Interceptive orthodontics /certified fixed orthodontic courses by Indian dental academy

INTERCEPTIVE
ORTHODONTICS
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INDIAN DENTAL ACADEMY
Leader in continuing dental education
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INTERCEPTIVE
ORTHODONTICS
DefDef : It is that phase of art & science of: It is that phase of art & science of
Orthodontics employed to recognize andOrthodontics employed to recognize and
eliminate any potential irregularities oreliminate any potential irregularities or
malpositions in the developing dentofacialmalpositions in the developing dentofacial
complex.complex.

INTERCEPTIVE ORTHODONTICS
ProceduresProcedures
 Space regainingSpace regaining
 Serial ExtractionSerial Extraction
 Control of abnormal HabitsControl of abnormal Habits
 Correction of Developing X-biteCorrection of Developing X-bite
 Diastema closureDiastema closure
 Muscle ExercisesMuscle Exercises
 Removal of Premature contactsRemoval of Premature contacts
 Interception of Skeletal malrelationshipInterception of Skeletal malrelationship
 Removal of Soft tissue or bony barrier to eruptionRemoval of Soft tissue or bony barrier to eruption
of teethof teeth www.indiandentalacademy.comwww.indiandentalacademy.com

SPACE REGAININGSPACE REGAINING
Regaining space in Arch PerimeterRegaining space in Arch Perimeter
ConditionsConditions ––
1) One or more primary teeth have been lost.1) One or more primary teeth have been lost.
2) Some space in the arch is lost due to mesial drift2) Some space in the arch is lost due to mesial drift
of first permanent molars.of first permanent molars.
3)To recapture the space in dentition which was3)To recapture the space in dentition which was
once there (According to Mixed Dentitiononce there (According to Mixed Dentition
analysis.)analysis.)

Mesial Drift of Permanent Molars-Mesial Drift of Permanent Molars-
 During mesial drift 3 kinds of tooth movements areDuring mesial drift 3 kinds of tooth movements are
possible-possible-
Mesial crown tippingMesial crown tipping
RotationRotation
TranslationTranslation
 Where maxillary second primary molars are lostWhere maxillary second primary molars are lost
maxillary first permanent molars generally tipmaxillary first permanent molars generally tip
mesially. It cause DB cups to become moremesially. It cause DB cups to become more
prominent occlusally.till more prominent buccally.prominent occlusally.till more prominent buccally.

 When second primary molar is lostWhen second primary molar is lost before thebefore the
eruption of 1st permanent molar, during eruptioneruption of 1st permanent molar, during eruption
of 1st permanent molar, translation is observed.of 1st permanent molar, translation is observed.
 Mandibular 1st permanent molars showMandibular 1st permanent molars show – mesial– mesial
tipping – Rotation – Translationtipping – Rotation – Translation
 AdditionallyAdditionally they show –they show – Lingual tippingLingual tipping duringduring
mesial movement due to absence lingual root .mesial movement due to absence lingual root .

 Depending upon the type of movement requiredDepending upon the type of movement required
the space regaining Appliance is to be used.the space regaining Appliance is to be used.
 Tipping & rotationTipping & rotation back usually occurback usually occur
Comfortably withComfortably with finger springfinger spring & they should& they should
attempted before translationattempted before translation

 Simple finger springs cannot move molars bodily.Simple finger springs cannot move molars bodily.
They Cannot overextend the arch perimeter pastThey Cannot overextend the arch perimeter past
its original dimensionits original dimension
 TimingTiming – Before the eruption of second permanent– Before the eruption of second permanent
molarsmolars
 LimitsLimits - Space regaining procedures should be- Space regaining procedures should be
limited to reestablish 3 m.m. or less space.limited to reestablish 3 m.m. or less space.
 Space is easier to regain in Maxillary arch than inSpace is easier to regain in Maxillary arch than in
mandible. Because of increased anchorage formandible. Because of increased anchorage for
removable appliances is offered by palatal vault &removable appliances is offered by palatal vault &
possibility of use of Extra- oral force.possibility of use of Extra- oral force.

