This is presentation on 'Interceptive and Preventive Dentistry' for reference at BDS level.

1. PEDIATRIC DENTISTRY
SEMINAR ON
PREVENTIVE AND INTERCEPTIVE
ORTHODONTICS
Submitted by
Dr Tridib Goswami
(2010-11)

2. PREVENTIVE
AND INTERCEPTIVE
ORTHODONTICS

3. Index:
• Preventive Orthodontics
–
–
–
–
Parent Education
Caries control
Care of Deciduous Dentition
Maintenance of quadrant wise tooth shedding time
table
– Check up of oral habits and habit breaking
appliance if necessary
– Extraction of Supernumerary teeth
– Space maintenance

4. Index:
• Interceptive Orthodontics
–
–
–
–
–
–
–
Serial Extraction
Space regaining
Crowding
Correction of developing cross-bite
Midline Diastema
Muscle exercise
Interception of skeletal mal-relation
• Orthodontic Trainer
• Conclusion
• Reference

5. Introduction
• Preventive orthodontics is that part of
orthodontic practice which is concerned
with the patient and parent education,
supervision of growth and development of
dentition and the cranio-facial structure
which is largely the responsibility of a
general dentist.
• Many of the procedures are common in
preventive and interceptive orthodontics
but the timings are different.

6. Introduction
• Preventive is undertaken before the
malocclusion occurs where as Interceptive
is done once the malocclusion has already
manifested.
• Example :
– Extraction of supernumerary teeth is done
before they cause malocclusion is preventive
whereas in interceptive extraction is done after
the damage is done.

7. Preventive
Orthodontics

8. Definition:
• Preventive orthodontics –
Graber (1966) has defined
preventive orthodontics as the
actions taken to preserve the
integrity of what appears to be
normal occlusion at a specific time.

9. Parent Education:
• Preventive dentistry should ideally begin
much before the birth of the child.
• The expecting mother should be told about
nutrition and ideal environment for the
fetus's development.
• Soon after birth educate the parent about
nursing and care of the child, advise the
use of physiological nipple instead of the
conventional nipple in case of bottle
feeding which may lead to orthodontic
problems.

10. Parent Education
• Parent should be educated on nursing
bottle syndrome.
• Should be taught about maintenance of
good oral hygiene and correct brushing
habits.

11. Physiologic nipples,pacifiers ,
conventional nipples &Nursing
bottle caries

12. Caries Control:
• Caries involving proximal surface of
deciduous teeth if not restored may lead to
the loss of arch length due to mesial
drifting and create discrepancies between
the arch length and tooth material when
the bigger permanent teeth erupt.
• Caries should be detected using clinical
and radiographic examination.

13. Care Of Deciduous Dentition
• It includes timely check up’s of deciduous
dentition and restoration of carious tooth.
• As deciduous dentition act’s as an
excellent space maintainers care must be
taken to prevent premature loss of the
teeth.
• This can be accomplished by procedures
like pit and fissure sealant and fluoride
application.

14. Maintenance Of Quadrant Wise
Tooth Shedding Time Table
• There should not be more than 3 months
difference between shedding deciduous
tooth and eruption of permanent teeth.
• Factors leading to delay in eruption:
– Presence of over retained deciduous tooth
roots.
– Presence of unresorbed root fragments.
– Supernumerary tooth.
– Cyst or tumor.
– Fibrosis of gingiva
– Ankylosed primary teeth.

15. Check up of oral habits and habit
breaking appliance if necessary:
• Habits such as finger and thumb sucking , nail
biting tongue thrusting and lip biting should be
identified and stopped in time so as to prevent
mal-occlusion.
• Habit breaking appliances can be used to stop
these habits, they are of two kinds:
– Fixed habit breaker
• Example – Blue Grass Appliance
– Removable habit breaker
• Example – Palatal Crib
– Both the appliances act as a reminder and make the
habit an unhappy experience.

16. Adverse Habits
Thumb Sucking
Effect of thumb sucking
Effect of nail biting
Effect of lip biting

17. Habit Breaking Appliance
Fixed
Removable

18. Extraction Of Supernumerary
teeth:
• Presence of supernumerary teeth may
interfere with the eruption of nearby
normal teeth and cause mal-occlusion, so
must be extracted before it causes any
such problem.
• Presence of an unerupted mesiodense
should be identified and extracted before it
causes mal-occlusion in this case
approximation of the central incisors.

