Moving Interceptive Orthodontics Forward Through Open Discussion
Interceptive orthodontic treatment is an area of great interest among orthodontists, pediatric dentists, and general dentists. The four most recent conferences sponsored by the AAO that covered early treatment were sold out. Despite this clear interest, there has been minimal discussion about the subject. Progress towards new methods for effectively treating mixed dentition cases has also been limited.
The main roadblock to intercepting a developing malocclusion is the prevailing viewpoint that all phase I treated cases will require a 2nd comprehensive phase of treatment once the remaining permanent teeth erupt. This unsubstantiated claim is based on the assumption that early treatment should only address the functional/skeletal aspects of a developing malocclusion and leave treatment of the dental component to a later permanent dentition phase.
We believe that what is missing is interactive dialogue that will foster new ideas towards the progress of interceptive orthodontic treatment. That is why we created this site – to provide an opportunity for dental professionals to have an open discussion about interceptive orthodontic treatment and help move the discipline forward.
We encourage all interested professionals to participate in the discussion. Please e-mail your opinions and methods to: info@interceptiveortho.com and we will post them on this educational website.
ARTICLES
02/22/2014
02/15/2014
06/13/2014
7/17/2017
7/24/2018
Case Gallery
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- Early mixed dentition. Moderate upper and lower crowding, deep bite.
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- Late mixed dentition, post-interceptive treatment. Space created to align incisors and facilitate eruption of remaining permanent teeth.
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- Post-retention, no additional (Phase II) treatment needed.
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- Early mixed dentition. Excessive maxillary development, Class II occlusion with severe overjet, deep bite.
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- Initial cephalogram.
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- Late mixed dentition. Mechanics involved in were use of MEA in conjunction with headgear, LLA, upper and lower fixed appliances with I-tips in both arches, and Class II elastics. The treatment was able to decrease overjet and overbite, and decrease maxillary protrusion.
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- Post-retention.
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- Final cephalogram.
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- Early mixed dentition. Inference at the incisors is causing mandible to shift forward into an anterior crossbite (pseudo-Class III).
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- Initial cephalogram.
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- Permanent dentition. No Phase II treatment necessary. A button was used to rotate #21.
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- Final cephalogram.
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- Post-retention. Profile picture reveals mildly deficient maxilla and mildly excessive mandible, but occlusion remains Class I despite a Class III tendency.
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- Early mixed dentition, Class III occlusion and anterior crossbite. No forward shift of the mandible.
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- MEA used to expand maxilla and LLA used to coordinate lower molars with upper molars.
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- Brackets are bonded to deciduous teeth with I-tips creating a gingival sweep increasing from primary 2nd molars to primary canines. Observe the gingival position of the arch wire in relation to lower incisor brackets in upper set of pictures. This will create an intrusive force on the lower incisors after engagement (lower set of pictures).
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- The lower incisors have intruded into a position more level with the buccal segments. This has created clearance between the upper and lower incisors to promote correction of the anterior crossbite.
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- The degree of underbite present prior to bonding the upper arch.
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- Brackets are bonded to upper incisors and deciduous canines. I-tips of the deciduous canine brackets direct the arch wire gingival to the upper incisors brackets before engagement (upper set of pictures). After engagement, an intrusive force will occur at the upper incisors. Intruding the upper incisors will create more clearance for correction of the anterior crossbite.
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- Upper incisors are intruding, lower incisors are being retracted.
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- Upper incisors are level with buccal segment, while lower incisors are continuing to be retracted. Upper and lower incisors have full clearance has been achieved between the upper and lower incisors.
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- Open coil springs being used to evenly distribute space in upper and lower quadrants and coordinate midlines.
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- Open coil springs were used to advance the upper incisors. The anterior crossbite has been eliminated at this point.
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- Class III elastics are being used over-correct the overjet.
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- Upper arch is debonded at this point. Eruption of the permanent canines and premolars is almost complete.
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- Brackets are bonded to permanent canines and premolars to continue over-correcting the overjet. There is space available in the buccal segments for this over-correction.
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- Lower spaces are now close and overjet is mildly excessive.
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- Permanent dentition. As noted previously, minimal additional treatment was performed in the lower arch to overcorrect the overjet.
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- Early mixed dentition. Narrow maxilla, posterior crossbite on left side.
