Interceptive Orthodontics Research Articles

Prevention and Intervention in Mixed Dentition Period: A Short Review

Preventive and/or interceptive orthodontics in the mixed dentition implies several different possibilities like the guiding of erupting permanent teeth into an ideal position; using simplified procedures that produce a savings of time and effort; obtaining a more stable early result with less retention problems; avoidance of extraction of permanent teeth by utilizing the additional deciduous posterior tooth mass, distalization and/or expansion of posterior segments. Guidance of the eruption and development of the primary and permanent dentitions is an integral part of the care of pediatric patients. Such guidance should contribute to the development of a permanent dentition that is in a harmonious, functional and esthetically acceptable occlusion. This article aims to provide a simple guide to the correct diagnosis of anomalies and to choosing the most suitable treatment for each case.

Space supervision and guidance of eruption in management of lower transitional crowding: A non-extraction approach

Mandibular incisor crowding in the mixed dentition is one of the most common problems presenting to the orthodontist. Asymmetry of alignment, premature loss of primary canine(s), and disruption in arch integrity are all early benchmarks of a tooth size/arch length discrepancy in the transitional dentition that can occur independent of any skeletal discrepancy. Space supervision and guidance of eruption refer to treatment interventions during the early to mid-mixed dentition periods that influence the eruption patterns and positioning of the permanent teeth during their transition. Generally considered applicable to individuals with adequate overall arch dimensions to accommodate a normal complement of permanent teeth with an acceptable esthetic and functioning occlusion, guidance of eruption involves the implementation of directed interventions to optimize the eruption and alignment patterns of the permanent teeth as part of a non-extraction protocol.

Evaluation of Orthodontic Treatment Needs Using the Dental Aesthetic Index in Iranian Students

BackgroundIn the contemporary orthodontics, the number of people who demand orthodontic treatment to improve their psychosocial issues related to facial esthetic is constantly increasing. Even in treatment plans, appearance and esthetic gain more attention.ObjectivesThe purpose of this study was to determine the need for orthodontic treatment on the basis of the dental aesthetic index (DAI) in the Iranian students of Ahvaz city.Material and MethodsThis cross sectional study was performed on 900 students aged between 11 - 14 years (450 boys, 450 girls). Schools were selected based on random cluster sampling from different parts of the city. Students\\ who had or were having orthodontic treatment including those on interceptive orthodontics, were excluded from the study. Two questionnaires were used; the first one included different DAI criteria, and the second one included two questions about orthodontic treatment need and satisfaction of personal dental appearance. The results were analyzed by Chi-Square and T test.ResultsIn 70.9% of the students, DAI score was 13 - 25, 19.2% of the samples had a DAI score of 26 - 30, the DAI score of 7.8% was 31 - 35, and in 2.1% the DAI score was greater than 35. The association between the DAI score and sex was not statistically significant (P = 0.778). In relation to orthodontic treatment need, 44.8% of students answered positively, while in 55.2% the answer was negative. In relation to satisfaction with appearance, 21% of the students were satisfied with their appearance, 59% were relatively satisfied, and 19.9% were not satisfied with their appearance. The association between DAI score and the need for orthodontic treatment and satisfaction of dental appearance was significant (P = 0.000).ConclusionIn comparison to other studies, the students in Iran (Ahvaz) have a better dental appearance and less need for orthodontic treatment. Significantly positive correlations were found between the DAI and satisfaction of dental appearance, orthodontic treatment need and student’s perception.

Interceptive orthodontics – current evidence-based best practice

This article examines the key areas relating to interceptive orthodontics, ie crossbites, anterior and posterior; eruption problems and impaction (including incisors and canines); poor quality first permanent molars; infra-occluded primary molar teeth; non-nutritive sucking habits (digit and pacifier sucking) leading to anterior openbite, posterior crossbite and increased overjet; centreline shifts related to unilateral loss of primary teeth; and increased overjet and associated risk of trauma. It aims to provide information and recommendations. The GDP requires evidence to support the clinical management of common problems presenting in the mixed dentition.