19. Supernumerary teeth:

20. Space Maintenance
• Space maintenance is done by providing
an appliance which only checks space
loss and is not concerned with
development of dentition.
• Premature loss of deciduous teeth can
cause drifting of teeth which may lead to
loss of space, to prevent this space
maintainers are provided.

21. Ideal requirements:
• Maintains mesio-distal dimension of
space.
• Should not interfere with vertical eruption
of adjacent tooth.
• Should provide mesio-distal space
opening when required.
• Maintain individual functional movement of
teeth

22. Classification
of Space
Maintainers

23. Removable Space Maintainers
Classification:• Unilateral maxillary posterior
• Unilateral mandibular posterior
• Bilateral maxillary posterior
• Bilateral mandibular posterior
• Bilateral maxillary anterior and posterior
• Bilateral mandibular anterior and posterior
• Primary/permanent anterior
• Complete primary teeth loss.

24. Removable Space Maintainers
Advantages
• Easy to clean permits maintenance of
proper oral hygiene.
• When appliance not worn allows blood
circulation to soft tissue.
• Room can be made for the erupting
permanent teeth without changing the
appliance.

25. Removable Space Maintainers
Disadvantage:
• Can be lost or broken by the patient.
• Uncooperative patients may not wear the
appliance.
• May cause irritation to the underlying soft
tissue.

26. Removable Space Maintainers
Acrylic Partial Denture
• Used in patients who have undergone
multiple extraction.
• Can be modified to allow eruption of teeth.
• Inclusion of artificial teeth in denture
restores masticatory function.

27. Before and after
placement of acrylic
partial denture

28. Removable Space Maintainers
Full or Complete Denture
• In some cases like in Rampant caries all
primary teeth may require extraction in
which case this complete denture is given.
• These dentures not only restore
masticatory function along with esthetics,
but also guide the I permanent molar into
position.
• During the eruption of the permanent
incisors a portion of the denture is cut
away and adjusted accordingly.

29. Removable Space Maintainers
Removable Distal Shoe Space Maintainer:
• This is an immediate acrylic partial denture
which is put into position immediately after
extraction so as to guide the I permanent
molar when the II deciduous molar is lost
prematurely.
• The acrylic extends into the alveolus after
removal of the primary tooth which is
removed after eruption of the permanent
tooth.

30. Fixed Space Maintainers
Advantages:
• Bands and loops used require no or
minimal tooth preparation.
• Jaw growth is not hampered.
• Can be used in uncooperative patients.
• Masticatory function restored if pontics are
used.

31. Fixed Space Maintainers
Disadvantage:
• Elaborate instrumentation with expert skill
required.
• Supra eruption can take place if pontics
not used.
• There can be decalcification of tooth
material under the bands.

32. Fixed Space Maintainers
Band and Loop Space Maintainer:
• It is a unilateral fixed appliance used for
posterior segments.
• Most commonly used space maintainer.
• Tooth distal to the extraction site is banded
and a loop of thick stainless steel wire is
soldered to it with it’s mesial end touching
the tooth mesial to the extraction site.

33. Fixed Space Maintainers
Band and Loop Appliance:
Construction:
• The larger tooth, the II deciduous Molar is
used.
• A loop of thick stainless steel wire is
soldered to the band which spans the
edentulous area and contacts the
abutment tooth below the contact area.
• The loop is contoured to rest on the
tissues on both sides with an opening in
the loop sufficient to allow eruption of the
cusp of the underlying permanent tooth.

34. Fixed Space Maintainers
Band and Loop Space Maintainers:
Advantages:
• Low cost factor.
• Takes little chair time.
• Can be adjusted easily to accommodate
changing dentition
Disadvantages:
• Does not prevent continued supra-eruption
of opposing tooth.
• Caries check is difficult.
• Oral Hygiene maintenance is difficult.

35. Showing band and loop appliance on one side
and crown and loop on the other.

36. Fixed Space Maintainers
Crown And Loop Appliance:
• In this appliance crown is used along with
a loop in the same manner as in band and
loop appliance.
• Crown is preferred in case of the abutment
tooth is highly carious.
• In case the abutment tooth has had vital
pulp therapy.
Construction:
• It is the same as that of the band and loop
difference being instead of a band a crown
is used.

37. Fixed Space Maintainers
Crown And Loop Appliance:
Advantage:
• The crown increases the life of the
underlying weakened tooth.
• They also prevent the supra-eruption of
the opposing tooth.
Disadvantage:
• It is difficult to remove the crown to make
adjustments in the loop.

