaking appliance if

necessarynecessary Occlusal equilibrium if there are any occlusal Occlusal equilibrium if there are any occlusal

prematuritiesprematurities Prevention of damage to occlusion.eg:-milwaukee Prevention of damage to occlusion.eg:-milwaukee

bracesbraces Extraction of supernumerary teethExtraction of supernumerary teeth Space maintenanceSpace maintenance Management of deeply locked first permanent molarManagement of deeply locked first permanent molar Management of abnormal frenal attachmentsManagement of abnormal frenal attachments

Parent EducationParent Education Ideally much before birth of childIdeally much before birth of child Expecting mother-nutrition,ideal environment for Expecting mother-nutrition,ideal environment for

developing fetus.developing fetus. Soon after birth—Proper nursing and care of child.Soon after birth—Proper nursing and care of child. If bottle fed---use physiologic nipple and not If bottle fed---use physiologic nipple and not

conventional nipple which are non physiologic(ie,do not conventional nipple which are non physiologic(ie,do not permit suckling by movement of tongue and lower permit suckling by movement of tongue and lower jaw).leading to various orthodontic problems of teeth.jaw).leading to various orthodontic problems of teeth.

Do not use pacifiers for a long time.Do not use pacifiers for a long time. Prevention of nursing bottle syndrome(due to bottle Prevention of nursing bottle syndrome(due to bottle

feeding during night….upper teeth caries..but lower no feeding during night….upper teeth caries..but lower no caries)caries)

Need for maintaining good oral hygieneNeed for maintaining good oral hygiene Correct method of brushing teethCorrect method of brushing teeth

Physiologic nipples,pacifiers , conventional Physiologic nipples,pacifiers , conventional nipples &Nursing bottle cariesnipples &Nursing bottle caries

Caries control:Caries control: Caries in proximal surface of Caries in proximal surface of

deciduous teeth if not restored leads deciduous teeth if not restored leads to loss of arch length by movement to loss of arch length by movement of adjacent teeth into the space and of adjacent teeth into the space and thus cause discrepancies between thus cause discrepancies between arch length and tooth material when arch length and tooth material when larger permanent teeth erupt into the larger permanent teeth erupt into the oral cavity.oral cavity.

Care of deciduous dentitionCare of deciduous dentition

Prevention and timely restoration of Prevention and timely restoration of carious teeth.carious teeth.

All efforts to prevent early loss of All efforts to prevent early loss of deciduous teeth(they are natural deciduous teeth(they are natural space maintainers)space maintainers)

Simple preventive procedures like: Simple preventive procedures like: Application of topical fluorides,Pit & Application of topical fluorides,Pit & fissure sealnts etc.fissure sealnts etc.

Extraction of supernumerary teeth:Extraction of supernumerary teeth: Supernumerary & supplemental Supernumerary & supplemental

teeth can interfere with eruption of teeth can interfere with eruption of nearby normal teeth.nearby normal teeth.

They deflect adjacent teeth and They deflect adjacent teeth and erupt in abnormal positions.erupt in abnormal positions.

They should be identified and They should be identified and extracted before they cause extracted before they cause displacement of other teeth.displacement of other teeth.

Supernumerary teeth:Supernumerary teeth:

Eliminating Occlusal Interferance:Eliminating Occlusal Interferance:

These lead to deviations in These lead to deviations in mandibular path of closure and also mandibular path of closure and also predispose bruxism.predispose bruxism.

Detected by using articulating paper Detected by using articulating paper and premature contact removed by and premature contact removed by selective grinding is carried out.selective grinding is carried out.

Maintenance of tooth shedding time table:Maintenance of tooth shedding time table: Not more than 3 months between Not more than 3 months between

shedding of deciduous and eruption of shedding of deciduous and eruption of permanent teeth.permanent teeth.

Delayed eruption due to:Delayed eruption due to: Over retained deciduous teeth rootsOver retained deciduous teeth roots Unresorbed deciduous root fragmentsUnresorbed deciduous root fragments Supernumerary toothSupernumerary tooth Cysts and tumorsCysts and tumors Over hanging restoration (deciduous Over hanging restoration (deciduous

teeth)teeth) Fibrosis of gingivalFibrosis of gingival Ankylosed primary teethAnkylosed primary teeth

Management of akylosed teeth:Management of akylosed teeth:

Absence of PDL membrane in a small Absence of PDL membrane in a small area or whole for the root surface.area or whole for the root surface.

