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Definitions and Terms
Preventative early treatment
Patient education and maintenance of a favorable
orthodontic condition. (e.g. patient education of stopping
digit sucking habits, space maintenance appliances)
Interceptive early treatment
Improvement of an orthodontic problem. (e.g. primary tooth
guidance extractions, reduction of excessive overjet, growth
modification
appliances, space redistribution, space creation, deep bite
reduction, habit
appliances)
Corrective
Complete or nearly complete correction of an orthodontic
problem. (e.g. crossbite correction, growth modification
alignment of teeth)

 Definition:
Defined as that phase of the science and
art of orthodontics employed to recognize &
eliminate potential irregularities & malpositions
of the developing dento-facial complexes.
 Unlike preventive orthodontic procedures,
interceptive orthodontics is undertaken at a time
when the malocclusion has already developed or
is developing .Thus interceptive orthodontics
basically refers to measures undertaken to
prevent a potential malocclusion from
progressing into a more severe one.


 Definitions:
Any procedure that eliminates or reduces
the severity of malocclusion in the
developing dentition.(Popovich and
Thompson 1979, Hiles 1985.)
All simple measures that eliminate the
developing malocclusion. (Ackerman and
Proffit 1980)

 Many of the procedures are common in
preventive and interceptive orthodontics but
the timings are different
 Preventive procedures are undertaken in
anticipation of development of a problem.
whereas interceptive procedures are taken
when the problem has already manifested.

Preventive group includes
• Parent and Patient Education
• Caries control
• Care of deciduous dentition
• Extraction of supernumerary teeth
• Eliminating occlusal interference
• Management of Quadrant wise Tooth
Shedding timetable.
• Management of ankylosed tooth
• Management of abnormal frenal attachment
• Oral habit checkup
• Prevention of Milwaukee brace damage
• Space maintenance

 Guide jaw growth
 Lower the risk of trauma to the protruded
front teeth
 Correct harmful habits like thumb sucking,
tongue thrusting, lip wedging
 Improve appearance and self–esteem
 Guide permanent teeth into a more favorable
position
 Improve the way lips meet

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

 Serial Extraction is an interceptive
orthodontic procedure usually initiated in
the early mixed dentition.
 It is a procedure that includes the planned
extraction of certain deciduous teeth & later
specific permenent teeth in an orderly
sequence & pre-determined pattern to guide
the erupting permenent teeth into a more
favourable position.

 Kjellgren (1929) used the term “Serial extraction”
to describe a procedure where some deciduous
teeth followed by permenent teeth were extracted
to guide the rest of the teeth into normal
occlusion.
 Nance during 1940’s popularized this technique in
united states of AMERICA, termed it “planned &
progressive extraction” & has been called the
‘father’ of Serial extraction philosophy in united
states.
 Hotz in 1970 called such a procedure “active
supervision” of teeth by extraction.

Based on 2 basic principles:
 Arch-length tooth material discrepancy---Tooth
material >arch length…hence, teeth extracted….so
that rest of tooth occlude normally.
 Physiologic tooth movement----
Removal some teeth,let’s the rest of the
teeth(which are erupting) to be guided by natural
forces to extraction spaces.

6.Patients with straight profile and pleasing appearance
7. Where growth is not enough to overcome the discrepancy
between tooth material and basal bone.

Contraindications of Serial Extraction
 Class II & III malocclusion with skeletal abnormalities.
 Space dentition.
 Anodontia/ oligodontia.
 Open bite & deep bite.
 Midline diastema.
 Class I malocclusion with minimal space deficiency.
 Unerupted malformed teeth. Eg. Dilacerations.
 Extensive caries or heavily filled I permenent molars.
 Mild disproportion between arch length & tooth material.

 Treatment is more physiologic as it involves guidance of
teeth into normal positions.
 Psychological trauma associated with malocclusion can be
avoided by treatment of the malocclusion at an early
stage.
 It eliminates the duration of multi-banded fixed
treatment.
 Better oral hygiene is possible thereby reducing the risk of
caries.
 Health of investing tissue is preserved.
 Lesser retention period is indicated at the completion of
treatment.
 More stable results are achieved as the tooth material &
arch length are in harmony.

Disadvantages of Serial Extraction:
 It can not be universally applied to all patients.
 Treatment time is prolonged as the treatment is carried
out in stages spread over 2-3 years.
 It requires the patient to visit the dentist thus patient
co-operation is needed.
 As the extraction spaces are created that close gradually
the patient has a tendency of developing tongue thrust.