SPACE REGAINING APPLIANCESSPACE REGAINING APPLIANCES
 Removable Appliance – Ideal design for tipping one molarRemovable Appliance – Ideal design for tipping one molar
 Components – Retentive – Adam’s claspComponents – Retentive – Adam’s clasp
Active – Helical finger springActive – Helical finger spring
base plate – Acrylicbase plate – Acrylic
 Activation- one posterior tooth can be moved up to 3 m.m.Activation- one posterior tooth can be moved up to 3 m.m.
distally during 3 to 4 months and full time appliance wear.distally during 3 to 4 months and full time appliance wear.
 The spring is activated approx 2 m.m. to produceThe spring is activated approx 2 m.m. to produce
1m.m. movement / month1m.m. movement / monthwww.indiandentalacademy.comwww.indiandentalacademy.com

 Removable appliances can be used for space regarding inRemovable appliances can be used for space regarding in
mand arch . But they to distort &are prone to breakage , &mand arch . But they to distort &are prone to breakage , &
may be difficult to retain . Tissue irritation is also a problemmay be difficult to retain . Tissue irritation is also a problem
& thus patient’s co-operation to wear the appln is poor& thus patient’s co-operation to wear the appln is poor
 Use of screw for space regaining is also advocated.Use of screw for space regaining is also advocated.
 Active lingual arch is also used for mandibular spaceActive lingual arch is also used for mandibular space
regainingregaining

 A lip bumperA lip bumper is also used as a space regaining applianceis also used as a space regaining appliance
in mandibular arch. It is Constructed of anin mandibular arch. It is Constructed of an .036.036” wire bow” wire bow
with an acrylic pad which fits into tubes on permanent firstwith an acrylic pad which fits into tubes on permanent first
molars. It increases length of arch by moving the molarsmolars. It increases length of arch by moving the molars
distally. The lower lip transmit force on lip bumper todistally. The lower lip transmit force on lip bumper to
move the molars back.move the molars back.

 When space regaining by tipping is neededWhen space regaining by tipping is needed bilaterally orbilaterally or
when bodily movement is required E/O forcewhen bodily movement is required E/O force is the choiceis the choice
of treatment.of treatment.
 Approx.Approx. 100-200100-200gms force on each sidegms force on each side 14-16 hours14-16 hours oror
more wear of H.G./Daymore wear of H.G./Day
 ToTo tip molarstip molars, the outer bow of H.G. must be accurately, the outer bow of H.G. must be accurately
placed so that the resultant force vector passesplaced so that the resultant force vector passes occlusal toocclusal to
center of resistancecenter of resistance, which is near the midpoint of the root, which is near the midpoint of the root

 For tipping movementFor tipping movement – with neck strap– with neck strap
attachment – The outer bow should be long &attachment – The outer bow should be long &
should extend Posteriorly near to the ear lobeshould extend Posteriorly near to the ear lobe
 For bodily movementFor bodily movement – The outer bow must be– The outer bow must be
positioned so that the resultant force is through orpositioned so that the resultant force is through or
above the center of resistance. The outer bowabove the center of resistance. The outer bow
should be shorter & higher & Head cap orshould be shorter & higher & Head cap or
combination of head cap & head strap is required.combination of head cap & head strap is required.
 Asymmetric face BowAsymmetric face Bow – To deliver more forces to– To deliver more forces to
one side of the arch.one side of the arch.

SERIAL EXTRACTION

 In cases of class I Malocclusion whereIn cases of class I Malocclusion where toothtooth
material and basal bone discrepancymaterial and basal bone discrepancy is present.is present.
ExpansionExpansion of the arches was the choice of theof the arches was the choice of the
treatment during the yrs-1930-1940.treatment during the yrs-1930-1940.
 However the clinicians later found that suchHowever the clinicians later found that such
expansion procedures did not provide for stableexpansion procedures did not provide for stable
results and resulted in relapseresults and resulted in relapse. There fore during. There fore during
early 1940 the wave of expansionism precipitatedearly 1940 the wave of expansionism precipitated
&& extraction of tooth / teethextraction of tooth / teeth became thebecame the
choice of the treatmentchoice of the treatment

 It wasIt was kjellgren in 1929kjellgren in 1929 who coined the termwho coined the term
‘Serial extraction‘Serial extraction’ to describe a procedure where’ to describe a procedure where
some deciduous teeth were extracted andsome deciduous teeth were extracted and
followed by extraction of permanent teeth tofollowed by extraction of permanent teeth to
guide the rest of the teeth into normal occlusionguide the rest of the teeth into normal occlusion
 NanceNance during 1940’sPopularized this techniqueduring 1940’sPopularized this technique
in USA and termed it planned and progressivein USA and termed it planned and progressive
extraction.extraction.
 HotzHotz in 1970 called this procedure as Activein 1970 called this procedure as Active
supervision of teeth by extraction.supervision of teeth by extraction.