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- Late mixed dentition, post-interceptive treatment. Two MEA appliances were used to correct crossbite. No additional (Phase II) treatment was needed, although post-retention records are not yet available
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- Early mixed dentition. Primary dentition has just given way to eruption of the permanent central incisors. Posterior crossbite is present on right side. There is a thumb-sucking habit.
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- Late mixed dentition. Two MEA appliances were used to correct crossbite. Minor tooth movement needed to be done during retention because retainers were not worn well enough.
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- Early mixed dentition. Deep bite with crossbite on left side.
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- Upper arch bonded with I-tips of #C and #H brackets to intrude the upper incisors. Notice that the mesial wings of the #C and #H brackets are tipped gingivally in the upper set of pictures. The lower set of pictures shows the gingival deflection of the arch wire, which will intrude the upper incisors.
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- Observe the decrease in the overbite which has occurred. The maxilla is being expanded while the incisors are being aligned and intruded.
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- I-tips were placed in the lower arch as well. The deciduous brackets have been removed at this point to allow for the exfoliation of the deciduous teeth.
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- Permanent dentition. No Phase II treatment is necessary.
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- Post-retention. An asymmetry in the mandible has contributed to the left side Class II occlusion despite the correction of the crossbite on the left side.
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- Post-retention. Occlusal equilibration was done to eliminate occlusal interferences.
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- Early mixed dentition. Long lower face with an open bite, chin deviated to the right.
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- Late mixed dentition, post-interceptive treatment. Overbite achieved but minimal. The patient was asked to wear a high-pull chin cup at night during retention.
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- Permanent dentition, no additional (Phase II) treatment needed. The overbite has remained stable. Assymetry of the mandible has contributed to the lower midline being off to the right.
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- Post-retention.
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- Late mixed dentition, post-interceptive treatment. Maxilla was widened and incisors were uprighted. Lip protrusion has decreased in profile picture. Incisors were intruded using the MEA appliance as anchorage. Gingival display has not noticeably improved due to bunching at the gingiva of the lateral incisors.
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- Early mixed dentition. Narrow maxilla with protrusive upper incisors, gummy smile.
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- Permanent dentition, no additional (Phase II) treatment needed. Maxillary width increase has remained stable and gingival display is desirable.
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- Early mixed dentition. Excessive gingival display, narrow maxilla
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- Late mixed dentition, post-interceptive treatment. MEA appliance was used to increase maxillary width and as anchorage to decrease the gummy smile.
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- Permanent dentition. No additional (Phase II) treatment needed.
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- Post-retention. Maxillary width increase and decrease in gummy smile have remained stable.
ABOUT
Dr. Cameron Mashouf migrated to the United States in 1969 after receiving his DDS degree from the University of Tehran. He completed his Orthodontic Specialty at Loyola University of Chicago and his Master of Science degree in Histology at the University of Illinois in Chicago. He completed a one year fellowship position at the University of Chicago with doctors Tom Graber and Joe Jaraback.
In 1976, he moved to San Francisco and took a teaching position at the Department of Orthodontics, University of Pacific in San Francisco. For the next ten years, along with Dr. Eugene Roberts, he taught Growth and Development at UOP and at Mount Zion Hospital.
From the beginning Dr. Mashouf was involved in the clinical aspect of orthodontics, first in a solo practice in Marin County and later along with Dr. Ray Katz in a combined ortho-pedo practice in San Francisco which spanned over twenty two years.
Dr. Mashouf has been practicing in San Jose since 1987. He also has an Adjunct Associate Professor teaching position at the University of Pacific, Dugoni School of Dentistry in San Francisco.
Dr. Kayhan Mashouf completed his dental education at Boston University School of Dental Medicine. He then matriculated at the University of Colorado in Denver to specialize in orthodontics. Upon completing his residency in February of 2013 with a Certificate of Orthodontic Specialty and a Master of Science Degree in Dentistry, he returned to his hometown of San Jose, CA to join his father’s practice.
Dr. Mashouf’s major area of interest is interceptive orthodontic treatment in younger children (7-9 years of age). He believes that the biological adaptability present at this stage of development is highly advantageous in correcting misaligned teeth and discrepanacies. He also enjoys teaching and has traveled to provide lectures about early mixed dentition treatment, most notably at the annual American Association of Pediatric Dentistry Conference in 2013.