Methods of gaining space by Extraction /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.

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  • Location in arch such that space gained by Xn utilized for correction of both anterior and posterior segments.
  • Bimaxillary dento alveolar protrusion.
  • Riedel- treatment time is reduced.
  • Methods of gaining space by Extraction /certified fixed orthodontic courses by Indian dental academy

    1. 1. 1 Methods of gaining Space ExtractionsExtractions INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
    2. 2. 2  Increased ability to move teeth under better control: ever-Increased ability to move teeth under better control: ever- expanding choice of extraction.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:Facial profile alteration:  Maxi retraction of U&L anteriors: 4s (laterals)Maxi retraction of U&L anteriors: 4s (laterals)  Lesser retraction in lower face: U4s and L5sLesser retraction in lower face: U4s and L5s  Less overall retraction: 5s or 6s.Less overall retraction: 5s or 6s. Deep anterior overbite:Deep anterior overbite:  CloserCloser.(.( Mechanically easier to level, as spaces areMechanically easier to level, as spaces are closed).closed). incisors – min time and effort.incisors – min time and effort. Open bite:Open bite:  5 or 6 Xn. Accentuate the curve of Spee.5 or 6 Xn. Accentuate the curve of Spee. GRABER:GRABER: RRemoval of 5s in mandibular arch preferable.emoval of 5s in mandibular arch preferable. ‘‘.’ reduces the tendency of relapse of openbite &lingually.’ reduces the tendency of relapse of openbite &lingually inclined incisors seen occasionally with Xn of 4s.inclined incisors seen occasionally with Xn of 4s. www.indiandentalacademy.com
    4. 4. 4 Extraction of Ist premolars. ADVANTAGES :ADVANTAGES :  Erupts before any other post teeth, after 6.Erupts before any other post teeth, after 6.  Eruptive sequence : Xn at proper time.Eruptive sequence : Xn at proper time.  Strategically located close to the incisors.Strategically located close to the incisors.  Center of each half of arch .’. Ant & post crowding.Center of each half of arch .’. Ant & post crowding.  Protraction of molars not required.Protraction of molars not required.  4 Xn adequate anchorage for retraction of 6 teeth.4 Xn adequate anchorage for retraction of 6 teeth.  Contact b/w canine and 2Contact b/w canine and 2ndnd premolar satisfactory.premolar satisfactory. www.indiandentalacademy.com
    5. 5. 5 1. Convex profile with severe crowding. 2. Class II div I with deep anterior bite. 3. Class I with severe crowding. 4. Class I with bimaxillary protrusion. Indications for I st premolar extraction: www.indiandentalacademy.com
    6. 6. 6 Indications for I st premolar extraction. www.indiandentalacademy.com
    7. 7. 7 Extraction of 2nd premolars: History: Henry(1965) 1.mild degree of crowding & excellent profile. 2.No crowding and fullness of lips. Begg: unless carious or poorly formed. Nance: Ist person.Mild discrepancy. Avoids dished-in-face & less tendency for relapse. Carey: 2.5-5mm www.indiandentalacademy.com
    8. 8. 8  DEWEL:DEWEL: Xn creates more space in borderline cases,Xn creates more space in borderline cases, closed by reducing the anchorage value of buccal segmentsclosed by reducing the anchorage value of buccal segments  LOGAN:LOGAN:  U4 more esthetic than 5U4 more esthetic than 5  Contact b/w 4 and 6 tended to stay closed.Contact b/w 4 and 6 tended to stay closed.  Reduced possibility of buccal/lingual furrows in XnReduced possibility of buccal/lingual furrows in Xn site ‘.’ of rapid closure.site ‘.’ of rapid closure.  Closure of ant open bite, by reducing post verticalClosure of ant open bite, by reducing post vertical dimension.dimension.  De CASTRO:De CASTRO: 3 independent segments.3 independent segments. • 5s Xed only post segment shortened.5s Xed only post segment shortened. • 4s Xed, both segments shortened-4s Xed, both segments shortened- functionalfunctional integrity of the dentition.integrity of the dentition. www.indiandentalacademy.com
    9. 9. 9 INDICATIONS FOR 2ND PREMOLAR EXTRACTION 1.Good profile+mild crowding 2.flat profile+moderate crowding 3.Class II div 1 on skeletal class I +mild crowding. 4. Mild Class III inter-arch relation+mild crowding in U arch. 5.Congenitally missing,impacted. 6. Grossly destructed/heavy restn. 7. Abnormal root morphology. 8. Open bite. www.indiandentalacademy.com