PrinciplesPrinciples
1)1) Arch length – tooth material discrepancyArch length – tooth material discrepancy ––
Whenever there is excess of tooth material inWhenever there is excess of tooth material in
relation to arch length it is advisable to reducerelation to arch length it is advisable to reduce
tooth material. This principle is utilized intooth material. This principle is utilized in
serial extraction procedures where toothserial extraction procedures where tooth
material is reduced by selective extraction ofmaterial is reduced by selective extraction of
teeth so that rest of the teeth can be guide toteeth so that rest of the teeth can be guide to
normal occlusion.normal occlusion.

PrinciplesPrinciples
2 )Physiologic tooth movements2 )Physiologic tooth movements ––
Human teeth have tendency of mesialHuman teeth have tendency of mesial
migration and teeth move towardsmigration and teeth move towards
extraction space .Thus, by selectiveextraction space .Thus, by selective
removal of some the teeth, the rest of theremoval of some the teeth, the rest of the
teeth which are in the process of eruptionteeth which are in the process of eruption
are guided by natural forces into extractionare guided by natural forces into extraction
spacesspaces

DEFINATIONDEFINATION
The procedure of removal of certainThe procedure of removal of certain
deciduous teeth and later specificdeciduous teeth and later specific
permanent teeth in an orderly sequencepermanent teeth in an orderly sequence
and predetermined pattern to guideand predetermined pattern to guide
erupting permanent teeth into moreerupting permanent teeth into more
favorable position is called asfavorable position is called as serialserial
extractionextraction

INDICATIONS FOR SERIAL
EXTRACTION
1) Class I malocclusion where there is harmony between1) Class I malocclusion where there is harmony between
skeletal and muscle systems.skeletal and muscle systems.
2 )Arch length deficiency as compared to tooth material is2 )Arch length deficiency as compared to tooth material is
most important Indication.most important Indication.
Arch length deficiency is observed due to –Arch length deficiency is observed due to –
 Absence of physiologic spacingAbsence of physiologic spacing
 Unilateral / bilateral premature loss of deciduousUnilateral / bilateral premature loss of deciduous
canines with midline shiftcanines with midline shift
 Malposed / impacted lateral incisors that erupt palatallyMalposed / impacted lateral incisors that erupt palatally
out of archout of arch
 Irregular / crowded upper, lower AnteriorsIrregular / crowded upper, lower Anteriors
 Localized gingival recession in lower anterior region isLocalized gingival recession in lower anterior region is
characteristic feature of arch length deficiency.characteristic feature of arch length deficiency.

Ectopic eruption A.L of teeth.Ectopic eruption A.L of teeth.
 Mesial migration of Buccal segmentMesial migration of Buccal segment
 Abnormal eruption pattern and sequence.Abnormal eruption pattern and sequence.
 lower anterior flaring.lower anterior flaring.
 Ankylosis of one or more teeth.Ankylosis of one or more teeth.
3) Where growth is not enough to overcome3) Where growth is not enough to overcome
the discrepancy between tooth material &the discrepancy between tooth material &
basal bone.basal bone.
4) Patients with straight profile and pleasing4) Patients with straight profile and pleasing
appearance.appearance.

Contra indication s / LimitationsContra indication s / Limitations
forfor SERIAL EXTRACTION
 In cases of class ii or class iii malocclusion whereIn cases of class ii or class iii malocclusion where
skeletal bases are abnormally relatedskeletal bases are abnormally related
 In cases where there is spacing between teeth.In cases where there is spacing between teeth.
 In cases having oligodontia or missing teeth .In cases having oligodontia or missing teeth .
 In cases with open bite and deep bite.In cases with open bite and deep bite.
 In cases of class I malocclusion where space deficiencyIn cases of class I malocclusion where space deficiency
is minimum .is minimum .
 Unerupted malformed teeth.Unerupted malformed teeth.
 Extensive caries or heavily filled first permanent molars.Extensive caries or heavily filled first permanent molars.
 Mild disproportion between arch length and toothMild disproportion between arch length and tooth
material that can be treated by proximal stripping.material that can be treated by proximal stripping.