They do not resorb---prevent permanent They do not resorb---prevent permanent teeth from erupting.or deflect them to teeth from erupting.or deflect them to erupt in abnormal positions.erupt in abnormal positions.

Diagnose such tooth and surgical Diagnose such tooth and surgical removal removal at an appropriate time removal removal at an appropriate time for permanent tooth eruption.for permanent tooth eruption.

Managemnet of abnormal frenal Managemnet of abnormal frenal attachments:attachments:

Thick and fleshy Thick and fleshy maxillary labial maxillary labial frenum leads midline frenum leads midline diastema.diastema.

Diagnosis –blanch Diagnosis –blanch test.Treated at an test.Treated at an early stage for early stage for prevention.prevention.

Ankyloglossia or Ankyloglossia or tongue tie -abnormal tongue tie -abnormal devpt of tongue.devpt of tongue.

Difficulty in speech Difficulty in speech and swallowing:-and swallowing:-surgically treated.surgically treated.

Oral habits ,checkups and educating patients and Oral habits ,checkups and educating patients and parents.parents.

Identify and stop habits such as Identify and stop habits such as Thumb sucking ,nail biting ,tongue Thumb sucking ,nail biting ,tongue thrusting and lip biting.thrusting and lip biting.

Prevention starts with proper nursing Prevention starts with proper nursing nipple and pacifiers to enhance normal nipple and pacifiers to enhance normal functional and deglutitional activity.functional and deglutitional activity.

Preventing MILWAUKEE Brace Preventing MILWAUKEE Brace DamageDamage::

Orthopedic appliance used for correction Orthopedic appliance used for correction of scoliosis.of scoliosis.

It applies tremendous force on the It applies tremendous force on the mandible and the developing occlusion mandible and the developing occlusion leading to retardation of mandibular leading to retardation of mandibular growth and possible deformities.whenever growth and possible deformities.whenever such appliance used, occlusion should be such appliance used, occlusion should be protected using functional appliance or protected using functional appliance or positioners.made of soft materials.positioners.made of soft materials.

MILWAUKEE BRACESMILWAUKEE BRACES

Deeply locked permanent first molars:Deeply locked permanent first molars:

Ocasionally the deciduous second Ocasionally the deciduous second molar have a prominent distal bulge molar have a prominent distal bulge which prevents the eruption of the which prevents the eruption of the first permanent molars.Slicing these first permanent molars.Slicing these distal surface helps in guiding the distal surface helps in guiding the eruption of first permanent molars.eruption of first permanent molars.

Space Maintenance:Space Maintenance:

Premature loss ->drifting of adjacent Premature loss ->drifting of adjacent teeth.This cause abnormal axial inclination of teeth.This cause abnormal axial inclination of teeth,spacing & shift in midline.teeth,spacing & shift in midline.

Premature loss of deciduous anteriors leads Premature loss of deciduous anteriors leads to very little orthodontic changes.to very little orthodontic changes.

Premature loss of permanent 1st molars-shift Premature loss of permanent 1st molars-shift of anteriors takes place.of anteriors takes place.

Premature loss of permanent 2nd molar--first Premature loss of permanent 2nd molar--first permanent molar migrate mesially.results in permanent molar migrate mesially.results in insufficient space for erupting premolars & insufficient space for erupting premolars & hence impaction.hence impaction.

Space maintainers—maintains space created Space maintainers—maintains space created by premature loss of deciduous teeth.by premature loss of deciduous teeth.

Ideal requirements of space maintainers:Ideal requirements of space maintainers:

Maintain entire mesio-distal space created by loss of Maintain entire mesio-distal space created by loss of teeth.teeth.

Restore function as far as possible.Restore function as far as possible. Prevent over-eruption of opposing tooth.Prevent over-eruption of opposing tooth. Simple in construction.Simple in construction. Strong enough to withstand functional forces.Strong enough to withstand functional forces. Should not exert excessive stress on opposing teeth.Should not exert excessive stress on opposing teeth. Permit maintenance of oral hygiene.Permit maintenance of oral hygiene. Must not restrict normal growth and development & Must not restrict normal growth and development &

natural adjustments which takes place during natural adjustments which takes place during transition from deciduous to permanent dentition.transition from deciduous to permanent dentition.