    10. 10. 10Extraction of 2nd premolars: ADVANTAGES: 1. Original facial contours retained without reduction of lip profile. www.indiandentalacademy.com
    11. 11. 11 ADVANTAGES:  U 4 more esthetic along side canine.U 4 more esthetic along side canine.  Lesser tendency for extraction space to open in L arch.Lesser tendency for extraction space to open in L arch.  Less possibility of buccal/lingual furrow in Xn space.Less possibility of buccal/lingual furrow in Xn space.  Easy correction of Class II molar correction to Class IEasy correction of Class II molar correction to Class I molar relation.molar relation. www.indiandentalacademy.com
    12. 12. 12 Ist Molar Extraction:  Avoided:Avoided: Not provide adequate space in the ant region.Not provide adequate space in the ant region. 5 & 7 may tip in the Xn space.5 & 7 may tip in the Xn space. Deepening of bite.Deepening of bite. Masticatory efficiency.Masticatory efficiency. www.indiandentalacademy.com
    13. 13. 13 Carious- beyond restorationCarious- beyond restoration RCTreated, - than a perfectly good premolar.RCTreated, - than a perfectly good premolar. Multi filled teeth- crown.Multi filled teeth- crown. Premature Xn of 6, to preserve symmetry.Premature Xn of 6, to preserve symmetry. Facial considerations: large chin buttons&/ prominentFacial considerations: large chin buttons&/ prominent nosenose (4- dished-in)(4- dished-in) ((rationale: farther back less facial change)rationale: farther back less facial change) Open bite cases.Open bite cases. Indications: www.indiandentalacademy.com
    14. 14. 14 Ist Molar Extraction:  Not to allow U7 locked behind L7.Not to allow U7 locked behind L7. Horizontal elastics – until danger of locking has passed.Horizontal elastics – until danger of locking has passed.  Mesially inclined 7, lesser degree of anchor bendMesially 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
    15. 15. 15 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 butClass II div 1 with perfect lower arch alignment but growth expectation inadequate.growth expectation inadequate.  Class II div 1 active growth over. Pt non cooperative.Class II div 1 active growth over. Pt non cooperative.  Class II div 1 with good lower arch over basal bone, withClass II div 1 with good lower arch over basal bone, with some growth expectation.some growth expectation.  Class II div 1 with mild open bite.Class II div 1 with mild open bite. www.indiandentalacademy.com
    16. 16. 16  Problems with Xn of 4s:Problems with Xn of 4s:  Tipping, opening of space (5 small to fill the space)Tipping, opening of space (5 small to fill the space)  Mesial tipping of 6, hanging palatal cuspMesial tipping of 6, hanging palatal cusp Avoided with 6 Xn.Avoided with 6 Xn.  Good molar relation.Good molar relation.  U 4 occlude with L4U 4 occlude with L4  8s erupt normally.8s erupt normally.  Min patient cooperationMin patient cooperation  Stable results.Stable results.  Tuberosity not crowded.Tuberosity not crowded.  Results similar to nonext.Results similar to nonext.  Rx duration is reduced.Rx duration is reduced.  Profile maintained.Profile maintained. www.indiandentalacademy.com
    17. 17. 17 2nd MOLAR EXTRACTION:  David W.Liddle-David W.Liddle- AJO 1977AJO 1977  Malocclusion: potential force by developing 7,8.Malocclusion: potential force by developing 7,8.  Xn of 7s to intercept this forward force.Xn of 7s to intercept this forward force.  4 Xn: treating the effect and not the cause.4 Xn: treating the effect and not the cause.  10-12mm of space :satisfies arch length problem, not10-12mm of space :satisfies arch length problem, not apparent when patient smiles.apparent when patient smiles.  91% 7 Xn.91% 7 Xn.  6 move distally in response to pressure.6 move distally in response to pressure.  Over compressed CT fibers- move 3 &4 to a more normalOver compressed CT fibers- move 3 &4 to a more normal occlusion.occlusion. www.indiandentalacademy.com