1)1) Early and orderly sequence of extractions allow the eruptionEarly and orderly sequence of extractions allow the eruption
of permanent teeth in more favorable position which is moreof permanent teeth in more favorable position which is more
physiological and not traumatic.physiological and not traumatic.
2) Psychological trauma associated with malocclusion can be2) Psychological trauma associated with malocclusion can be
avoided due to early treatmentavoided due to early treatment
3 ) Better oral hygiene can maintained reducing the risk of3 ) Better oral hygiene can maintained reducing the risk of
cariescaries
4) Health of investing tissues is preserved4) Health of investing tissues is preserved
5) It eliminates or reduces the duration of multibanded fixed5) It eliminates or reduces the duration of multibanded fixed
treatmenttreatment
6) Shorter retention period is required.6) Shorter retention period is required.
7) The results are more stable as tooth material & arch length7) The results are more stable as tooth material & arch length
are in harmonyare in harmony
ADVANTAGES OFADVANTAGES OF SERIAL EXTRACTION :

DISADVANTAGES OFDISADVANTAGES OF SERIAL
EXTRACTION :
1)While treating the patient with serial extraction it is assumed1)While treating the patient with serial extraction it is assumed
that growth will not be Sufficient to overcome thethat growth will not be Sufficient to overcome the
discrepancy. However growth prediction is hazardous & isdiscrepancy. However growth prediction is hazardous & is
difficult to predict in advance the amount of inter caninedifficult to predict in advance the amount of inter canine
Arch width growth / mandibular growth & it requires clinicalArch width growth / mandibular growth & it requires clinical
judgment & experience.judgment & experience.
2) As the treatment is carried out in stages, the treatment time2) As the treatment is carried out in stages, the treatment time
may be prolonged.may be prolonged.
3) As the patient is school going patient co-operation is needed.3) As the patient is school going patient co-operation is needed.
4) As the created extraction spaces close gradually the patient4) As the created extraction spaces close gradually the patient
has the tendency of developing abnormal tongue thrusthas the tendency of developing abnormal tongue thrust
habit.habit. www.indiandentalacademy.comwww.indiandentalacademy.com

5)5) There is a tendency of overbite deepening because of lingualThere is a tendency of overbite deepening because of lingual
tipping of incisors (mostly lower)tipping of incisors (mostly lower)
6) Instead of arch length increasing it may actually decrease6) Instead of arch length increasing it may actually decrease
because of mesial movement of Buccal segment.because of mesial movement of Buccal segment.
7) Sometimes, there may be mesiopalatal rotation of upper first7) Sometimes, there may be mesiopalatal rotation of upper first
molar resulting in a tendency for class ii .molar resulting in a tendency for class ii .
8) Ditching or space can exist between canine and 2nd8) Ditching or space can exist between canine and 2nd
premolar.premolar.
9) Extraction of premolar does not always allow distal drifting of9) Extraction of premolar does not always allow distal drifting of
canine and its eruption in first premolar space . If canine iscanine and its eruption in first premolar space . If canine is
impacted, it may require surgical exposure & Orthodonticimpacted, it may require surgical exposure & Orthodontic
intervention.intervention.
10) Axial inclination of teeth at the end of serial extraction10) Axial inclination of teeth at the end of serial extraction
treatment may require correction with fixed appliancetreatment may require correction with fixed appliance
therapytherapy

METHODS OF SERIALMETHODS OF SERIAL
EXTRSCTIONEXTRSCTION
 Following three methods are popularFollowing three methods are popular
1.1. Dewel’s methodDewel’s method
2.2. Tweed’s methodTweed’s method
3.3. Nance methodNance method

Dewel’s methodDewel’s method
 - Dewel proposed- Dewel proposed three stepthree step serial extraction procedure.serial extraction procedure.
That is extraction of C, D , 4 sThat is extraction of C, D , 4 s

Step IStep I
Age : 8-9 yrs
Procedure : Extraction of C C
C C
Purpose : To create space for alignment of 21 12
21 12

Step 2Step 2
Age : 9 - 10 yrs
Procedure : Extraction of D D
D D
Purpose : To facilitate eruption of 4 4
4 4www.indiandentalacademy.comwww.indiandentalacademy.com

Step 3Step 3
Age :Erupting 1 pre molar
Procedure : Extraction of 4 4
4 4
Purpose : To permit eruption of 3 3
3 3www.indiandentalacademy.comwww.indiandentalacademy.com