A Scottish cost analysis of interceptive orthodontics for thumb sucking habits

There is a potential cost saving to be made within the NHS by providing simple interceptive treatment rather than comprehensive treatment at a later date. The focus of this study is to determine the size of this potential cost by looking at the cost to NHS Tayside for the provision of interceptive treatment for cessation of thumb sucking and where this has been unsuccessful (or not provided) the costs of correction of the associated malocclusion. A cost analysis is described, investigating the costs of treatment solely to the NHS, both in the primary and secondary setting. Three potential treatment pathways are identified with the costs calculated for each pathway. The actual cost of providing this treatment in NHS Tayside, and the potential cost saving in Tayside if there was a change in clinical practice are calculated. Both discounting of costs and a sensitivity analysis are performed. The cost to NHS Tayside of current practice was calculated to be between £123,710 and £124,930 per annum. Change in practice to replace use of a removable with a fixed habit breaker for the interceptive treatment of thumb sucking reduced the calculated cost to between £99,581 and £105,017. A saving could be made to the NHS, both locally and nationally, if the provision of a removable habit breaker was changed to a fixed habit breaker. In addition, increasing the proportion receiving active treatment, in the form of a fixed habit breaker, rather than monitoring, would appear to further reduce the cost to the NHS considerably.

Facial Profile Evaluation of Isolated Pierre Robin Sequence

To evaluate numerically the facial profile of children with isolated Pierre Robin sequence (PRS) and to compare them with a control group that has no pathologies and exhibits regular and balanced facial growth, with no skeletal alterations. Eighty-three children aged 5 to 10 years (PRS group, n = 60; control group, n = 23) were selected. Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC-USP). Children from the control group were taken from the program of Interceptive Orthodontics at HRAC-USP. Angular and ratio analyses of the facial profiles in both groups were realized through digital photographs. The PRS group was subdivided into two groups--complete and incomplete--according to the sagittal extension of the cleft palate, to investigate the possible influence of cleft extension on the face. The facial convexity angle and the facial inferior third angle were considerably higher in the PRS groups than in the control group and were not significantly different between PRS groups. Nasolabial angle did not differ between groups. The facial profile was more convex in individuals with PRS than in those with regular facial growth and with no pathology. The mandible was responsible for the convexity of the profile in PRS because of its lack off anterior projection. An important relationship between the extension of the cleft palate and alterations in facial profile in PRS was not observed.

Randomized Clinical Trial of Interceptive and Comprehensive Orthodontics

Focusing public insurance programs on interceptive orthodontics (IO) may increase access for low-income children. This report presents outcomes from a randomized clinical trial (RCT) comparing IO with comprehensive orthodontics (CO) in Medicaid patients. One hundred seventy pre-adolescents with Medicaid-eligible malocclusions were randomized to IO (n = 86) followed by observation (OBS) or OBS followed by CO (n = 84). One hundred thirty-four completed the trial. Models at pre-treatment (baseline) and following ≤ 2 years of intervention and 2 years of OBS (48 mos) were scored by calibrated examiners using the Peer Assessment Rating (PAR) and Index of Complexity, Outcome and Need (ICON). Overall outcomes and clinically meaningful categorical ICON data on need/acceptability, complexity, and improvement were compared. At baseline, groups were balanced by age, gender, ethnicity, and PAR/ICON scores. Most were minorities. Most (77%) were rated as difficult-to-very difficult. Scores improved significantly for both groups, but CO more than IO (PAR, 18.6 [95%CI 15.1, 22.1] vs.10.1 [95%CI 6.7, 13.4]; ICON, 44.8 [95% CI 39.7, 49.9] vs. 35.2 [95%CI 29.7, 40.6], respectively). On average, IO is effective at reducing malocclusions in Medicaid patients, but less than CO. (ClinicalTrials.gov number CT00067379)

Innovative chairside technique for the correction of ectopically erupting permanent first molar

Introduction : Maxillary permanent first molars are frequently found ectopic teeth in mixed dentition. If left untreated, it may cause serious sequel including early loss of the primary second molar, space loss, and impaction of second premolars. Clinical Innovation: This article describes a new successful innovative method for the correction of ectopically erupting maxillary first permanent molar in an 8-year-old boy. Discussion: Early correction of ectopically erupting permanent molars is an integral part of interceptive orthodontics. Several treatment methods have been suggested. Among these, the interproximal wedging techniques are the simplest but are not always appropriate or feasible. The other treatment modalities may be either complicated, expensive, or require impression taking, appliance delivery, and activation appointments. The following case illustrates a new chairside technique that eliminates the need of impression taking, appliance delivery, and activation appointments and is very simple.