    18. 18. 18 2nd MOLAR EXTRACTION: ADVANTAGES AND INDICATIONSADVANTAGES AND INDICATIONS  DDisimpaction of 3isimpaction of 3rdrd molars, faster eruptionmolars, faster eruption  Prevention of “dished-in” at the end of facial growthPrevention of “dished-in” at the end of facial growth  Prevention of late incisor imbricationPrevention of late incisor imbrication  Facilitation of 1Facilitation of 1stst molar distalizationmolar distalization  Distal movement only as needed to correct the overjetDistal movement only as needed to correct the overjet  Fewer “residual”spaces at the end of RxFewer “residual”spaces at the end of Rx  Less likelihood of relapseLess likelihood of relapse  Good functional occlusionGood functional occlusion  Good mandibular arch formGood mandibular arch form  Overbite reduction.Overbite reduction. www.indiandentalacademy.com
    19. 19. 19 Indications: Chipman:Chipman:  Xn 7 - caries, ectopic, rotated.Xn 7 - caries, ectopic, rotated.  Mild – moderate discrepancy with good profile.Mild – moderate discrepancy with good profile.  Crowding in tuberosity area ,with a need for distalCrowding in tuberosity area ,with a need for distal movement of 1movement of 1stst molar.molar. Lehman - preconditionsLehman - preconditions  8 in favorable angulation 15-30*angle to the long axis of8 in favorable angulation 15-30*angle to the long axis of the 1the 1stst molar.molar.  Normal in size/shape & root area is sufficient w.r.t 2Normal in size/shape & root area is sufficient w.r.t 2ndnd molar.molar.  No congenitally missing teeth.No congenitally missing teeth. www.indiandentalacademy.com
    20. 20. 20 Disadvantages:  Too much tooth substance removed in Cl I mal occlusionToo much tooth substance removed in Cl I mal occlusion with mild crowding.with mild crowding.  Location far from area of concern.Location far from area of concern.  No help in correction of A-P discrepancy without patientNo help in correction of A-P discrepancy without patient cooperation .cooperation .  Possible impaction of 3Possible impaction of 3rdrd molars even with 2molars even with 2ndnd molar Xnmolar Xn  Unacceptable positions of erupted 3Unacceptable positions of erupted 3rdrd molars –second, latemolars –second, late stage of fixed therapy.stage of fixed therapy.  9-20% missing 39-20% missing 3rdrd molars.molars. www.indiandentalacademy.com
    21. 21. 21 Timing for mandibular 2nd molar extraction:  Kokich:Kokich: 1.1. 33rdrd molar crowns completely formed, Xn beforemolar crowns completely formed, Xn before roots begin to developroots begin to develop 2.2. 30*to the occlusal plane30*to the occlusal plane 3.3. 33rdrd molars in close proximity to 2molars in close proximity to 2ndnd molar-drift.molar-drift. Halderson, Huggins, Lehman and Smith.Halderson, Huggins, Lehman and Smith. Before radiographic evidence of root formnBefore radiographic evidence of root formn.(.(12-14yrs)12-14yrs) Consensus opinion: as soon as 2Consensus opinion: as soon as 2ndnd molar erupts.molar erupts. angulation.angulation. www.indiandentalacademy.com
    22. 22. 22 3rd Molar Extraction:  Xn to prevent lower anterior crowding?Xn to prevent lower anterior crowding?  Distal movement of 6,7– impaction of 8.Distal movement of 6,7– impaction of 8.  Xn of 8 before retracting.Xn of 8 before retracting. Contraindications:Contraindications:  11stst or 2or 2ndnd molars are extracted.molars are extracted. www.indiandentalacademy.com
    23. 23. 23 Incisor Extraction:  Mandibular incisors- therapeutic valueMandibular incisors- therapeutic value  11stst sign of incipient malocclusionsign of incipient malocclusion  Difficult to treat as they relapse easily.Difficult to treat as they relapse easily.  Not a new idea.Not a new idea.  Jackson (1904)Jackson (1904)  Riedel :Riedel : Xn of 2 lowerXn of 2 lower Incisors-arch form withoutIncisors-arch form without Expn of intercanine widthExpn of intercanine width  Angle:Angle: Inexcusable.disharmony b/wInexcusable.disharmony b/w Occlusal planes, abnormal overbiteOcclusal planes, abnormal overbite www.indiandentalacademy.com
    24. 24. 24 Incisor extraction: Indications:-  For mandibular incisors:For mandibular incisors:  Extreme crowding / protrusion.Extreme crowding / protrusion.  Gingival recession & loss ofGingival recession & loss of overlying bone on labial surface.overlying bone on labial surface.  Lateral incisors severely # inLateral incisors severely # in young children.young children.  Rarely-discrepancy in sizes of U &Rarely-discrepancy in sizes of U & L incisors themselves, 1 incisorL incisors themselves, 1 incisor can be removed.can be removed.  Reidel- Rx time reduced.Reidel- Rx time reduced.  min facial change.min facial change. www.indiandentalacademy.com
