1
Atypical extractions
www.indiandentalacademy.com
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiand...
2
 Increased ability to move teeth under better control: ever-
expanding choice of extraction.
Factors affecting choice o...
3
Facial profile alteration:
 Maxi retraction of U&L anteriors: 4’s
 Lesser retraction in lower face: U4’s and L5’s
 Le...
4
Atypical extractions
 Incisors
 Canines
 Asymmetric premolar extraction
 molars
www.indiandentalacademy.com
5
Incisor Extraction:
 Mandibular incisors- therapeutic importance
 1st sign of incipient malocclusion
Difficult to tre...
6
Incisor extraction:
Indications:-
 For mandibular incisors:
 Extreme crowding / protrusion.
 Gingival recession & los...
7
Incisor extraction:
Advantages:
1. Maintains/ reduces intercanine
width
2. General arch form is maintained
– greater sta...
8
Incisor extraction:
Disadvantages:-
 Reopening of space . Central Incisor.
 Danger of creating a tooth size discrepanc...
9
Upper Incisor Extraction:
 Rarely indicated.
 Unfavorable impaction of U incisor.
 Bu/Li blocked out lateral, with go...
10
Summarize:
 Incisor Xn not often.
 Possibility must always be considered.
 Careful planning with diagnostic setup
ww...
11
Extraction of Canines:
 Not extracted.
 Long path of eruption.
 Conditions where indicated:
 Impossible to bring in...
12
Where teeth should be positioned in the face and jaws and
how to get them there---Thomas Creekmore JCO sep 1997
www.ind...
13www.indiandentalacademy.com
14
Premolar extraction
 Single premolar extraction
 3 premolar extraction---AJO-DO sep 2003
Class II sub division
www.in...
15www.indiandentalacademy.com
16www.indiandentalacademy.com
17
Ist Molar Extraction:
 Avoided:
Not provide adequate space in the ant region.
5 & 7 may tip in the Xn space.
Deepen...
18
Carious- beyond restoration
RCTreated, - than a perfectly good premolar.
Multi filled teeth- crown.
Premature Xn of...
19
Ist Molar Extraction:
 Not to allow U7 locked behind L7.
Horizontal elastics – until danger of locking has passed.
 M...
20
Single arch extraction – U 6 or what to do
when non extraction treatment fails.
Raleigh Williams. AJO 1979
 Class II d...
21
 Problems with Xn of 4s:
 Tipping, opening of space (5 small to fill the space)
 Mesial tipping of 6, hanging palata...
22
2nd MOLAR EXTRACTION:
 David W.Liddle- AJO 1977
 Malocclusion: potential force by developing 7,8.
 Xn of 7s to inter...
23
2nd MOLAR EXTRACTION:
ADVANTAGES AND INDICATIONS
 Disimpaction of 3rd molars, faster eruption
 Prevention of “dished-...
24
Indications:
 Chipman:
 Xn 7 - caries, ectopic, rotated.
 Mild – moderate discrepancy with good profile.
 Crowding ...
25
Disadvantages:
 Too much tooth substance removed in Cl I mal occlusion
with mild crowding.
 Location far from area of...
26
Timing for mandibular 2nd molar extraction:
 Kokich:
1. 3rd molar crowns completely formed, Xn before
roots begin to d...
27
3rd Molar Extraction:
 Xn to prevent lower anterior crowding?
 Distal movement of 6,7– impaction of 8.
 Pain
 Contr...
28
The Effect of Different Extraction sites upon
incisor retraction. Raliegh Williams et al AJO 1976
 Relation b/w root s...
29
Non extraction 1.5mm
1st molars u&l 6.0mm
U4 and L5 8.7mm
1st premolars 9.2mm
1st premolars
&1st molars 16.9mm
www.indi...
30
Conclusion:
 Location of the Xn site-
Root surface area.
Predict incisor retraction.
 Should be considered in diagn...
31
 Orthodontic treatment may include extractions of
any tooth in the arch.
 Based on sound diagnosis, treatment objecti...
32
 “Different extractions for different malocclusions” – Sidney
Brandt, Safirstein AJO 1975
 Extractions in Orthodontic...
33
References:
 The effect of different extraction sites upon incisor
retraction- Raleigh Williams & Hosila AJO 1976
 Wh...
