INTERCEPTIVE ORTHODONTICS

Interceptive orthodontics is the practice of extracting the deciduous dentition in an attempt to avoid an adult malocclusion. This is performed in two basic situations. The most common situation is in the case of retained deciduous teeth. The other reason is where there is a malocclusion present in the deciduous teeth and extraction of these teeth may allow the patient to correct itself during its growth phase.

Retained deciduous teeth are defined by the fact that the deciduous tooth is still present when the adult tooth erupts. This can cause serious malocclusions as well as promote periodontal disease. This procedure is performed as soon as the adult teeth are noted, even if the deciduous teeth are loose. 

When there is a malocclusion present when the deciduous teeth are present, extraction of the deciduous teeth can allow the teeth or jaws to correct themselves during growth. Oftentimes, the jaws will grow at different rates, which will result in an undershot (class III) or overshot (class II) malocclusion. It is possible to have the teeth on the short arcade get caught behind teeth on the other arcade. This will not allow the jaw to catch up which it often wants to do. Extracting the deciduous teeth on the jaw that is short will remove this adverse dental interlock. This will allow the jaw to grow if it wants to, but will not cause the jaw to move. For base narrow or anterior crossbite situations that are caused by the teeth being out of alignment (class I) extraction may allow the adult teeth to come into the correct location.

A severe Class II malocclusion in a puppy resulting in palatal trauma from the mandibular canine. Removing this interlock is necessary to prevent the painful occlusion including extraction of the opposite mandibular canine and the mandibular incisors. This patient will likely require additional oral surgery as the adult dentition appears.

For both of these conditions the procedure should be performed as soon as possible to allow the greatest benefit for the patient. This means in the case of deciduous malocclusions the procedure is performed at about 8 weeks of age. With the anesthetic protocols that we have now, this is not a large concern. The patient is anesthetized and a dental radiograph exposed. This is done to determine the state of the deciduous root, but also to determine the presence and location of the corresponding adult tooth. The deciduous tooth is VERY CAREFULLY extracted to avoid damaging the erupting adult tooth. Before eruption the enamel is very soft and easily damaged. If the enamel is damaged it will result in permanent enamel hypoplasia. It is important the entire root be removed. This is because a retained root will interfere with occlusion and can also be a source of infection.