Interceptive orthodontics is undertaken at a time when malocclusion has already developed or developing. The difference between preventive and interceptive orthodontics lies in the timing of the services rendered. Preventive orthodontic procedures are undertaken when the dentition and occlusion are perfectly normal, while the interceptive procedures are carried out when signs and symptoms of a developing malocclusion are evident.

Interceptive orthodontic procedures may include:

• Serial extraction/guidance of occlusion: Serial extraction is an interceptive orthodontic procedure undertaken in the (early) mixed dentition period that involves planned removal of certain primary and permanent teeth in a programmed sequence, so as to relieve crowding in the arches and to guide the remaining erupting permanent teeth into a more favorable position. The procedure includes multiple teeth extractions (Cs,Ds,Es then 4s) in special timing sequence between age of 8-10 years, When executed properly in carefully selected patients with the proper assessment can produce the best possible and the most stable results with minimal or in some cases no further need of corrective mechanotherapy at a later stage when all permanent teeth erupts.
  • Indications Lec. Serial extraction procedure is primarily indicated in developing class I malocclusions with moderate to severe arch length-tooth material discrepancy with resultant crowding of teeth. Serial extraction gives best results in patients with ideal orthognathic profile and in whom all the components of stomatognathic system (i.e. neuromuscular envelop, basal jaw bones, and teeth) are in balance with good facial harmony.
• Correction of developing cross-bites: Occasionally, even with adequate arch-length, the maxillary lateral incisors erupt too far palatally and their crowns are forced completely to the palatal side of the crown of the opposing mandibular incisors as the maxillary and the mandibular teeth are brought into habitual occlusion Anterior crossbite should be intercepted and treated at an early stage so as to prevent future severe dentofacial abnormality. If the condition is left untreated it may develop into severe skeletal malocclusion (e.g. Cl III), which requires invasive orthodontic treatment. Therefore, it is desirable to intercept and treat the crossbite, as soon as it is recognized.
• Control of abnormal oral habits: Correction of deleterious oral habits, such as:
  • Thumb sucking
  • tongue thrusting
  • Mouth breathing
  • Should be undertaken as a part of interceptive orthodontic procedure. Not all oral habits damage the dentoalveolar structures and thus, do not require orthodontic interventions. If definite damage due to any oral habits exists, then thorough case history should be recorded. The optimal time for appliances placement is between the age of 3.5 – 4.5 years. The oral habits can be intercepted by either removable or fixed orthodontic appliances, with crib.
• Proximal stripping of deciduous teeth to facilitate the eruption of adjacent permanent teeth: Proximal stripping of first or second deciduous molars often require to facilitate the eruption of adjacent succedaneous permanent teeth into normal occlusion, e.g.,
  • Proximal stripping of mesial surface of mandibular deciduous first molar can be of help in preventing mandibular anterior crowding
  • When there is lack of space for maxillary canine to erupt, then space can be created by disking of second deciduous molar, which leads to distal drifting of the first premolar creating space for the canine to erupt.