Alternative approach to serial extraction-Tweed / Nance MethodAlternative approach to serial extraction-Tweed / Nance Method
 In this method, at around 8 yrs of ageIn this method, at around 8 yrs of age 54,64,74,8454,64,74,84
are extracted followed by extraction ofare extracted followed by extraction of 14,24,34,44,14,24,34,44,
and thenand then 53,63,73,8353,63,73,83
 Due to first extraction ofDue to first extraction of 54,64,74,8454,64,74,84 instead ofinstead of
53,63,73,8353,63,73,83 there is less lingual tipping of thethere is less lingual tipping of the
incisors and less tendency to develop a deep bite.incisors and less tendency to develop a deep bite.
 Extraction ofExtraction of 54,64,74,8454,64,74,84 also encourage earlyalso encourage early
eruption oferuption of 14,24,34,4414,24,34,44
Post Serial extraction functional appliance therapy -Post Serial extraction functional appliance therapy -
Correction of Axial inclination of the teeth and finalCorrection of Axial inclination of the teeth and final
finishing of the occlusion can be done with fixedfinishing of the occlusion can be done with fixed
appliance therapyappliance therapy.. www.indiandentalacademy.comwww.indiandentalacademy.com

Moderate Crowding CasesModerate Crowding Cases

Moderate Crowding CasesModerate Crowding Cases
(Less than 4mm space deficiency predicted for successors)
Decisions to be taken –
•Expansion of arch or extraction of permanent teeth.
•In cases of transitional anterior crowding more than 2to3 mm
even though predicated available total space is adequate-
•Extraction of Cs when crowding in anterior region is observed.
This causes lingual tipping of incisors and reduces arch length.
For this , fixation of lingual arch to align incisors is the choice of
treatment –This maintains / slightly increases arch length. (If
disking of primary Anteriors done it leads to sensitivity and may
be pulp exposure )

 If incisors are rotated /severely irregular – Advantage –If incisors are rotated /severely irregular – Advantage –
multibanded fixed appliance.multibanded fixed appliance.
 If incisors segment is flat /straight –extraction of Cs initiallyIf incisors segment is flat /straight –extraction of Cs initially
creates spacing.creates spacing.
But crowding of incisors re-appear when 3s and 4s erupt –But crowding of incisors re-appear when 3s and 4s erupt –
adv:adv: selective disking/ ext of Es along with lingual arch forselective disking/ ext of Es along with lingual arch for
maintaining the space.maintaining the space.
 If expansion is choice of treatment then 31,32,41,42 can beIf expansion is choice of treatment then 31,32,41,42 can be
tipped labially by 1to2mm creating additional arch length.tipped labially by 1to2mm creating additional arch length.
 The appliance used is either removable appln having fingerThe appliance used is either removable appln having finger
springs on incisors or removable lingual arch with U loopssprings on incisors or removable lingual arch with U loops
mesial to banded molars for expansion.mesial to banded molars for expansion.

Mild crowding casesMild crowding cases
 Adequate space predicted for successorsAdequate space predicted for successors
 During transient phase of developing occlusion –upDuring transient phase of developing occlusion –up
to 2mm incisors crowding may resolve without any Rx.to 2mm incisors crowding may resolve without any Rx.
 No need to give Rx if crowding is observed less thanNo need to give Rx if crowding is observed less than
2mm.2mm.

 If crowding is 3-4mm –disking of enamelIf crowding is 3-4mm –disking of enamel
surfaces of primary laterals and caninessurfaces of primary laterals and canines
advocated.advocated.
(Enamel thickness at the height of contour is to be(Enamel thickness at the height of contour is to be
reduced.)reduced.)
 If incisors are rotated – Rx is to be started inIf incisors are rotated – Rx is to be started in
early permanent dentition period.early permanent dentition period.
 Disking of primary molars along with fixation ofDisking of primary molars along with fixation of
lingual arch is also advocated if crowding islingual arch is also advocated if crowding is
observed when 33,&43 &34&44 eruptobserved when 33,&43 &34&44 erupt

Ankylosis of Teeth
•Primary teeth
•Permanent teeth

 When primary molar fails to attain occlusal level-called asWhen primary molar fails to attain occlusal level-called as
“submergence”“submergence”
 Sometimes primary molar is buried beneath the cervixSometimes primary molar is buried beneath the cervix
of adjacent teeth & partially covered by soft tissue.of adjacent teeth & partially covered by soft tissue.
 When primary molar becomes Ankylosed, there is aWhen primary molar becomes Ankylosed, there is a
localized arrest of eruption & alveolar growth. Sometimeslocalized arrest of eruption & alveolar growth. Sometimes
1st permanent molars tip mesially over the crowns of1st permanent molars tip mesially over the crowns of
ankylosed Esankylosed Es
Primary Teeth-Primary Teeth-