38. Fixed Space Maintainers
Lingual Arch Space Maintainers:
• Most effective space maintainer for the
lingual arch.
• Consists of bands on the I permanent
molars or II deciduous molars which is
joined by a stainless steel wire contacting
the lingual surface the 4 mandibular
incisors.
• This device prevents mesial drifting of the
molars and also the lingual collapse of the
anterior teeth.

39. Fixed Space Maintainers
Lingual Arch Space Maintainers:
Construction:
• The wire should be made to contact the
cingula of mandibular incisors slightly
above the gingival papilla.
• Posteriorly the wire extended should
maintain 3-4 mm contact with the lingual
surface of the band to provide for long
solder joint.

40. Fixed Space Maintainers
Lingual Arch Space Maintainers:
Advantage:
• Allows eruption of permanent teeth without
interference.
• Ease of cleaning for proper Oral Hygiene.
Disadvantage:
• May cause unwanted movement.
• Does not prevent supra-eruption of
opposing teeth.

41. Lingual Arch Space Maintainer

42. Fixed Space Maintainers
Palatal Arch Appliance/ Nance Palatal
Appliance:
• It is similar in design as that of the lingual
arch difference being the wire does not
contact the anterior teeth.
• It incorporates an acrylic button in the
anterior region that contacts the palatal
tissue.
• It prevents the
mesial drifting of the
maxillary molars.

43. Fixed Space Maintainers
Nance Arch Appliance:
Construction:
• The wire should extend from the deepest
and most anterior point in the middle of
hard palate.
• ‘U’ bend is given in the wire for retention of
the acrylic 1-2 mm away from the soft
tissue.
• The acrylic button provides excellent
resistance against forward movement.
• Posteriorly the wire is soldered to the
molar bands.

44. Fixed Space Maintainers
Palatal Arch Appliance/ Nance Palatal
Appliance:
• Advantage:
• Maintains space bilaterally.
• Does not contact the maxillary incisors so
better oral hygiene can be maintained.
• Disadvantage:
• May cause tissue hyperplasia and
infection due to poor oral hygiene.
• Does not prevent supra-eruption of
opposing teeth.

45. Nance Space Holding Appliance

46. Fixed Space Maintainers
Transpalatal arch:
• Stabilizes the maxillary I permanent
molars
• Consists of thick stainless steel wire that
spans the palate connecting the bands on
I molar on either side.
• Best indicated when one side of the arch is
intact and the other has several missing
primary teeth.

47. Fixed Space Maintainers
Transpalatal arch appliance:
Construction:
• The arch is soldered to molar bands
present on the I permanent maxillary
molars of both sides.
• The arch is straight, without any button
and does not touch the palate.

48. Fixed Space Maintainers
Transpalatal arch appliance:
Advantage:
• Prevents rotation of the tooth.
• No soft tissue irritation on the palate.
Disadvantage:
• May cause both the molars to tip together.
• Can be used only in the case of unilateral
tooth loss, one side must be intact.

49. Transpalatal arch

50. Fixed Space Maintainers
Distal shoe space maintainer:
• This appliance guides the I permanent
molar into position when the II deciduous
molar is prematurely removed.

51. Fixed Space Maintainers
Distal Shoe Space Maintainer:
Construction:
• In the lower arch, the contact area of the
distal extension should have a slight
lingual position while in maxillary should
be slightly facial over the crest of the
alveolar ridge.
• Adequate width must be provided or the
tooth may slip.
• The length of the distal extension should
be the same as the mesio-distal dimension
of the II deciduous molar.
• The gingival extension should be
constructed to extend 1 mm below the
marginal ridge.

52. Fixed Space Maintainers
Distal Shoe Space Maintainer:
Advantage:
• Guides the I permanent molar into it’s
position before it’s occlusal eruption.
Disadvantage:
• Over extension causes injury to permanent
tooth bud.
• Prevents complete epithelialization of the
extraction site.

53. Interceptive
Orthodontics

54. Definition:
• Interceptive orthodontics –
The American Association of
orthodontists (1969) defined
interceptive orthodontics as the phase
of science and art of orthodontics
employed to recognize and eliminate
the potential irregularities and malpositioning in the developing dentofacial complex.

55. Serial Extraction:
• It is correctly timed and planned
removal of deciduous and
permanent teeth in mixed
dentition stage.