• Correction of occlusal interferences: Occlusal interferences present during the development of occlusion can deflect the mandible anteriorly, laterally or posteriorly. Once occlusal prematurities are identified by using articulating paper, they are corrected by the reduction of crown height using pearshaped stone in a center-angled handpiece. Occasionally, a lingually placed tooth particularly a maxillary lateral incisor or cuspid can deflect the mandible either anteriorly or posteriorly resulting in crossbite. In such situations, the interferences cannot be corrected by occlusal reduction, therefore orthodontic appliances will help in correcting the malocclusion by eliminating the interference.
• Interception of skeletal malrelations:
  • Interception of Class II Malocclusion: Class II malocclusion due to maxillary excessive growth can be intercepted by restricting the maxillary growth by the use of face bow with head gear. Class II malocclusion due to mandible insufficiency can be intercepted by the use of myofunctional appliances. Interception of Class III Malocclusion: Class III malocclusion due to mandibular prognathism can be intercepted by restricting the mandibular growth by use of chin cup. Class III malocclusion due to maxillary deficiency can be intercepted by the use of myofunctional appliances or orthopedic appliance (reversed head gear).  
• Space regaining: Space lost usually by the mesial drifting of permanent molar and distal drifting of deciduous first molar when second deciduous molar is lost prematurely or by drifting of teeth adjacent to impacted tooth , therefore it is recommended to re-open the space by different designs of orthodontic appliances.
• Muscle exercises: Dentoalveolar structures are surrounded on sides by the soft tissue envelop made of orofacal musculature. Development and maintenance of normal occlusion depends on presence of normal oro-facial muscular balance. Muscle exercises help in improving aberrant muscle activity.
• Exercises for the Lips (Circumoral Musculatures): A number of exercises have been advocated for the lips and circumoral musculature in patients with hypotonic lips and short upper lips:
  • Stretching of the upper lip to maintain lip seal is an important therapeutic measure in patients having short hypotonic lips. To aid in the stretching, the patient is asked to hold a piece of paper between the lips.
  • Patient can be asked to stretch the upper lip interiorly towards the chin.
  • Lip massaging.
  • Button Pull Exercise: A button of one and half inch is taken and a thread passed through the button hole. Patient is asked to place the button behind the lips and pull the thread, while restricting it from being pulled out by using lip pressure.
  • Tug of War Exercise:- This involves use of two buttons, with one kept behind the lips while the other button is held by another person to pull the thread.
  • Playing a Reed Musical Instrument:- Playing a reed musical instrument produces fine lip tonicity.
• Exercise for Tongue: 
  • One Elastic Swallow: Used for Correction of positioning of the tongue when the Patient is asked to keep elastic of 5/16" on the tip of tongue and hold the tongue against the patient's rugaee area and swallow .
  • Two Elastic Swallow:Two elastics of 5/16", are replaced over the tongue, one in the midline and the other on the tip and the patient is asked to swallow with the elastic in position .
• Removal of soft tissue and bony barriers: Removal of soft tissue and bony barrier is a surgical interceptive orthodontic procedure, which involves excision of the soft tissue and removal of bone, covering the crown of the unerupted .tooth, to create the space so that the tooth can erupt without any hindrance. The extent of soft tissue and bone removal should be such that the greatest diameter of the crown of the tooth should be able to easily emerge. The surgical wound is given a cement dressing for a period of two weeks.