TREATMENTTREATMENT
 not to compromise for Arch lengthnot to compromise for Arch length
 Use space maintainers / Regainer.Use space maintainers / Regainer.
 If opposing tooth shows signs of extrusion ,restoreIf opposing tooth shows signs of extrusion ,restore
the ht. Of ankylosed tooth up to occlusal level withthe ht. Of ankylosed tooth up to occlusal level with
composite resin.composite resin.
 Ankylosed teeth are kept in place till the time ofAnkylosed teeth are kept in place till the time of
their successors erupt . Then they are extracted.their successors erupt . Then they are extracted.

Permanent teethPermanent teeth
––common site-1st molarscommon site-1st molars
TREATMENT :TREATMENT :
-loosening & Repositioning the tooth with-loosening & Repositioning the tooth with
forceps.forceps.
-Extraction-Extraction

MISSING PERMANENTMISSING PERMANENT
TEETHTEETH
Common sitesCommon sites
–– Mand 2nd premolarsMand 2nd premolars
-Max Lateral Incisors-Max Lateral Incisors

Treatment of missing mandibularTreatment of missing mandibular
2nd premolars2nd premolars
 If the pt. Has ideal / normal occlusion - Maintain EsIf the pt. Has ideal / normal occlusion - Maintain Es
 If width of Es greater then 5s - reduce M-D with ofIf width of Es greater then 5s - reduce M-D with of
Es to improve inter cuspationEs to improve inter cuspation
 If roots of Es are more divergent - reduction of M-DIf roots of Es are more divergent - reduction of M-D
width of Es is not helpful .width of Es is not helpful .
Rx Ext Es - F.P.D.Rx Ext Es - F.P.D.
 At the age of 7-8 Yrs if Es are extracted 1st permanentAt the age of 7-8 Yrs if Es are extracted 1st permanent
molar drifts mesiallymolar drifts mesially

Treatment of missing max lateral incisorTreatment of missing max lateral incisor
 Avoid Long Term Retention of BsAvoid Long Term Retention of Bs
 In some cases erupting permanent canine resorbsIn some cases erupting permanent canine resorbs
the root of Primary Lateral incisor & erupt at the sitethe root of Primary Lateral incisor & erupt at the site
of exfoliated Bs .Thus primary canine retains as itsof exfoliated Bs .Thus primary canine retains as its
successor has shifted to Lateral Incisor’s place. Butsuccessor has shifted to Lateral Incisor’s place. But
most of these primary canines are lost by the end ofmost of these primary canines are lost by the end of
adolescence . If this situation doesn't arise then Bsadolescence . If this situation doesn't arise then Bs
are retained till 3s erupt in place of Cs . In thisare retained till 3s erupt in place of Cs . In this
situation 2s are replaced as F.P.Dsituation 2s are replaced as F.P.D

 In some cases missing 2s produces largeIn some cases missing 2s produces large
Diastema betn 11,21 . To maximize the mesialDiastema betn 11,21 . To maximize the mesial
drift of erupting 3, the Diastema should bedrift of erupting 3, the Diastema should be
closed & retained C is extracted before 4closed & retained C is extracted before 4
erupts, though it is not resorbing . so 4 migrateerupts, though it is not resorbing . so 4 migrate
in 3s position & other post. Teeth can movein 3s position & other post. Teeth can move
mesially & close the space.mesially & close the space.
 Later axial inclination are to be corrected withLater axial inclination are to be corrected with
F.A., Recountouring of ants. & resin build upsF.A., Recountouring of ants. & resin build ups
are to be done for Esthetic purposeare to be done for Esthetic purpose

Supernumerary TeethSupernumerary Teeth
Common site – Max. ant. RegionCommon site – Max. ant. Region
 They create problem in eruption &They create problem in eruption &
alignment of the adjacent teeth.alignment of the adjacent teeth.
RxRx ––
 Ext of supernumerary toothExt of supernumerary tooth
Earlier they are removed , more likely theEarlier they are removed , more likely the
teeth will erpt in normal fashionteeth will erpt in normal fashion

Removal of soft tissue & Bony BarrierRemoval of soft tissue & Bony Barrier
Changes in the overlying keratinisedChanges in the overlying keratinised
tissue occur in long standing edentuloustissue occur in long standing edentulous
regions. Slow eruption of incisor in thisregions. Slow eruption of incisor in this
region results due to supernumeraryregion results due to supernumerary
tooth / ankylosed primary tooth.tooth / ankylosed primary tooth.
 Whenever permanent tooth fails toWhenever permanent tooth fails to
erupt timely, its eruption may beerupt timely, its eruption may be
stimulated by surgically exposing thestimulated by surgically exposing the
crown.crown.

