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1. Interceptive Orthodontics
Supervised by:
Dr. Ahmed Altarawneh
Dr. Raghda Al-shammout
Dr. Anwar Rahamneh
Dr. Hanan Alhabarneh

2. What is Interception?
Any procedure that eliminates or
reduces the severity of malocclusion
in the developing dentition.
All simple measures that eliminate
the developing malocclusion. (Proffit)

3. When To decide about
intervention
The AAO recommends that all
children should be seen by a
specialist no later than 7 years.
Screening of for orthodontic
problems seems to be suitable in
children between the age of 9-11.

4. Why to Intervene?
Decrease the risk of trauma.
Decrease comprehensive treatment
time.
Eliminate future centerline, A-P,
vertical, and transverse discrepancy.
Improve social and psychological
well-being.

5.  Recognition of dental pathology or related
conditions and commencing treatment
appropriately.
 Eliminate habits and airway abnormalities that
contribute to malocclusion.
 Space management in the developing
dentition.

6.  In an educational leaflet targeting the parents,
the AAO stated nine signs to look for in a
growing individual;
1. Anterior crossbite
2. Posterior crossbite
3. Crowding of the permanent dentition
4. Spacing
5. Anterior openbite
6. Deepbite
7. Reverse overjet
8. Proclination of the upper labial segment
9. Oral habits

7. Problems targeted by
Interceptive Orthodontics

8.  Skeletal Problems
 Dental problems
 Soft tissue and Habits

9. Skeletal problems
•Class III skeletal problems
•Class II skeletal problems
•Transverse relationship problems
and asymmetries

10. The cervical vertebral maturation
method.
Cervical Stages (CS) 1-6

12. Class III
 Before the age of eight, CS-1, to have a
skeletal correction.
 Utilizing reverse pull headgear combined with
an RME.
 Indication
1. Average or reduced LFH
2. Mild skeletal class III
3. Normal upper and lower incisor inclination
4. Average to increased overbite
5. GROWING COOPERATIVE PATIENT

13. • CS-1, characterized by flat inferior borders of
C2 to C4, this stage occurs from approximately
the time of the eruption of the Primary
dentition until about 2 years before skeletal
growth peak.
• To correlate it dentally, the use of FM with the
eruption of the permanent central incisor or in
severe cases in the primary dentition.

15.  Problems with early treatment
1. Soft tissue and skeletal relapse after treatment.
2. Long treatment time and retention phase.
3. Proclination of the upper labial segment.
4. Unfavorable growth.

16. Class II
 Timing
• At the growth spurt CS- 3 and CS- 4 that is in the late mixed
dentition or early permanent dentition.
 Indications
1. Class II patient with increased overjet that put the individual
in risk of trauma or bullying.
2. Lip incompetence due to upper labial segment proclination
or maxillary skeletal protrusion.
3. Mandibular retrusion

17.  CS-3, the maximum craniofacial growth
velocity is anticipated. However at CS-4
continued skeletal growth can be seen but to
a lesser degree than CS-3.

18. Advantages of early treatment
 Better cooperation
 Psychosocial advantages
 Elimination of gingival/palatal trauma
 Less root resorption than one phase
treatment
 Decreased upper incisor trauma

19. Disadvantages
 Prolonged course of treatment.
 Difficult extraction decision while young age.
 Vertical lip growth don’t reach its maximum
until the age 12-14, rendering the stability of
corrected overjet questionable.
 Burning patient co-orporation.

20. Advantages of late treatment
 One phase treatment
 Easy extraction decision
 Better final occlusion
 Primary second molar utilized for
retraction/crowding management.

21. How to intervene
•Maxillary distalization
•Mandibular enhancement
mechanics (FJO)

22. Maxillary distalization
In patients with forward positioning
dentition in relation to the skeletal
base

23. • Dentoalveolar distalization (e.g.,
Pendulum/Pendex appliance, Distal Jet, TAD-
secured distalizers)

28. Mandibular Enhancement
Mechanics (FJO)
To influence the mandibular
dentition and the growth of the
skeletal base

29. • Many appliances have been described but all
work to achieve a Class I occlusion by
posturing the mandible forward during
growth.
Examples; Activator, Bionator, FR-2, Herbst
appliance, the MARA appliance, and Twin
Block.

35. Dental problems

36.  Crowding and space loss
 Spacing
 Abnormalities in tooth position and eruption
 Displacement and crossbites
 Abnormalities in tooth form, shape, and size
 Hypodontia
 Supernumeraries
 Traumatic loss of a labial segment tooth

37. Crowding and space loss
Early extraction of a primary tooth
Over retained primary tooth
Tooth size-arch size discrepancy
Developmental

39. Leeway space utilization
TPA and LLB to maintain leeway
space and prevent mesial drifting of
the first permanent molar

40. Serial Extraction
Dependent upon proper patient
selection and accurate diagnosis.
Used for the management of severe
tooth-size/arch-size discrepancy.

41. • Indications:
a. Class I skeletal base.
b. Good prognosis of permanent first molars
c. Good oral hygiene
d. Good OJ and OB
Graber states that SE maybe indicated when
there will not be enough space to
accommodate all permanent teeth.

42. • Proffit and coworkers cite a predicted a
discrepancy of 10 mm or greater.
• Ringenberg mentions a discrepancy of 7 mm
or more.
The primary factor in SE decision is large tooth
size (e.g., maxillary central incisor width
greater than 10.0mm), also A-P position of
lower incisor teeth and their relation to the lip

43. Abnormalities in tooth position
and eruption
Transposition
Impaction
Ectopic eruption
Ankylosis and ICRR
Delayed incisor eruption
PFE

44. Transposition
• In the early mixed dentition, distal eruption of
the lower lateral incisor with the loss of
primary canine and first molar.
Interception will reposition the lateral into more
mesial position and eliminating transpostion
or the loss of that lateral when the canine is in
active eruption.
This requires a FA and traction to tip the tooth in
position. LLB is needed for anchorage.