Your doctor has recommended Phase I orthodontic treatment for you/your child. Although orthodontic treatment can lead to a healthier and more attractive smile, you should also be aware that any orthodontic treatment has limitations and potential risks that you should consider before undergoing treatment.

You may undergo a routine orthodontic pre-treatment examination including radiographs (x-rays) and photographs. Your doctor may also take impressions or intraoral scans of your teeth. The recommended appliance will be placed after a thorough prophylaxis (clean). This insert procedure can take up to 30minutes and can cause some discomfort. Unless instructed otherwise, you should follow up with your doctor every 12 weeks; these appointments are generally made in advance at the practice. Patients may require additional impressions/techniques to help with regular orthodontic treatment.

Most people consider orthodontic treatment for a great smile. But added benefits include better bite (to chew your food), ease of cleaning (it is a lot easier to clean teeth when they are straighter, tooth brushes are manufactured to clean your teeth while they are straight), good joint health, to improve speech.

Like other orthodontic treatments, the use of Phase I appliances may involve some of the risks outlined below:

• Failure to maintain the appliances, not using the product as directed by your doctor, missing appointments, and erupting or atypically shaped teeth can lengthen the treatment time and affect the ability to achieve the desired results
• Dental tenderness may be experienced from time to time
• Gums, cheeks and lips may be scratched or irritated
• Tooth decay, periodontal disease, inflammation of the gums or permanent markings (e.g. decalcification) may occur if patients consume foods or beverages that contain high sugar levels, do not brush and floss their teeth properly after snacks and meals, or do not use proper oral hygiene and preventative maintenance
• The appliance may temporarily affect speech and may result in a lisp, although any speech impediment caused by the appliance should disappear within one or two weeks
• Phase I appliances may cause a temporary increase in salivation or mouth dryness and certain medications can heighten this effect
• Fixed appliances can come off throughout your treatment if you eat hard and sticky foods, if this happens you will be required to have it replaced as soon as an appointment is available
• The bite may change throughout the course of treatment and may result in temporary patient discomfort
• At the end of orthodontic treatment, the bite may require adjustment (“occlusal adjustment”)
• Atypically shaped, erupting and/or missing teeth may affect the ability to achieve the desired results
• General medical conditions and use of medications can affect orthodontic treatment
• Health of the bone and gums which support the teeth may be impaired or aggravated
• Oral surgery may be necessary to correct crowding or severe jaw imbalances that are present prior to using braces. If oral surgery is required, risks associated with anesthesia and proper healing must be taken into account prior to treatment
• Product breakage is more likely in patients with severe crowding and/or multiple missing teeth
• Orthodontic appliances or parts thereof may be accidentally swallowed or aspirated
• In rare instances, problems may also occur in the jaw joint, causing joint pain, headaches or ear problems
• Allergic reactions may occur
• Teeth that are not at least partially held by the braces may undergo supraeruption
• In rare instances, patients with hereditary angioedema (HAE), a genetic disorder, may experience rapid local swelling of subcutaneous tissues including the larynx, HAE may be triggered by mild stimuli including dental procedures

We need your permission to use all the components of the clear aligner system, as well as your commitment to full-time (22 hours/day) wear of the aligners.

 

Attachments

For certain types of movements, aligners can lose their grip on a tooth and fail to get the desired tooth movement. To overcome this, aligners are custom designed as small tooth-colored bumps that are temporarily and precisely bonded to some teeth to improve the effectiveness of the aligners and tooth movement. A small bubble in your aligner will correspond precisely to each of these attachments.

 

Clear Aligner Full Conditions

The Clincheck Video simulation is only a guide to what we can expect and not a guarantee that will be achieved. Compliance and care of your aligners well can help. Aligners should be worn for at least 22 hours out of 24 hours to achieve the best results. It is important to make all of your scheduled visits to our office. This will allow us to check your progress and deliver new aligners. You may be required to wear elastics to correct certain tooth movements or help with bite correction. Elastics should be worn as directed by your orthodontist. Aligners may be used in conjunction with different appliances to aid in bite correction (i.e Herbst appliance). Compliance with both is essential for optimal tooth movement and results. If you have poor compliance with either aligners or elastics or poor tooth movement with your aligners, braces (in conjunction with other appliances) may be required.
 

Interproximal Reduction (IPR)

Interproximal reduction (IPR) is filing between your teeth to create up to a quarter of a millimeter (0.25mm) of space per tooth surface. Since this is the thickness of a few pieces of paper it is generally not even noticeable. The filing is usually done with a thin strip of metal that has fine diamond particles. Dentists use this to polish fillings between teeth so it will feel like we are polishing in between your teeth with floss that is gritty. IPR is very valuable because a small amount of IPR on a number of teeth can create space needed to correct crowding without extracting any teeth. IPR reduces friction between tight teeth facilitating movement. IPR can render better tooth shape and broader contact between teeth. This may be more stable, more aesthetic and even enable better periodontal health. IPR may help avoid extractions as an alternative to create space.

 

Refinement

At the end of treatment, we may order further aligners for ensuring that the outcome with your smile is as close to being perfect as possible. 

 

Retention

At the end of the treatment, we recommend the use of retainers to keep your teeth from shifting back to their original position. We recommend permanent, fixed. I understand teeth can shift if retainers are not used.