Effects of interceptive orthodontics on orbicular muscle activity: A surface electromyographic study in children

The purpose of this study was to assess by surface electromyography (sEMG) the changes in upper and lower orbicular oris (OO) muscles produced by a preformed functional device in subjects with Class II, division 1 malocclusion, deep bite, and labial incompetence. Twenty-eight subjects were selected: 13 subjects (mean age 9 ± 1.5 years) with Class II malocclusion, deep bite, and labial incompetence were treated with a preformed functional device, while 15 subjects (mean age 9.5 ± 0.8 years) with normal occlusion were used as control. Inclusion criteria for both groups were: presence of mixed dentition, no previous orthodontic treatment, and absence of speech disturbance. sEMG recordings were taken at the time of the first visit (T0), and after 3 (T1) and 6 months (T2) for the treated group, and at T0 and T2 for the control group. The sEMG recording was performed at rest, and while kissing, swallowing, opening the mouth, clenching the teeth, and during protrusion of the mandible, by placing electrodes at the area of muscle contraction. At T0, except during swallowing, the treated group always showed a lower sEMG activity of the lower OO muscle with respect to the control group, with significant differences at rest and during mandibular protrusion ( p < 0.05). In the treated group, a significant increase in muscle tone was observed for the lower OO muscle from T0 to T1, but only at rest. The upper OO muscle showed a significant increase during the protrusion of the mandible from T1 to T2. No significant change was observed in the control group during the follow-up. Muscular contractility of treated patients at T2 reached the same values as that of the control group at T2. Interceptive orthodontics seems to improve the form and function of the orofacial muscle structure. Improvement in muscle contraction after treatment was demonstrated by sEMG.

Interceptive Orthodontic Treatment may be Effective in Reducing the Severity of Developing Malocclusion

Dental effects of interceptive orthodontic treatment in a Medicaid population: interim results from a randomized clinical trial. Jolley CJ, Huang GJ, et al. Am J Orthod Dentofacial Orthop 2010;137:324-33. Stuart D. Josell, DMD, MDent Sc To compare a group of mixed dentition patients receiving interceptive orthodontic care with a group of mixed dentition patients under observation for a similar period of time. Government- Supported by the Northwest/Alaska Center to Reduce Oral Health Disparities NIDCR grant #U54-DE 014254 and the University of Washington Orthodontic Program Randomized controlled trial Level 2: Limited-quality, patient-oriented evidence Not applicable

Interceptive Orthodontic Treatment of Class II Malocclusions is Slightly More Successful with Headgear/Biteplane than with Bionator Treatment

Article Title and Bibliographic Information Effectiveness of early treatment of Class II malocclusion. Wheeler TT, McGorray SP, Dolce C, Taylor MG, King GJ. Am J Orthod Dentofacial Orthop 2002;121:9-17. Reviewer Anne-Marie Bollen, DDS, MS, PhD Purpose/Question To investigate the success of early treatment with a headgear/biteplate or a bionator in patients with Class II malocclusion and compare this to changes over a similar time period in untreated observation subjects. Source of Funding Government: National Institute of Dental Craniofacial Research Grant No. DE08715 Type of Study/Design Randomized controlled trial Level of Evidence Level 1: Good-quality, patient-oriented evidence Strength of Recommendation Grade Grade B: Inconsistent or limited-quality patient-oriented evidence

Progressive changes in arch width from primary to early mixed dentition period: A longitudinal study

The present study was conducted to evaluate, on a longitudinal basis, the changes in intercanine and intermolar widths form the primary to the early mixed dentition periods. A total of 38 children aged 4-5 years, with normal occlusion without any proximal caries or any dental anomalies, were selected. The impressions were recorded and casts were prepared. Intercanine and intermolar widths were measured on these dental casts with the help of a digital vernier calliper. After 3 years follow-up, the impressions were recorded again and dental casts were prepared. Intercanine and intermolar widths were measured again at this stage and were compared with the baseline data using the paired t-test and the chi square test. There is a significant increase in the intercanine (3.93 + 1.70 mm) and intermolar width (1.49 + 1.77 mm) during the transition period from primary to early mixed dentition in both the arches and both the sexes. The gender-wise comparison showed a greater increase in males than in females, but this was not statistically significant. A thorough knowledge of growth changes during various stages of the mixed dentition period are important for a pediatric dentist to make an accurate diagnosis and treatment planning during preventive and interceptive orthodontics.

Interceptive Orthodontic Treatment Improves Malocclusions Over no Treatment, but does not Produce Finished-Quality Results

Effectiveness of interceptive orthodontic treatment in reducing malocclusions. King GJ, Brudvik P. Am J Orthod Dentofacial Orthop 2010;137:18-25. Anne-Marie Bollen, DDS, MS, PhD. The purpose of this study was to investigate the effectiveness of interceptive treatment. National Institute of Dental and Craniofacial Research (NIDCR grant #U54DE14254). A retrospective cohort study. Level 2: Limited-quality, patient-oriented evidence. Not applicable.