34
Thank you
For more details please visit
www.indiandentalacademy.com
www.indiandentalacademy.com
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Atypical ext /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078

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Atypical ext /certified fixed orthodontic courses by Indian dental academy

  1. 1. 1 Atypical extractions www.indiandentalacademy.com INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com
  2. 2. 2  Increased ability to move teeth under better control: ever- expanding choice of extraction. Factors affecting choice of extraction 1. Treatment objectives 2. Type of malocclusion 3. Esthetics (large chin button, prominent nose) 4. Growth pattern. 5. Conditions of teeth.(caries, multifilled teeth, impacted, ectopic, severe rotation) 6. Health of supporting tissues. www.indiandentalacademy.com
  3. 3. 3 Facial profile alteration:  Maxi retraction of U&L anteriors: 4’s  Lesser retraction in lower face: U4’s and L5’s  Less overall retraction: 5’s or 6’s. Deep anterior overbite:  Closer.( Mechanically easier to level, as spaces are closed). incisors – min time and effort. Open bite:  5 or 6 Xn. Accentuate the curve of Spee. GRABER: Removal of 5s in mandibular arch preferable. ‘.’ reduces the tendency of relapse of openbite &lingually inclined incisors seen occasionally with Xn of 4s. www.indiandentalacademy.com
  4. 4. 4 Atypical extractions  Incisors  Canines  Asymmetric premolar extraction  molars www.indiandentalacademy.com
  5. 5. 5 Incisor Extraction:  Mandibular incisors- therapeutic importance  1st sign of incipient malocclusion Difficult to treat as they relapse easily.  Not a new idea.  Jackson (1904)  Riedel(1975) : Xn of lower Incisors  Angle: Inexcusable. Disharmony b/w Occlusal planes, abnormal overbite www.indiandentalacademy.com
  6. 6. 6 Incisor extraction: Indications:-  For mandibular incisors:  Extreme crowding / protrusion.  Gingival recession & loss of overlying bone on labial surface.  Lateral incisors severely # in young children.  Discrepancy in sizes of U & L incisors themselves, 1 incisor can be removed.  Reidel- Rx time reduced.  min facial change. www.indiandentalacademy.com
  7. 7. 7 Incisor extraction: Advantages: 1. Maintains/ reduces intercanine width 2. General arch form is maintained – greater stability 3. Retention period- less 4. Anterior segments can be retracted readily, if needed. 5. Immediate solid tooth support of entire buccal segments. 6. Easy reduction of overbite, reshaping 7. Mechanotherapy is simplified. Space closure quick.www.indiandentalacademy.com
  8. 8. 8 Incisor extraction: Disadvantages:-  Reopening of space . Central Incisor.  Danger of creating a tooth size discrepancy.  1 incisor Xn- deepbite- if normal tooth size relationship is present before Xn.  Color difference of canine. www.indiandentalacademy.com
  9. 9. 9 Upper Incisor Extraction:  Rarely indicated.  Unfavorable impaction of U incisor.  Bu/Li blocked out lateral, with good contact b/w central and canine.  Congenital missing of 1 lateral incisor  Dilacerated tooth.  Trauma, caries & periodontal disease  Gardiner et al: U crowding, mesial displacement of root apices of U3 - Xn of lateral incisor. www.indiandentalacademy.com
  10. 10. 10 Summarize:  Incisor Xn not often.  Possibility must always be considered.  Careful planning with diagnostic setup www.indiandentalacademy.com
  11. 11. 11 Extraction of Canines:  Not extracted.  Long path of eruption.  Conditions where indicated:  Impossible to bring in alignment.  Gross displacement Bu/Li  4 in contact with 2 & does not show palatal cusp. Decision : position of apex. www.indiandentalacademy.com
  12. 12. 12 Where teeth should be positioned in the face and jaws and how to get them there---Thomas Creekmore JCO sep 1997 www.indiandentalacademy.com
  13. 13. 13www.indiandentalacademy.com
  14. 14. 14 Premolar extraction  Single premolar extraction  3 premolar extraction---AJO-DO sep 2003 Class II sub division www.indiandentalacademy.com
  15. 15. 15www.indiandentalacademy.com
  16. 16. 16www.indiandentalacademy.com
  17. 17. 17 Ist Molar Extraction:  Avoided: Not provide adequate space in the ant region. 5 & 7 may tip in the Xn space. Deepening of bite. Masticatory efficiency. www.indiandentalacademy.com
  18. 18. 18 Carious- beyond restoration RCTreated, - than a perfectly good premolar. Multi filled teeth- crown. Premature Xn of 6, to preserve symmetry. Facial considerations: large chin buttons&/ prominent nose (rationale: farther back less facial change) Open bite cases. Indications: www.indiandentalacademy.com
  19. 19. 19 Ist Molar Extraction:  Not to allow U7 locked behind L7. Horizontal elastics – until danger of locking has passed.  Mesially inclined 7, lesser degree of anchor bend. Wilkinson’s Extraction: 1942 8 ½ to 9 ½ yrs. Extraction of all Ist molars. Basis: •Additional space for eruption of 8s. •Crowding of lower arch minimized. •Disadvantages- www.indiandentalacademy.com