56. Serial Extraction:
Indication:
– Class 1 anterior crowding.
– Lingual eruption of lateral incisors.
– Midline shift potential due to unilateral canine
loss.
– Ankylosis of tooth.
Contraindication:
–
–
–
–
Mild to moderate crowding.
Deep or open bite
Midline Diastema.
Cleft lip and palate cases.

57. Serial Extraction
Advantage:
– Better oral hygiene is possible.
– It eliminates or reduces the duration of
multibanded fixed treatment.
– More stable results obtained.
Disadvantage:
– Treatment time is prolonged.
– Extraction of buccal teeth can result in
deepening of bite
– Requires patient to visit the dentist often.

58. Space Regaining
• The treatment which is done so as
to regain the space which is lost due
to space closure following early loss
of deciduous teeth.
• Appliance used for regaining the
space are called space regainers.

59. Fixed Space Regainers
Open Coil Space Regainer:
• This is a reciprocal active space regainer
which is used once the I premolar has
erupted so as to create space for the II
premolar.
Radiograph Showing Pre and Post Space Regaining

60. Space Regaining
Open Coil Space Regainer
Construction:
• Molar band is fitted on the I permanent molar to
which molar tubes are soldered or spot welded
horizontally both bucally and lingually.
• A stainless steel wire which is slightly smaller than
the tube size is selected and bent into a ‘U’ shape,
the base of which should contain a reverse bend to
contact the distal surface of the I premolar.
• A spaced coil is selected which will slide on the
wire.
• The band is cemented with the spring coil
compressed.

61. Fixed Space Regainers
Greber’s Space Maintainer:
• This appliance can easily be fabricated in
the mouth in a single short appointment.
Construction:
• A ‘U’ shaped assembly which may be welded
or soldered , is fitted in the tube, the appliance
placed and the wire section extended to
contact the tooth mesial to the edentulous
area.
• Push coil springs are used which is measured
and cut adding 1-2 mm extra to allow spring
activation.
• The springs are compressed enough to allow
the assembly to fit into the edentulous area.

62. Greber’s Space Regainer

63. Fixed Space Regainers
Hotz Lingual Arch:
• This is a device used for moving the molar
diatally.
• It is best suited for a situation where the I
molar had drifted mesially but the premolar
or cuspid has not.
• Anchorage for movement is achieved as
the arch contacts all the teeth.

64. Fixed Space Regainers
Lip Bumper:
• The appliance is most easily used for the
space regaining procedure in which
bilateral Movement is desired.
• It is used to relief the lip pressure which
can be used to distallize the molars.
Construction:
• It consists of a heavy labial arch wire over
which a heavy acrylic flange is prepared in
the anterior region such that it does not
contact the lower anterior.

65. Lip Bumper
Pre treatment and post treatment
photographs showing distal
movement of molars and alignment
of the incisors

66. Fixed Space Regainers
Anterior Space Regainer:
• This is a device used for anterior space
regaining direct bonding is done to attach
the labial tubes to the lateral incisors.
• The pressure is generated by an activated
open coil spring.

67. Removable Space Regainer
Free End Space Regainer:
• It utilizes a labial arch wire for stability and
retention, with a back-action loop spring .
• The base of the appliance is made of
acrylic resin.
• Movement of the permanent molar is
achieved by activating the free end wire
loop.

68. Free End Space Regainer

69. Removable Space Regainer
Split Saddle Space regainer:
• In this the functional part of the appliance
consists of a block that is split buccolingually and joined by a wire in the form of
a buccal and lingual loop.
• Appliance is activated by periodic
spreading of the loops.

70. Removable Space Regainer
• Jack Screw:
• In this appliance the space is regained by
expansion of the screw in the edentulous
space expanding the plates anterioposteriorly.

71. Jack Screw Appliance

72. Crowding
• It is a condition where the tooth are not in
there normal position in the arch they are
abnormally placed.
• It occurs when there is inadequate arch
circumference to accommodate the teeth
in proper alignment.

73. Crowding
Maxillary and Mandibular Arch of the same patient
showing crowding

74. Crowding
Options for management of crowding:
• Observe – In some cases the crowding is
self correcting so, no treatment is required.
• Disc Primary Teeth – Sometimes the
primary teeth prevents the incisors to align
itself, in such cases the primary teeth is
proximally stripped using a bur or a
proximal stripper.
• Extraction Of Teeth – In some cases
extraction of teeth is required so as to
create space.
Proximal Stripper

75. Correction Of Developing
Crossbite:
Crossbite :
• Anterior cross bite is an abnormal labiolingual relationship between one or more
of the anterior teeth while posterior
crossbite it is an abnormal bucco-lingual
relationship of a tooth or teeth in the
maxilla or mandible, or both, in centric
relationship.