It should not come in the way of other functions It should not come in the way of other functions

Classification of Space maintainersClassification of Space maintainers

According to Hitchcock:According to Hitchcock: Removable or fixed or Removable or fixed or

semifixed.semifixed. With bands or without bands.With bands or without bands. Active or passive.Active or passive. combinations of the above.combinations of the above.

According to Raymond C. Thurow:According to Raymond C. Thurow: 1.Removable1.Removable 2.Complete arch-LingualArch2.Complete arch-LingualArch Extra-oral AnchorageExtra-oral Anchorage 3.Individual tooth.3.Individual tooth.

According to Hinrichsen:According to Hinrichsen: 1.Fixed space maintainers:1.Fixed space maintainers: Class IClass I a)Non-functional typesa)Non-functional types i)Bar type.i)Bar type. ii)Loop type.ii)Loop type. b)Functional typesb)Functional types i)Pontic typei)Pontic type ii)Lingual arch type.ii)Lingual arch type. Class II-Cantilever typeClass II-Cantilever type (distal shoe,band & loop)(distal shoe,band & loop) 2.Removable Space 2.Removable Space maintainers:maintainers: Acrylic partial dentures.Acrylic partial dentures.

Removable space maintainersRemovable space maintainers Removed & reinserted by patient.Removed & reinserted by patient. It can be functional or non-functional.It can be functional or non-functional. Functional----teeth provided to aid in mastication, speech and Functional----teeth provided to aid in mastication, speech and

estheticsesthetics Non functional----only an acrylic extension.over edentuluous area Non functional----only an acrylic extension.over edentuluous area

to prevent space closure.to prevent space closure.

Indications:Indications: When esthetics is of importance.When esthetics is of importance. When abutment teeth cannot support fixed applianceWhen abutment teeth cannot support fixed appliance Cleft palate patients---for obturarion of palatal defects.Cleft palate patients---for obturarion of palatal defects. If radiographs reveal that the unerupted permanent tooth is not If radiographs reveal that the unerupted permanent tooth is not

going to erupt in less than 5 months.going to erupt in less than 5 months. If permanent teeth is not fully erupted.so a band cannot be If permanent teeth is not fully erupted.so a band cannot be

adapted.adapted. Multiple loss of deciduous teeth requiring functional replacement.Multiple loss of deciduous teeth requiring functional replacement.

Contraindications:Contraindications: Lack of patient co-operationLack of patient co-operation Allergy to acrylicAllergy to acrylic Epileptic patients having uncontrolled seizures.Epileptic patients having uncontrolled seizures.

Some commonly used removable Some commonly used removable space maintainers:space maintainers:

Acrylic partial Acrylic partial denturesdentures

Full or complete Full or complete denturesdentures

Removable distal Removable distal shoe space shoe space maintainersmaintainers

Fixed Space Maintainers:Fixed Space Maintainers: Space mainainers that are fixed or fitted onto the teeth are called Space mainainers that are fixed or fitted onto the teeth are called

fixed space maintainers.fixed space maintainers.

Advantages:Advantages: Bands & crowns are used.So ,minimum or no tooth preparationBands & crowns are used.So ,minimum or no tooth preparation Do not interfere with passive eruption of abutment teeth.Do not interfere with passive eruption of abutment teeth. Jaw growth is not hampered.Jaw growth is not hampered. The succedaneous permanent teeth are free erupt into the oral The succedaneous permanent teeth are free erupt into the oral

cavitycavity Useful in uncooperative patientsUseful in uncooperative patients Masticatory function is restored if pontics are placed.Masticatory function is restored if pontics are placed.

Disadvantages:Disadvantages: Elaborate instrumentationElaborate instrumentation Experts skillExperts skill May result in decalcification of tooth material under bandsMay result in decalcification of tooth material under bands Supra eruption of opposing tooth if no pontics are placedSupra eruption of opposing tooth if no pontics are placed If pontics used ,it may interfere with vertical eruption of abutment If pontics used ,it may interfere with vertical eruption of abutment

teeth & may prevent eruption of replacing permanent teeth,If the teeth & may prevent eruption of replacing permanent teeth,If the patient fails to report.patient fails to report.