46. In the late mixed dentition, the more common
transposition is of the maxillary canine and
first premolar or lateral incisor.
Complex treatment course.

47. Impaction
• 3’s and 5’s
Most common causes for impaction are localized and
may result from one of the following factors:
• Tooth size-arch length discrepancy
• Early loss or over retained primary tooth
• Alveolar cleft
• Dilaceration
• Ankylosis
• Abnormal tooth bud postion
• Pathology
• Iatrogenic
• Familial tendency
• Class II Division 2

48. Ectopic eruption
When a permanent tooth causes either
resorption of a primary tooth other than the
one it supposed to replace or an adjacent
permanent one. It indicates a lack of space or
aberrant eruption path. Sometimes it’s a
symptom of Temporary Incisor Crowding
which is normal in that stage.
The lateral incisor is the most common cause
and loss of the primary canine.

49. It can cause:
• Midline shift
• Localized space problems and impactions
• Arch asymmetry

50. • Intervention is aimed to prevent midline shift
and loss of space.
It depends upon space assessment,
a. Adequate space and no midline shift, then stabilize the
lateral incisor in place and utilize a Lingual arch with a spur.
b. If booth primary canines are lost, then every action to
prevent lingual tipping of the incisors, which increases
crowding. Use passive lingual arch.
c. If midline shift occurred with/without space loss then
complex FA treatment is indicated with proper mechanics
and anchorage prior to canine eruption.

52. Ectopic eruption of Maxillary first molar
a. If 1 to 1.5 mm of primary second molar
resorption, 2/3 of the cases are self-
corrected.
b. If more resorption or blockage of eruption
persists for more than 6 months then;
• Brass wire looped and tightened around the contact point
and reviewed every 2 weeks
• Simple fixed appliance with bands on either E or 6 or both
with a spring activated in between with a TPA
• Extensive resorption and mesial drift then extract the E and
space management should be started

53. Ankylosed Primary Tooth
Ankylosis or ICRR of the primary tooth
a. When the permanent successor is present,
Maintaining it until an interference with the eruption or drift of
the adjacent teeth is observed, then extract and space
maintainer or FA to reposition and regain space lost.
b. If no successor is present then the tooth should be extracted
and adjacent teeth are brought into the space at least
partially to bring bone into the defect in preparation for
prosthetic replacement or space closure.
SPACE MAINTAINENCE IS CONTRAINDICATED

54. ICRR of a permanent tooth
• If shallow then cavity preparation and a
suitable filling
• If large or compromised crown status then
extract

55. Crossbite
Anterior crossbite
Posterior crossbite

56. Anterior Crossbite
• Should be assessed in CR that yields three
different scenarios;
a. True class III malocclusion then treatment as stated
previously or surgery.
b. Pseudo class III
c. Class I molar and canine relationships, then its treated by a
removable appliance with a Z-spring or a FA if needed and
elimination of any interferences

57. Posterior Crossbite
• Assess in CR and this might yields a three
scenarios;
a. CR coincident with CO with bilateral crossbite
b. CR not coincident with CO, bilateral crossbite in CR
shift to a unilateral crossbite
c. CR coincident with CO with unilateral crossbite
If a finger sucking habit is observed then use QH
providing the midsagital suture didn’t close
If sutural closure is anticipated then use
Jackscrew and plan for FA therapy.

58. Habits
 Digit-sucking habit “Non-nutritive Sucking
Habit”
 Tongue thrust
 Mouth breathing

59. Digit Sucking Habit
• Depends on frequency and intensity and
duration.
• Causes anterior open bite and/or posterior
crossbite
• The posterior crossbite is more associated
with pacifier use more than 18 months.
• The most important factor in habit
intervention is the child desire to stop that
habit.

60. Nondental Therapy
Appliance Therapy

61. Intervention is initiated by the time the upper centrals
are near eruption, starting with a simple talk to the
child as a grown up.
Reminder therapy.
If that fails then a reward system can be implemented.
If all of these fail, elastic bandage wrapped around the
elbow to prevent flexing of the arm and utilized at
night only for 6-8 weeks.
THE CHILD SHOULD BE SERIOUS ABOUT
WANTING TO STOP THE HABIT

62. • Appliance therapy is used when the
Nondental therapy fails to stop the habit
• Removable appliances are contraindicted
• Maxillary lingual arch with an anterior crib
device

63. Summary
• Orthodontic treatment is dependent on proper diagnosis and
treatment planning, with solid understanding of the etiology
of orthodontic problems.
• This is achieved by utilizing all the information provided by
the study casts, radiographs, photographs, intraoral and
extraoral examination, and thorough clinical examination and
patient interview.
• Interceptive orthodontics are an integral part of our specialty
and can improve patient oral and general well-being.
• Proper treatment timing can reduce patient suffering and
reduce treatment time and makes it easier for us to manage
further problems.

64. References
1. AAO, American association of orthodontics.
2. AAO website, www.aaoinfo.org
3. Orthodontics; Current Principles and Techniques sixth edition 2017,
Chapter 16, 34.
4. Contemporary Orthodontics, 2013 chapter 11.
5. Contemporary Orthodontics, 2013 chapter 12.

65. THANK YOU