 The soft tissue overlying the crown of uneruptedThe soft tissue overlying the crown of unerupted
tooth is excised & bone is removed. The tissuetooth is excised & bone is removed. The tissue
is removed in such a manner that the greatestis removed in such a manner that the greatest
diameter of the crown of the tooth is exposed.diameter of the crown of the tooth is exposed.
This wound is then dressed with cement. ThisThis wound is then dressed with cement. This
will hasten the eruption of tooth.will hasten the eruption of tooth.
 If there is further delay in eruption, tractionIf there is further delay in eruption, traction
can be applied to the exposed crown using acan be applied to the exposed crown using a
bonded attachment & Fixed appliance.bonded attachment & Fixed appliance.

Myotherapeutic ExercisesMyotherapeutic Exercises
 A.P.Rogers (1906)described the role of muscleA.P.Rogers (1906)described the role of muscle
imbalance in Etiology Of maloclusion. Heimbalance in Etiology Of maloclusion. He
suggested that muscle exercises be used as ansuggested that muscle exercises be used as an
adjunct to mechanical correction ofadjunct to mechanical correction of
malocclusion.malocclusion.
 PurposePurpose –– They are not used to increase theThey are not used to increase the
size or strength of muscles as used for bodysize or strength of muscles as used for body
building.building.
 They are used to create normal Oro-facialThey are used to create normal Oro-facial
muscular function to aid growth & dev. Ofmuscular function to aid growth & dev. Of
normal occlusion.normal occlusion.www.indiandentalacademy.comwww.indiandentalacademy.com

Exercise For Masseter MuscleExercise For Masseter Muscle
To strengthen masseter – pt is asked toTo strengthen masseter – pt is asked to
clench the teeth till counting 10 numbersclench the teeth till counting 10 numbers
serially. This is to be repeated frequentlyserially. This is to be repeated frequently
for some duration of time .for some duration of time .

Exercise For MandibularExercise For Mandibular
PosturePosture
 Exercise For Mandibular Posture - When aExercise For Mandibular Posture - When a
child has faulty body posture, mandibularchild has faulty body posture, mandibular
posture is also at fault.posture is also at fault.
 When the spine is straight & head is well placedWhen the spine is straight & head is well placed
over it with the person’s eyes looking ahead, theover it with the person’s eyes looking ahead, the
mandible is in a favorable position of posture.mandible is in a favorable position of posture.
 Simply asking the pt. To walk upright withSimply asking the pt. To walk upright with
shoulders squared & eyes ahead can produceshoulders squared & eyes ahead can produce
immediate effect in appearance & self imageimmediate effect in appearance & self image

Exercise For Lips – Orbicularis oris &Exercise For Lips – Orbicularis oris &
Circumoral MusclesCircumoral Muscles --
They are to be introduced after correctionThey are to be introduced after correction
of proclination of teeth.of proclination of teeth.
1 Patient is asked to stretch upper lip in a1 Patient is asked to stretch upper lip in a
downward direction towards chin.downward direction towards chin.
2 Holding & pumping of water back & forth2 Holding & pumping of water back & forth
behind lips.behind lips.
3 Massaging the lips3 Massaging the lips
4 playing of wind instrument4 playing of wind instrument

5 Button pull exercise - A button of large diameter5 Button pull exercise - A button of large diameter
is taken & thread is passed through the buttonis taken & thread is passed through the button
hole. Patient is asked to place the button behindhole. Patient is asked to place the button behind
the lip & pull the thread while restricting it fromthe lip & pull the thread while restricting it from
being pulled out by using lip pressure.being pulled out by using lip pressure.
6 Tug of war exercise6 Tug of war exercise
7 Patient is asked to keep little water in the mouth.7 Patient is asked to keep little water in the mouth.
The upper lip is extended over the incisal edgesThe upper lip is extended over the incisal edges
of upper ants . and the lower lip is placed overof upper ants . and the lower lip is placed over
the upper lip & the firm pressure is applied onthe upper lip & the firm pressure is applied on
the lips. –the lips. –advocated in cases with inherited shortadvocated in cases with inherited short
upper lipupper lip
8 To hold paper piece in between the lips8 To hold paper piece in between the lips