 Extraction of buccal teeth can result in deepening of the
bite.
 If the procedure are not carried out properly there is a
risk of arch length reducing by mesial migration of the
buccal segment.
 Ditching or space can exist b/w the canine & 2nd
premolar.
 The axial inclination of teeth at the termination of the
serial extraction procedure may require correction.

There are mainly three methods:-
•Dewel’s Method
•Tweed’s Method
•Nance method.

Dewel has proposed a 3 step serial
extraction procedure.
In the 1st Step, the deciduous canines are
extracted to create a space for alignment of
the incisors.
 This step is carried out at 8-9 years of
age.

 After 1 years, the deciduous 1st molars
are extracted so that the eruption of 1st
premolars is accelerated.

 This is followed by the extraction of the erupting
1st premolar to permit the permanent canines to
erupt in their place.

 In some cases, a Modified Dewel’s Technique
is followed where in the 1st premolar are
enucleated at the time of extraction of the 1st
deciduous molars.
 This is frequently necessary in the
mandibular arch where the canines often
erupt before the 1st PM

TWEED’S METHOD:
 This method involves the extraction of the
deciduous 1st molars around 8 years of age.
 This is followed by the extraction of the 1st
premolar & the deciduous canines.

This is similar to the Tweed’s technique &
involves the extraction of the deciduous 1st
molars followed by the extraction of the 1st
Premolars & the deciduous canines.

 Severe arch length discrepancies
>10mm space required
Shallow to normal overbite
Fuller lips/profile
Class I malocclusion
 Serial extraction, if successful, would still
necessitate comprehensive orthodontic
treatment

 Anterior cross bite is a condition characterized
by reverse overjet wherein one or more maxillary
anterior teeth are in lingual relation to the
mandibular teeth.
 Should be intercepted and treated at an early
stage to prevent a minor orthodontic problem
from progressing into a major dento-facial
anomaly.as an old maxim states
 “The best time to treat a crossbite is the first time it is
seen”
Or else it may grow into skeletal malocclusion
Classification:
 Dento-alveolar anterior crossbite.
 Skeletal anterior crossbite.
 Functional anterior crossbite.

Dento-alveolar anterior crossbite:
 One or more maxillary anterior teeth are in
lingual relation to the mandibular anteriors.
 Treated using tongue blades ,catalan’s
appliance and double cantilever springs.
Functional anterior crossbite:
 Pseudo class III malocclusion.., where the
mandible is compelled to close in a position
forward of it’s true centric relation.
 Treated by eliminating occlusal prematurities.
Skeletal anterior cross-bite:
 Treated by myofunctinal or orthopaedic
appliances

 Habit’s refers to certain actions involving the
teeth and other oral or perioral structures which
are repeated often enough by some patients to
have a profound and deleterious effect on the
positions of teeth and occlusion.
Some such habits are:
 Thumb sucking
 Tongue thrusting
 Mouth breathing

Local factors: THUMB SUCKING
 At what age should treatment be started?
-Da Silva et al (1991) “from the 5th year of age
-Proffit (1993) “before the eruption of
permanent incisors”
-Houston (1993) “ by 7-8 years of age “
-Mills (1982) “before permanent dentition”
-Larsson (1987) “before pubertal growth spurt”

Thumb sucking:
 Most frequently practiced by children.
 Causes damaging effect on dento-alveolar
structures.
 It’s presence upto2-1/2 to 3-4 years age is
considered normal.
 Persistence beyond 3-1/2 to 4 years have
damaging effect.& should be
intercepted
 Intercepted by use of HABIT BREAKERS that
could be removable or fixed.

Tongue thrusting:
 Condition in which tongue makes contact
with any teeth anterior to the molars during
swallowing.
 Deleterious habit , can clinically present
along with open bite and anterior
proclination.
 Intercepted using HABIT BREAKERS.&
trained for correct technique of swallowing.

 Early loss of primary molar and failure to use space
maintainers may lead to reduction in arch length by
mesial movement of 1st molars.
 Space regained by distal movement of first molar. Which
is undertaken at an early age prior to eruption of second
molar.
Commonly used space regainers:
 Gerber’s Space Regainer:
An ‘U’ tube and an ‘U’ rod .Rod inserted into tube
with activated spring at free ends of rod.
 Jack Screws:
Split acrylic plate with jack screw in relation to
edentulous space.Retained using Adam’s clasps.
 Cantilever Spring:
Removable appliances that incorporate simple finger
springs.