Dental effects of interceptive orthodontic treatment in a Medicaid population: Interim results from a randomized clinical trial

There are disparities in access to orthodontic treatment for children from low-income families. Systematic programs of limited-care interceptive and preventive orthodontics have been proposed as a solution. The purpose of this randomized clinical trial was to compare dental outcomes and funding eligibility from a group of Medicaid patients randomized to receive interceptive orthodontics (IO) in the mixed dentition or observation (OBS). One hundred seventy Medicaid-eligible children were randomized to receive IO or OBS and followed for 2 years, when complete data were available on 72 and 74 children, respectively. The 2-year changes in the peer assessment rating (PAR) were compared using the Student t test. The proportions of children no longer eligible for Medicaid funding as defined by handicapping labiolingual deviation (HLD) scores less than 25 at the 2-year follow-up were compared with the chi-square test. The IO patients had significantly greater decreases in the PAR scores--50%-compared with the OBS subjects, -6% (P <0.001). Negative and positive overjet and maxillary alignment were the components most affected by IO; they decreased by 11.0, 7.2, and 3.7 PAR points, respectively (P <0.001). Overbite showed little change. At the 2-year follow-up, 80% of the IO patients' malocclusions that qualified initially were no longer deemed medically necessary by the HLD index, compared with 6% in the OBS group (P <0.001). IO significantly reduces the severity of malocclusions and moves most from the "medically necessary" category to elective but does not produce finished results for most patients. Overjet and alignment were most readily corrected by interceptive treatment. Deep overbites were the least susceptible to IO correction.

Estudo da legalidade do exercício profissional da Ortodontia por cirurgião-dentista não-especialista

OBJETIVO: tendo em vista o conflito existente, no Ordenamento Jurídico brasileiro, entre o princípio da legalidade e o princípio da dignidade da pessoa humana no que diz respeito à prática da Ortodontia pelo cirurgião-dentista não-especialista, este trabalho teve como objetivo analisar a legislação e os julgados dos tribunais nesse assunto. MÉTODOS: realizou-se o levantamento da legislação referente ao ensino e à prática da Ortodontia no Diário Oficial da União e nos órgãos competentes. Com relação aos julgados dos tribunais, a pesquisa foi realizada nos Tribunais de Justiça e nos extintos Tribunais de Alçada de todos os Estados-membros da República Federativa do Brasil, bem como do Superior Tribunal de Justiça e do Supremo Tribunal Federal, utilizando as palavras-chave " Ortodontia" , " ortodôntico" e " ortodontista" . RESULTADOS: a legislação brasileira classifica os cursos de pós-graduação em stricto sensu e lato sensu, os quais possuem normas de funcionamento próprias. As Diretrizes Curriculares Nacionais determinam que, no curso de graduação em Odontologia, seja apenas ministrada a Ortodontia Preventiva. Os tribunais brasileiros entendem que, para a prática da Ortodontia Corretiva, é necessária habilitação em curso de pós-graduação. CONCLUSÃO: o curso de graduação em Odontologia é competente para o ensino da Ortodontia Preventiva; somente os cursos de pós-graduação stricto sensu e lato sensu são competentes para ensinar a Ortodontia Corretiva; é inconcebível a interpretação de que o legislador faculta ao cirurgião-dentista não-especialista praticar a Ortodontia Corretiva; e o cirurgião-dentista não-especialista só pode praticar procedimentos que estejam incluídos na categoria de Ortodontia Preventiva e Interceptiva.

DISCUSSION: Preventive and Interceptive Orthodontics: A Strong Theory Proves Weak In Practice

DISCUSSION: Preventive and Interceptive Orthodontics: A Strong Theory Proves Weak In Practice

Morfologia das 3ª e 4ª vértebras cervicais representativa do surto de crescimento puberal