76. Classification Of Crossbite:
•
•
•
•
Anterior or Posterior
Unilateral or Bilateral
True or Functional
Combination of the above

77. Crossbite
Pre treatment and
post treatment Photographs

78. Crossbite
Correction can be done by using:
• Z – spring
• Tongue blade
• Lower anterior inclined plane
• Appliance with screw and Z – spring
• Elastic bands

79. Use of Z-spring for anterior
crossbite correction

80. Use of tongue blade therapy for
anterior crossbite

81. Use of lower
anterior inclined
plane to correct
anterior crossbite

82. Correction with
appliance
incorporating screw
and Z-spring

83. Post treatment

84. Midline Diastema
• It is defined as space greater than 0.5 mm
between the proximal surface of adjacent
teeth.

85. Midline Diastema
Correction:
• Removable Appliance like Active Plate or
Split labial bow can be used.
• Fixed Appliances like Stainless steel
brackets with wire or elastic band or both
can be used.
• Presently for esthetic reasons lingual
appliances may be used for the same.

86. Reduction of midline
diastema

87. Muscle Exercises
• Dental tissues are surrounded by muscles
from all directions.
• It is vital for these muscles to have normal
function for the proper development of
dentition.
• So as to regain the normal strength of the
required muscle certain Muscle exercises
are advised.

88. Muscle Exercises
Exercise of the Masseter Muscle:
• Patient is asked to clench the teeth while
counting up to 10 and then release.
• This is repeated for some duration of time.

89. Muscle Exercises
• Exercise for the lips:
• Button Pull Exercise – A button of half
inch Diameter is used through which a
thread is passed n the placed behind the
lips, the thread is pulled by the patient
while he resist’s the buttons removal from
the mouth using lip pressure.
• Tug of war exercise – It is similar to the
above mentioned difference being two
buttons are used, one placed behind the
lips and the other is pulled by another
person.

90. Muscle Exercises
• Exercise For The Tongue:
– One Elastic swallow
– Two Elastic swallow
• These exercise are used to correct
improper swallowing.
– The Hold Pull Exercise
• This is used to stretch the lingual
frenum.

91. Interception Of Skeletal
Malocclusion
Interception Of Class II Malocclusion:
• Occurs as a result of excessive maxillary
growth or a deficient mandibular growth or
a combination of both.
• Such growth can be restricted with the use
of Face bow with head gear.
• Treatment is done by myo-facial
appliances.

92. For Class II correction

93. Interception Of Skeletal
Malocclusion
Interception Of Class III Malocclusion:
• Occurs as a result of mandibular
proganthism or maxillary retoganthism or a
combination of both.
• Chin up with head gear helps in restriction
of mandibular growth.

94. Class III Correction

95. Pre-orthodontic Trainer
• It is pre-fabricated, single size and ready
to use.
• Requires no impression and takes minimal
chair time.
• Designed specifically for mixed dentition
stage
• Two types are available:
– Starting/Phase 1, blue in colour and soft to
wear.
– Finishing/Phase 2, pink in colour and is harder.

96. Pre-orthodontic Trainer

97. Conclusion
The first step in maintaining good dentition is
to maintain good oral hygiene and control abnormal
oral habits which itself will reduce the requirement of
orthodontic treatment by a substantial amount.
The best treatment is prevention, so if at the
preventive stage itself we can evade malocclusion it
is less traumatic and also cost effective to the
patient. If incase we are unable to prevent the
malocclusion we must intervene to avoid adverse
occlusal and dental consequences. The use of such
orthodontics can prevent and stop the occurrence of
malocclusion leaving a beautiful arch and a confident
smiling face.

98. S.No.
Book
Author
Editions
1.
Text book of Pedodontics
Shobha Tandon
2nd
2.
Orthodontics
S.I. Bhalajhi
4th
The Art And Science
3.
Dentistry For Child And Adolescent Mc Donald
8th
4.
Text Book Of Pedodontics
Fenn
4th
5.
Principles And Practice Of
Arathi Rao
3rd
Pedodontics
6.
Internet

99. THANK YOU