Examples of fixed space maintainersExamples of fixed space maintainers Band and loop space Band and loop space

maintainers.maintainers.

Common…,distal Common…,distal tooth banded…stainless tooth banded…stainless steel wire soldered with steel wire soldered with mesial end touching mesial end touching mesial tooth….maily in mesial tooth….maily in posteriors.posteriors.

Crown & loop Crown & loop applianceappliance

Stainless steel crown Stainless steel crown on abutment teeth…other on abutment teeth…other same as band and loopsame as band and loop..

Lingual arch space maintainer:Lingual arch space maintainer: Most effective for space Most effective for space

maintenance in lower arch. Two maintenance in lower arch. Two band on the 2 mandibular first band on the 2 mandibular first molars/second deciduous molars/second deciduous molars,which are joined by a molars,which are joined by a stainless steel wire contacting stainless steel wire contacting the lingual surface of 4 the lingual surface of 4 mandibular incisors.used to mandibular incisors.used to preserve space created by preserve space created by multiple loss of primary multiple loss of primary molars.Helps in maintaining the molars.Helps in maintaining the arch perimeter by preventing arch perimeter by preventing mesial drift & also lingual mesial drift & also lingual collapse of anteriors.collapse of anteriors.

Platal arch appliance:Platal arch appliance:

(Nance holding arch)(Nance holding arch)

Similar to lingual arches.Similar to lingual arches.

They are designed to They are designed to prevent mesial prevent mesial migrationof maxillary migrationof maxillary molars.molars.

Transpalatal arch:Transpalatal arch:

For stabilizing maxillary For stabilizing maxillary first permanent molars.first permanent molars.

Distal shoe space maintainer:Distal shoe space maintainer: Intra alveolar appliance.The distal surface of the Intra alveolar appliance.The distal surface of the

second primary molar guides the unerupted first second primary molar guides the unerupted first permanent molars.when the second primary molar is permanent molars.when the second primary molar is removed prior to eruption of permanent 1st molar ,the removed prior to eruption of permanent 1st molar ,the intra-alveolar appliance provides greater control of the intra-alveolar appliance provides greater control of the path of eruption of the unerupted tooth and provides path of eruption of the unerupted tooth and provides undesirable mesial migration .The appliance now used undesirable mesial migration .The appliance now used in practice is Roche’s distal shoe or it’s modifications in practice is Roche’s distal shoe or it’s modifications using crown and band appliance with a distal intra-using crown and band appliance with a distal intra-gingival extension.gingival extension.

Esthetic anterior space maintainersEsthetic anterior space maintainers::

Band & bar type space maintainers.Band & bar type space maintainers. Abutment teeth on both side are Abutment teeth on both side are

banded and connected by a bar.banded and connected by a bar.

Planning for space maintainers:Planning for space maintainers:

1.Time elapsed since loss of tooth1.Time elapsed since loss of tooth 2.Dental age of patient.2.Dental age of patient. 3.Thickness of bone covering the 3.Thickness of bone covering the

unerupted teeth:unerupted teeth: 4.Sequence of eruption of teeth.4.Sequence of eruption of teeth. 5.Congenital absence of permanent 5.Congenital absence of permanent

teeth.teeth.

INTERCEPTIVE ORTHODONTICSINTERCEPTIVE ORTHODONTICS Definition:Definition: Defined as that phase of the science and art of Defined as that phase of the science and art of

orthodontics employed to recognize & eliminate orthodontics employed to recognize & eliminate potential irregularities & malpositions of the developing potential irregularities & malpositions of the developing dento-facial complexes.dento-facial complexes.

Unlike preventive orthodontic procedures,interceptive Unlike preventive orthodontic procedures,interceptive orthodontics is undertaken at a time when the orthodontics is undertaken at a time when the malocclusion has already developed or is malocclusion has already developed or is developing .Thus interceptive orthodontics basically developing .Thus interceptive orthodontics basically refers to measures undertaken to prevent a potential refers to measures undertaken to prevent a potential malocclusion from progressing into a more severe one. malocclusion from progressing into a more severe one.

Some of the procedures carried out in preventive Some of the procedures carried out in preventive orthodontics can also be carried out in interceptive orthodontics can also be carried out in interceptive orthodontics but the timings are different.orthodontics but the timings are different.