    25. 25. 25 Incisor extraction: Advantages: 1.1. Maintains/ reduces intercanineMaintains/ reduces intercanine widthwidth 2.2. General arch form is maintainedGeneral arch form is maintained – greater stability– greater stability 3.3. Retention period- lessRetention period- less 4.4. Anterior segments can beAnterior segments can be retracted readily if need be.retracted readily if need be. 5.5. Immediate solid tooth support ofImmediate solid tooth support of entire buccal segments.entire buccal segments. 6.6. Easy reduction of overbite-Easy reduction of overbite- intrusion, reshapingintrusion, reshaping 7.7. Mechanotherapy is simplified.Mechanotherapy is simplified. Space closure quick.Space closure quick.www.indiandentalacademy.com
    26. 26. 26 Incisor extraction: Disadvantages:-  Reopening of space . Central Incisor.Reopening of space . Central Incisor.  Danger of creating a tooth size discrepancy.Danger of creating a tooth size discrepancy.  ReidelReidel- 2 mandi incisors Xed to maintain- 2 mandi incisors Xed to maintain intercanine width.intercanine width.  1 incisor Xn- deepbite- if normal tooth size1 incisor Xn- deepbite- if normal tooth size relationship is present before Xn.relationship is present before Xn.  Color difference of canine.Color difference of canine. www.indiandentalacademy.com
    27. 27. 27 Upper Incisor Extraction:  Rarely indicated.Rarely indicated.  Unfavorable impaction of U incisor.Unfavorable impaction of U incisor.  Bu/Li blocked out lateral, with good contact b/w centralBu/Li blocked out lateral, with good contact b/w central and canine.and canine.  Congenital missing of 1 lateral incisorCongenital missing of 1 lateral incisor  Dilacerated tooth.Dilacerated tooth.  Gardiner et al:Gardiner et al: • U crowding, mesial displacement of root apicesU crowding, mesial displacement of root apices of U3 - Xn of lateral incisor.of U3 - Xn of lateral incisor. www.indiandentalacademy.com
    28. 28. 28 Summarize:  Incisor Xn rare.Incisor Xn rare.  Possibility must always be considered.Possibility must always be considered.  Careful planning with diagnostic setupCareful planning with diagnostic setup www.indiandentalacademy.com
    29. 29. 29 Extraction of Canines:  Not extracted. Profile.Not extracted. Profile.  Long path of eruption.Long path of eruption.  Conditions where indicated:Conditions where indicated:  Impossible to bring in alignment.Impossible to bring in alignment.  Gross displacement Bu/LiGross displacement Bu/Li  4 in contact with 2 & does not show palatal cusp.4 in contact with 2 & does not show palatal cusp. Decision : position of apex.Decision : position of apex. www.indiandentalacademy.com
    30. 30. 30 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 uponRelation b/w root surface area and Xn site selection upon incisor retraction.incisor retraction.  Efficient mechanotherapy.Efficient mechanotherapy.  Diagnostic line.Diagnostic line.  Larger the root surface area, greater the resistance toLarger the root surface area, greater the resistance to movement.movement. www.indiandentalacademy.com
    31. 31. 31 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
    32. 32. 32 Conclusion:  Location of the Xn site-Location of the Xn site- • Root surface area.Root surface area. • Predict incisor retraction.Predict incisor retraction.  Should be considered in diagnosis, so that aShould be considered in diagnosis, so that a desired Rx goal for the final position of incisorsdesired Rx goal for the final position of incisors within the facial profile can be achieved.within the facial profile can be achieved. www.indiandentalacademy.com
    33. 33. 33  Orthodontic treatment may include extractions ofOrthodontic treatment may include extractions of any tooth in the arch.any tooth in the arch.  Based on sound diagnosis, treatment objectives.Based on sound diagnosis, treatment objectives. www.indiandentalacademy.com Thank youThank you For more details please visitFor more details please visit www.indiandentalacademy.comwww.indiandentalacademy.com

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