Mouth breathing:
 Obstructive-nasal polyps ,tumors
,inflammations ,deviated septum
 Habitual –persistence of habit after removal
of the obstruction.
 It affects the orofacial equilibrium due to
lowered mandible & tongue posture. And
hence cause malocclusion.
 Intercepted by identifying and removing the
cause. If persists , VESTIBULAR SCREEN can
be used.

 Muscle exercises helps in developing improving aberrant muscle
functions.
 Masseter:
Clenching of teeth while counting till ten.
 Lips:
Stretching of upper lipto maintain lip seal(paper may be held b/w
lips)--for
hypotonic lip patients.
Stretch upper lip downwards towards chin.
Hold & pump water back & forth behind lips.
Massaging of the lips.
Button pull exercise:-1/2 inch button-thread passed through
buttonhole…place button behind lips & pull thread, By using lip
pressure.
 Tongue:
One elastic swallow
Tongue hold exercise.

 Interception of class II malocclusions:
Causes: Excess maxillary growth.
(Restricted by facebow with headgear)
Defficient mandibular growth.
(Myofunctional appliances)
Combination of both.
 Interception of class III malocclusions:
Causes: Mandibular prognathism.(Chin cap with head gear)
Maxillary retrognathism ( Face mask therapy )
Combination of both

GROWTH MODIFICATION
CLASS II (EARLY TREATMENT)
PRE-TREATMENT
CLASS II DIVISION 1
MIDDLE MIXED DENTITION
EARLY TREATMENT
(PHASE I)
EXTRA-ORAL TRACTION
CERVICAL HEADGEAR

 Excessive protrusions and
diastemas
These may lead to injury or avulsions
They are often reasons why kids get
teased
Thus, they affect the child’s self-
esteem
As the condition persists, the
mandibular lip may become
entrapped behind the maxillary
incisors, further perpetuating the
problem

 In Class II Div. 1
treatment, the upper
arch has to be
expanded
transversely to a
minor extent in order
to conform the lower
arch

A functional component
that has a use in
conjunction with a lower
fixed appliances to enforce
anchorage
It has been suggested that
it can be incorporated into
lower removable appliance
(Bell 1983)

 In Class II Division 2
upper incisors can be
procline some what
more than average
inclination and
anterior bite plane to
assist in reduction of
the overbite by using
removable appliance
for both treatment

 Pseudo Class III patients
◦ Class III patients which have a discrepancy between
centric relation and maximum intercuspation may
have a pseudo Class III
◦ This condition should be treated as soon we
recognize the symptoms before it develops into a
true Class III malocclusion
◦ Tt options – removal of premature contacts
- tongue position correction
-removal of airway obstruction

 True Class III malocclusions due to a
mandibular prognathism or maxillary
retrognathism
This condition is best treated early between the
ages of 8-12
This is a time when the mandible is undergoing
active growth which can be modified to the
patient’s advantage

TREATMENT OPTIONS
 Chin cap
Facemask
Reverse Twin Block
 FUNCTIONAL
APPLIANCES –Functional
regulator – Class III

CLASS III MALOCCLUSION
FUNCTIONAL APPLIANCE
FUNCTIONAL REGULATOR III
(FRANKEL III)

 Failure of teeth to erupt in appropriate time should
be intercepted by surgically exposing the crown.
 Over retained primary teeth, ankylosed primary
teeth & supernumerary teeth are possible causes of
non-eruption of succedaneous teeth . The soft
tissue and any bone overlying it are removed.
tissue is removed to that extent such that the
greatest diameter of the crown of the tooth is
exposed.

Local factors: DELAYED ERUPTION OF UPPER
PERMANENT CENTRAL INCISOR.
 Definition: 1 is considered to be delayed if
the contra-lateral tooth was fully erupted or
if teeth later in the usual eruption sequence
were present.
 Interceptive treatment: removal of
supernumerary with or without tooth
exposure.
 Treatment timing: as soon as the
supernumerary tooth is detected.

Local factors:RETAINED DECIDUOUS
TEETH.
 Definition: the deciduous tooth is considered
to be over retained if it made enamel contact
with its successor.
 Interceptive treatment: extraction.

Local factors:DIASTEMA
 Definition: space between the two upper
central incisors.
 Treatment if indicated: removal of pathology
(supernumerary, odontome, fraenum?….)

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