Procedures undertaken in interceptive Procedures undertaken in interceptive orthodontics:orthodontics:

Serial extraction.Serial extraction. Correction of developing crossbite.Correction of developing crossbite. Control of abnormal habits.Control of abnormal habits. Space regaining.Space regaining. Muscle exercises .Muscle exercises . Interception of skeletal malrelation.Interception of skeletal malrelation. Removal of soft tissue or bony barrier to Removal of soft tissue or bony barrier to

enable eruption of teeth.enable eruption of teeth.

SERIAL EXTRACTION:SERIAL EXTRACTION: Planned extraction of certain deciduous Planned extraction of certain deciduous

teeth and later specific permanent teeth teeth and later specific permanent teeth in an orderly sequence and pre-in an orderly sequence and pre-determined pattern to guide the erupting determined pattern to guide the erupting permanent teeth into a more favourable permanent teeth into a more favourable position…….when one can recognize and position…….when one can recognize and anticipate potential irregularities in the anticipate potential irregularities in the dento-facial complex.dento-facial complex.

History:-Kjellgren 1929 first used the term History:-Kjellgren 1929 first used the term “serial extraction”….Nance(USA) 1940’s “serial extraction”….Nance(USA) 1940’s popularized the techniquepopularized the technique

Rationale:Rationale:

Based on 2 basic principles:Based on 2 basic principles: Arch-length tooth material discrepancy---Arch-length tooth material discrepancy---

Tooth material >arch length…hence, Tooth material >arch length…hence, teeth extracted….so that rest of tooth teeth extracted….so that rest of tooth occlude normally.occlude normally.

Physiologic tooth movement----Physiologic tooth movement----

Removal some teeth,let’s the rest of the Removal some teeth,let’s the rest of the teeth(which are erupting) to be guided by teeth(which are erupting) to be guided by natural forces to extraction spaces.natural forces to extraction spaces.

Indications:Indications: Class I malocclusions showing harmony between Class I malocclusions showing harmony between

skeletal and muscular systemsskeletal and muscular systems Arch length deficiency.Arch length deficiency. Where growth is not enough to overcome the Where growth is not enough to overcome the

discrepancy between tooth material and basal bone.discrepancy between tooth material and basal bone. Patients with straight profile and pleasing appearancePatients with straight profile and pleasing appearance

Contraindications:Contraindications: Class II & III malocclusion with skeletal abnormalitiesClass II & III malocclusion with skeletal abnormalities Spaced dentitionSpaced dentition Anodontia/OligodontiaAnodontia/Oligodontia Open bite and deep biteOpen bite and deep bite Midline diastemaMidline diastema Class I malocclusion with minimal space deficiencyClass I malocclusion with minimal space deficiency Unerupted malformed teeth. E.g.dilacerationUnerupted malformed teeth. E.g.dilaceration Extensive caries or heavily filled first permanent molarsExtensive caries or heavily filled first permanent molars Mild disproportion between arch length and tooth Mild disproportion between arch length and tooth

material that can be treated by proximal stripping.material that can be treated by proximal stripping.

Procedure:Procedure:

Three popular methods are:Three popular methods are: Dewel’s methodDewel’s method 3 step-C(8-9yrs);D(9-10yrs);Erupting 4’s3 step-C(8-9yrs);D(9-10yrs);Erupting 4’s

Tweed’s methodTweed’s method D(8yrs);Erupting 4’s & CD(8yrs);Erupting 4’s & C

Nance methodNance method Similar to tweed’sSimilar to tweed’s

DEVELOPING ANTERIOR CROSSBITE:DEVELOPING ANTERIOR CROSSBITE: Anterior cross bite is a condition characterized Anterior cross bite is a condition characterized

by reverse overjet wherein one or more by reverse overjet wherein one or more maxillary anterior teeth are in lingual relation to maxillary anterior teeth are in lingual relation to the mandibular teeth.the mandibular teeth.