  20. 20. 20 Single arch extraction – U 6 or what to do when non extraction treatment fails. Raleigh Williams. AJO 1979  Class II div 1 with perfect lower arch alignment but growth expectation inadequate.  Class II div 1 active growth over. Pt non cooperative.  Class II div 1 with good lower arch over basal bone, with some growth expectation.  Class II div 1 with mild open bite. www.indiandentalacademy.com
  21. 21. 21  Problems with Xn of 4s:  Tipping, opening of space (5 small to fill the space)  Mesial tipping of 6, hanging palatal cusp Avoided with 6 Xn.  Good molar relation.  U 4 occlude with L4  8s erupt normally.  Min patient cooperation  Stable results.  Tuberosity not crowded.  Results similar to nonext.  Rx duration is reduced.  Profile maintained.  Open bite correction www.indiandentalacademy.com
  22. 22. 22 2nd MOLAR EXTRACTION:  David W.Liddle- AJO 1977  Malocclusion: potential force by developing 7,8.  Xn of 7s to intercept this forward force.  4 Xn: treating the effect and not the cause.  10-12mm of space :satisfies arch length problem, not apparent when patient smiles.  91% 7 Xn.  6 move distally in response to pressure.  Over compressed CT fibers- move 3 &4 to a more normal occlusion. www.indiandentalacademy.com
  23. 23. 23 2nd MOLAR EXTRACTION: ADVANTAGES AND INDICATIONS  Disimpaction of 3rd molars, faster eruption  Prevention of “dished-in” at the end of facial growth  Prevention of late incisor imbrication  Facilitation of 1st molar distalization  Distal movement only as needed to correct the overjet  Fewer “residual”spaces at the end of Rx  Good functional occlusion  Overbite reduction. www.indiandentalacademy.com
  24. 24. 24 Indications:  Chipman:  Xn 7 - caries, ectopic, rotated.  Mild – moderate discrepancy with good profile.  Crowding in tuberosity area ,with a need for distal movement of 1st molar.  Lehman - preconditions  8 in favorable angulation 15-30*angle to the long axis of the 1st molar.  Normal in size/shape & root area is sufficient w.r.t 2nd molar.  No congenitally missing teeth. www.indiandentalacademy.com
  25. 25. 25 Disadvantages:  Too much tooth substance removed in Cl I mal occlusion with mild crowding.  Location far from area of concern.  No help in correction of A-P discrepancy without patient cooperation .  Possible impaction of 3rd molars even with 2nd molar Xn  Unacceptable positions of erupted 3rd molars –second, late stage of fixed therapy.  9-20% missing 3rd molars. www.indiandentalacademy.com
  26. 26. 26 Timing for mandibular 2nd molar extraction:  Kokich: 1. 3rd molar crowns completely formed, Xn before roots begin to develop 2. 30*to the occlusal plane 3. 3rd molars in close proximity to 2nd molar-drift. Halderson, Huggins, Lehman and Smith. Before radiographic evidence of root formn.(12-14yrs) Consensus opinion: as soon as 2nd molar erupts. angulation. www.indiandentalacademy.com
  27. 27. 27 3rd Molar Extraction:  Xn to prevent lower anterior crowding?  Distal movement of 6,7– impaction of 8.  Pain  Contraindications:  1st or 2nd molars are extracted. www.indiandentalacademy.com
  28. 28. 28 The Effect of Different Extraction sites upon incisor retraction. Raliegh Williams et al AJO 1976  Relation b/w root surface area and Xn site selection upon incisor retraction.  Efficient mechanotherapy.  Diagnostic line.  Larger the root surface area, greater the resistance to movement. www.indiandentalacademy.com
  29. 29. 29 Non extraction 1.5mm 1st molars u&l 6.0mm U4 and L5 8.7mm 1st premolars 9.2mm 1st premolars &1st molars 16.9mm www.indiandentalacademy.com
  30. 30. 30 Conclusion:  Location of the Xn site- Root surface area. Predict incisor retraction.  Should be considered in diagnosis, so that a desired Rx goal for the final position of incisors within the facial profile can be achieved. www.indiandentalacademy.com
  31. 31. 31  Orthodontic treatment may include extractions of any tooth in the arch.  Based on sound diagnosis, treatment objectives. www.indiandentalacademy.com
  32. 32. 32  “Different extractions for different malocclusions” – Sidney Brandt, Safirstein AJO 1975  Extractions in Orthodontics- Nagalakshmi & Ashima Valiathan JICD vol 37 1995  Single arch extraction- upper first molars or what to do when nonextraction treatment fails- Raleigh Williams AJO oct 1979  Second molar extractions: A review – Samir Bishara, AJO- DO 1986 may  Second molar extraction in orthodontic treatment- David W. Liddle AJO dec 1977  Third Molars: A review Samir E. Bishara AJO feb 1983 References: www.indiandentalacademy.com
  33. 33. 33 References:  The effect of different extraction sites upon incisor retraction- Raleigh Williams & Hosila AJO 1976  Where teeth should be positioned in the face and jaws and how to get them there---Thomas Creekmore JCO sep 1997  Class II subdivision treatment success rate with symmetric and asymmetric extraction protocols- Guilherme Jansson, Dainesi, Fernando. AJO-DO sep 2003 www.indiandentalacademy.com
  34. 34. 34 Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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