Exercise For the Tongue – ( TongueExercise For the Tongue – ( Tongue
thrust patientsthrust patients.).)
 A proper contact position of tongue to palate atA proper contact position of tongue to palate at
the junction of hard & soft plate is shown to thethe junction of hard & soft plate is shown to the
patient with index finger. Patient is asked topatient with index finger. Patient is asked to
follow it & swallow – 50 times morning &follow it & swallow – 50 times morning &
eveningevening
 One elastic swallow-for improper positioning ofOne elastic swallow-for improper positioning of
tonguetongue
5/16 inch intraoral elastic is placed on the tip of the5/16 inch intraoral elastic is placed on the tip of the
tongue and the patient is asked to raise thetongue and the patient is asked to raise the
tongue and hold the elastic against the rougaetongue and hold the elastic against the rougae
area and swallowarea and swallow

Tongue hold exerciseTongue hold exercise
5/16 inch elastic is positioned over the5/16 inch elastic is positioned over the
tongue in a designated spot for atongue in a designated spot for a
prescribed period of time with the lipsprescribed period of time with the lips
closed.The patient is asked to swallowclosed.The patient is asked to swallow
with elastic in place and lips apart.with elastic in place and lips apart.
Two elastic swallowTwo elastic swallow
Two 5/16 inch elastics are placed over theTwo 5/16 inch elastics are placed over the
tongue one in the midline and the othertongue one in the midline and the other
on the tip and the patient is asked toon the tip and the patient is asked to
swallow with the elastics in position.swallow with the elastics in position.

The hold pull exerciseThe hold pull exercise
The tip of the tongue and the midpoint areThe tip of the tongue and the midpoint are
made to contact the palate and themade to contact the palate and the
mandible is gradually opened.Thismandible is gradually opened.This
exercise helps in stretching the lingualexercise helps in stretching the lingual
frenum.frenum.

Occlusal EquilibrationOcclusal Equilibration
 Def : Occlusal Equilibration (adjustment ) is theDef : Occlusal Equilibration (adjustment ) is the
systematic reshaping of the occlusal anatomy ofsystematic reshaping of the occlusal anatomy of
teeth to minimize the role of occlusalteeth to minimize the role of occlusal
interferences in reflexly determined mandibularinterferences in reflexly determined mandibular
occlusal positions.occlusal positions.
 Due to premature contacts of cusps of teethDue to premature contacts of cusps of teeth
mandible may be deflected forward / backward /mandible may be deflected forward / backward /
laterally resulting in functional malocclusion. Thislaterally resulting in functional malocclusion. This
may be intercepted by selective adjustment ofmay be intercepted by selective adjustment of
occlusion during mixed dentitionocclusion during mixed dentition

 Example :Example :
 sharp cusp tip of deciduous canine is selectivelysharp cusp tip of deciduous canine is selectively
ground to avoid lateral deflection & unilateralground to avoid lateral deflection & unilateral
functional X – bite .functional X – bite .
 In case of mild skeletal class III- as the patientIn case of mild skeletal class III- as the patient
closes the jaw from position of rest to position tocloses the jaw from position of rest to position to
occlusion , to achieve intercuspation in post.occlusion , to achieve intercuspation in post.
Region , the mandible may be deflectedRegion , the mandible may be deflected
anteriorly leading to functional class IIIanteriorly leading to functional class III
malocclusion .This can be intercepted bymalocclusion .This can be intercepted by
selectively beveling the labial surfaces of lowerselectively beveling the labial surfaces of lower
ants & palatal surfaces of upper ants.ants & palatal surfaces of upper ants.

THANK YOUTHANK YOU

For occlusal equilibration – articulationFor occlusal equilibration – articulation
paper , diamond bur, Diamond disk arepaper , diamond bur, Diamond disk are
required.required.
 After occlusal adjustment application ofAfter occlusal adjustment application of
topical fluoride is must to all the surfacestopical fluoride is must to all the surfaces
that were ground.that were ground.

Thank youThank you
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Interceptive orthodontics /certified fixed orthodontic courses by Indian dental academy

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