Should be intercepted and treated at an early Should be intercepted and treated at an early stage to prevent a minor orthodontic problem stage to prevent a minor orthodontic problem from progressing into a major dento-facial from progressing into a major dento-facial anomaly.as an old maxim statesanomaly.as an old maxim states

““The best time to treat a crossbite is the first The best time to treat a crossbite is the first time it is seen”time it is seen”

Or else it may grow into skeletal malocclusionOr else it may grow into skeletal malocclusionClassification:Classification: Dento-alveolar anterior crossbite.Dento-alveolar anterior crossbite. Skeletal anterior crossbite.Skeletal anterior crossbite. Functional anterior crossbite.Functional anterior crossbite.

Anterior CrossbiteAnterior Crossbite

Dento-alveolar anterior crossbite:Dento-alveolar anterior crossbite: One or more maxillary anterior teeth are in One or more maxillary anterior teeth are in

lingual relation to the mandibular anteriors.lingual relation to the mandibular anteriors. Treated using tongue blades ,catalan’s Treated using tongue blades ,catalan’s

appliance and double cantilever springs.appliance and double cantilever springs.

Functional anterior crossbite:Functional anterior crossbite: Pseudo class III malocclusion.., where the Pseudo class III malocclusion.., where the

mandible is compelled to close in a position mandible is compelled to close in a position forward of it’s true centric relation.forward of it’s true centric relation.

Treated by eliminating occlusal prematurities.Treated by eliminating occlusal prematurities.

Skeletal anterior cross-bite:Skeletal anterior cross-bite: Treated by myofunctinal or orthopaedic Treated by myofunctinal or orthopaedic

appliancesappliances

INTERCEPTION OF HABITS:INTERCEPTION OF HABITS:

Habit’s refers to certain actions Habit’s refers to certain actions involving the teeth and other oral or involving the teeth and other oral or perioral structures which are repeated perioral structures which are repeated often enough by some patients to have often enough by some patients to have a profound and deleterious effect on the a profound and deleterious effect on the positions of teeth and occlusion.positions of teeth and occlusion.

Some such habits are:Some such habits are: Thumb suckingThumb sucking Tongue thrustingTongue thrusting Mouth breathingMouth breathing

Thumb sucking:Thumb sucking: Most frequently practiced by children.Most frequently practiced by children. Causes damaging effect on dento-alveolar structures.Causes damaging effect on dento-alveolar structures. It’s presence upto2-1/2 to 3 years age is considered normal.It’s presence upto2-1/2 to 3 years age is considered normal. Persistence beyond 3-1/2 to 4 years have damaging effect.& Persistence beyond 3-1/2 to 4 years have damaging effect.&

should be should be interceptedintercepted Intercepted by use of Intercepted by use of HABIT BREAKERSHABIT BREAKERS that could be removable that could be removable

or fixed.or fixed. Tongue thrusting:Tongue thrusting: Condition in which tongue makes contact with any teeth anterior Condition in which tongue makes contact with any teeth anterior

to the molars during swallowing.to the molars during swallowing. Deleterious habit , can clinically present along with open bite and Deleterious habit , can clinically present along with open bite and

anterior proclination.anterior proclination. Intercepted using Intercepted using HABIT BREAKERSHABIT BREAKERS.& trained for correct .& trained for correct

technique of swallowing.technique of swallowing.

Mouth breathing:Mouth breathing: Obstructive-nasal polyps ,tumors ,inflammations ,deviated Obstructive-nasal polyps ,tumors ,inflammations ,deviated

septumseptum Habitual –persistence of habit after removal of the obstruction.Habitual –persistence of habit after removal of the obstruction. It affects the orofacial equilibrium due to lowered mandible & It affects the orofacial equilibrium due to lowered mandible &

tongue posture. And hence cause malocclusion.tongue posture. And hence cause malocclusion. Intercepted by identifying and removing the cause.If persists , Intercepted by identifying and removing the cause.If persists ,

VESTIBULAR SCREENVESTIBULAR SCREEN can be used. can be used.

Habit BreakersHabit Breakers

SPACE REGAINING:SPACE REGAINING: Early loss of primary molar and failure to use space Early loss of primary molar and failure to use space

maintainers may lead to reduction in arch length by maintainers may lead to reduction in arch length by mesial movement of 1st molars.mesial movement of 1st molars.

Space regained by distal movement of first molar. Space regained by distal movement of first molar. Which is undertaken at an early age prior to eruption of Which is undertaken at an early age prior to eruption of second molar.second molar.