OBJETIVOS: determinar a morfologia das 3ª e 4ª vértebras cervicais representativa dos estágios de pré-pico, pico e pós-pico de velocidade de crescimento estatural, definidos previamente pelos centros de ossificação do primeiro dedo em radiografias carpais ou do dedo polegar. MÉTODOS: foram utilizadas 120 telerradiografias em norma lateral de 106 pacientes selecionados da clínica de Ortodontia Preventiva e Interceptiva da Faculdade de Odontologia de Araçatuba-UNESP e Profis/HRAC-USP que apresentavam as correspondentes radiografias carpais ou do dedo polegar. As telerradiografias foram divididas em três grupos de 40 radiografias, de acordo com os estágios maturacionais pré-pico, pico e pós-pico, definidos pela imagem do primeiro dedo. A morfologia dos corpos das 3ª e 4ª vértebras cervicais foi determinada por dois examinadores devidamente calibrados em dois tempos diferentes. CONCLUSÕES: concluiu-se que o formato retangular horizontal com borda inferior reta foi representativo do estágio de pré-pico, independentemente da vértebra analisada. Já o formato retangular horizontal com borda inferior curva, especialmente se encontrado em C4, ou o formato quadrado com borda inferior reta caracterizaram o pico de velocidade de crescimento. O formato quadrado ou, principalmente, o retangular vertical com borda inferior curva determinaram o estágio de pós-pico de velocidade de crescimento da adolescência.

Space maintenance - indications and illustrated cases

Space maintenance should form an integral part of paediatric dentistry and interceptive orthodontics. It has two main aims: the maintenance of space for a future prosthesis, and the limitation of localized crowding. There are many varieties of space maintainer, broadly divided into two groups; fixed or removable. The design and use depend upon the number, size and position of the teeth missing, the teeth present in the mouth and the dental developmental stage the child has reached. Careful patient selection, timing of treatment and regular review is necessary to maximize the benefits. Clinical cases are presented illustrating the use of various space maintainers.

The effectiveness of phase I orthodontic treatment in a Medicaid population

The effectiveness of early orthodontic treatment for Medicaid-enrolled children in the mixed dentition was assessed and compared with results in a population of private-pay patients. Pre- and posttreatment casts from 196 subjects treated with interceptive orthodontics in the mixed dentition were evaluated by using the peer assessment rating (PAR) index and the index of complexity, outcome, and need (ICON). Ninety-six of the patients were treated at Odessa Brown Community Clinic in Seattle; their treatment was paid by Medicaid. One hundred private-pay patients were treated at the University of Washington graduate orthodontic clinic. The Medicaid and private-pay populations were comparable with respect to initial severity of malocclusion, as assessed by both indexes. PAR and ICON scores fell by similar amounts in the Medicaid (44.1% and 37.5%, respectively) and private-pay (46.8% and 37.3%, respectively) populations. Thus, the groups exhibited similar degrees of improvement with interceptive orthodontic treatment. According to the PAR and ICON, midline discrepancy, overjet, and esthetics exhibited the greatest improvement. The Medicaid population missed significantly more appointments and had poorer oral hygiene than the private-pay group, but these factors did not appear to worsen the outcomes, as measured by the 2 indexes. An appliance with 2 bands and 4 brackets was the most commonly used, and it produced the most significant treatment effect. Phase I orthodontic treatment significantly reduces malocclusion severity in Medicaid and private-pay populations. There was no difference in initial severity or final outcome, as assessed by the PAR and ICON, between Medicaid and private-pay populations. The degree of improvement in PAR scores did not appear to be associated with compliance.

Interceptive orthodontics in the real world of community dentistry.

To test the applicability and effectiveness of interceptive orthodontics in a community field trial. Prospective screening for suitable malocclusions, implementation of treatment and analysis of outcomes 12 months later. Community dentistry in urban and rural areas of Northern Ireland, 1996-98. The initial sample consisted of 2002 children (1014 boys, 988 girls) who were screened in routine community dental inspections. One thousand and sixty (523 aged 9 years, 537 aged 11 years) were domiciled in the urban area of greater Belfast and 942 (479 aged 9 years, 463 aged 11 years) in the rural area of Enniskillen and Omagh, Co. Tyrone. Interceptive orthodontic treatment. Dental health component of the Index of Orthodontic Treatment Need (IOTN) and specially devised local indices of treatment outcomes. With the use of an interception gauge, orthodontic screening was included in the community dental inspections without difficulty. Thirty-three per cent of children were in need of interceptive treatment. Only 20% of those in need both attended for recall and underwent treatment. Compliance was better in the rural area but the need, with particular reference to extraction of carious first molars, was greater in the urban area. The numbers of children in IOTN grades 4 and 5 fell from 69% at the beginning of the study to 42% at the end. The outcome judged by local indices was 94% in the range of complete success to minimal improvement with only 2% showing deterioration. One in three children screened in community dental inspections at age 9 and 11 years would benefit from interceptive orthodontics. Parents and children seem reluctant to accept offers of interceptive orthodontics and to having the treatment carried out. Among those complying fully, the interceptive measures are very successful. Not only does community interceptive orthodontics improve the condition being treated but also reduces the need for further treatment.