Interceptive orthodontic extractions

1. Driftodontics
Aslam Alkadhimi

2. Introduction
• This concept is applicable when extraction of the permanent
teeth are done without appliance therapy.
• Teeth have a natural tendency to drift into the extraction
space.
• Extraction of the lower first premolars are often associated
with spontaneous resolution of crowding in the lower
incisors region.
• Such spontaneous decrowding by drifting of teeth is referred
to as “Driftodontics”, & is less frequent in upper arch.

3. Different extractions
• Balancing the removal of a tooth on the opposite side of the same arch
• Compensating extraction of teeth are carried out in opposing arches to maintain buccal
occlusion
• Phased It may be possible to affect a change in molar occlusion b extracting in one arch only,
or a few months earlier than in the other
• Enforced extractions are carried out because they are necessary as in the case of grossly
decayed teeth, poor periodontal status, fractured tooth, impacted tooth, etc.
• Wilkinson extraction of all the four first permanent molars between the age of 8 ½ & 9
years. The basis of it is the fact that first molars are highly susceptible to caries.
• Scobie's Extractions of two premolars at the same time.
• Serial Concept was introduced by Kjellgren 1947. Nance is known as the Father of serial
Extractions. It is defined as Extractions of certain deciduous teeth and permanent teeth in
selected cases to overcome crowding. Usual sequence of extraction C D 4

4. Serial extractions
This technique aims to produce a well-aligned dentition in cases with a full
complement of teeth and no significant sagittal discrepancy, without the
need for orthodontic appliances.
Indications:
• Sever crowding in:
• 8-9 yrs old
• skeletal Class I
• normal OJ and OB
• 4`s developmentally ahead of 3`s
• First permanent molars of good prognosis
• all permanent teeth present

5. • Extraction of all the Cs as the 2s are erupting, which provides space
for these teeth to align
• Extraction of Ds around 12 months later to encourage eruption of 4s in
advance of the 3s
• Extraction of the 4s as the 3s are beginning their eruption, as this
allows for their spontaneous alignment
• Serial extraction borrows space in the mixed dentition for early
alignment of the labial segments and ultimately repays this by
extraction of four first premolars.

6. Disadvantages
• The child undergoes progressive extraction of twelve teeth;
• In the maxilla, 4s usually erupt before the 3s anyway;
• Extraction of Ds can result in significant buccal segment space loss if
the 3 does erupt before the first premolar;
• An aberrant position of the 3 can mean a failure to erupt even after
premolar extraction; and
• A fixed orthodontic appliance may be needed anyway to produce
good final alignment and close any residual space. It is easier, simpler
and more predictable to wait until the early permanent dentition
before undertaking premolar extraction and orthodontic alignment.

7. • Creekmore, TD. Teeth want to be straight, J. Clin. Orthod. 16:745-764,
1982
• Physiological drift is defined as the natural migration of a tooth into a
space created by extraction, congenital absence, decay, or
interproximal reduction without the application of any orthodontic
force.
• “Driftodontics” is a term that can be attributed to Dr. R.G. “Wick
Alexander in his 1986 textbook
• He defines it as the late placement of orthodontic appliances after
removal of permanent teeth. He noted that lower incisor crowding
tends to unravel, and the premolars and canines drift distally into the
extraction space.
• Most of the advantages of driftodontics occur in the first 6 months,
and they are generally ready for placement of their braces.
Driftodontics