Commonly used space regainers:Commonly used space regainers: Gerber’s Space Regainer:Gerber’s Space Regainer: An ‘U’ tube and an ‘U’ rod .Rod inserted into tube An ‘U’ tube and an ‘U’ rod .Rod inserted into tube

with activated spring at free ends of rod.with activated spring at free ends of rod. Jack Screws:Jack Screws: Split acrylic plate with jack screw in relation to Split acrylic plate with jack screw in relation to

edentulous space.Retained using Adam’s clasps.edentulous space.Retained using Adam’s clasps. Cantilever Spring:Cantilever Spring: Removable appliances that incorporate simple Removable appliances that incorporate simple

finger springs. finger springs.

Space RegainersSpace Regainers

MUSCLE EXERCISES:MUSCLE EXERCISES: Muscle exercises helps in developing improving aberrant muscle Muscle exercises helps in developing improving aberrant muscle

functions.functions. Masseter:Masseter: Clenching of teeth while counting till ten.Clenching of teeth while counting till ten. Lips:Lips: Stretching of upper lipto maintain lip seal(paper may be held Stretching of upper lipto maintain lip seal(paper may be held

b/w lips)--for b/w lips)--for hypotonic lip patients.hypotonic lip patients. Stretch upper lip downwards towards chin.Stretch upper lip downwards towards chin. Hold & pump water back & forth behind lips.Hold & pump water back & forth behind lips. Massaging of the lips.Massaging of the lips. Button pull exercise:-1/2 inch button,,,,thread passed through Button pull exercise:-1/2 inch button,,,,thread passed through buttonhole…place button behind lips& pull thread, By using lip buttonhole…place button behind lips& pull thread, By using lip

pressure.pressure. Tug of war exercise: instead 2 buttons.Tug of war exercise: instead 2 buttons. Tongue:Tongue: One elastic swallow One elastic swallow Tongue hold exercise.Tongue hold exercise.

Muscle ExercisesMuscle Exercises

INTERCEPTION OF SKELETAL MALRELATIONS:INTERCEPTION OF SKELETAL MALRELATIONS:

Interception of class II malocclusions:Interception of class II malocclusions: Causes: Excess maxillary growth. Causes: Excess maxillary growth. (Restricted by facebow with headgear)(Restricted by facebow with headgear) Defficient mandibular growth.Defficient mandibular growth. (Myofunctional appliances)(Myofunctional appliances) Combination of both.Combination of both.

Interception of class III malocclusions:Interception of class III malocclusions: Causes: Mandibular prognathism.(Chin cap with head gear)Causes: Mandibular prognathism.(Chin cap with head gear) Maxillary retrognathism ( Face mask therapy )Maxillary retrognathism ( Face mask therapy ) Combination of bothCombination of both

Chin cap,Head gear.Face maskChin cap,Head gear.Face mask

REMOVAL OF SOFT TISSUE & BONY BARRIERS:REMOVAL OF SOFT TISSUE & BONY BARRIERS:

Failure of teeth to erupt in appropriate Failure of teeth to erupt in appropriate

time should be intercepted by surgically time should be intercepted by surgically exposing the crown.exposing the crown.

Over retained primary teeth,ankylosed Over retained primary teeth,ankylosed primary teeth & supernumerary teeth are primary teeth & supernumerary teeth are possible causesof non-eruption of possible causesof non-eruption of succedaneous teeth . The soft tissue and succedaneous teeth . The soft tissue and any bone overlying it are removed.tissue any bone overlying it are removed.tissue is removed to that extent such that the is removed to that extent such that the greatest diameter of the crown of the greatest diameter of the crown of the tooth is exposed.tooth is exposed.

Bibliography:Bibliography:

Orthodontics The art & scienceOrthodontics The art & science – –S.I BhalajiS.I Bhalaji WWWWWW::

www.cda-adc.ca/jcda/vol-65/issue-11/612.html

http://coe.unk.edu/hiltonlm/AnkyloglossiaHiltonAyersFeb2003/

www.gro.co.jp/fixed.htm

TTHHAANNKK YYOOUU

Prepared By:Prepared By:

Mohammed Fihas ThulunadanMohammed Fihas Thulunadan

Ist BatchIst Batch

Royal Dental CollegeRoyal Dental College