serial extraction


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serial extraction

  2. 2. <ul><li>INTRODUCTION </li></ul><ul><li>HISTORY </li></ul><ul><li>RATIONALE </li></ul><ul><li>INDICATIONS </li></ul><ul><li>CONTRAINDICATIONS </li></ul><ul><li>ADVANTAGES </li></ul><ul><li>DISADVANTAGES </li></ul><ul><li>DIAGNOSITC PROCEDURE </li></ul><ul><li>PROBLEMS IN SERIAL EXTRACTION </li></ul>
  3. 3. INTRODUCTION : <ul><li>Serial Extraction is an interceptive orthodontic procedure usually initiated in the early mixed dentition. </li></ul><ul><li>It is a procedure that includes the planned extraction of certain deciduous teeth & later specific permenent teeth in an orderly sequence & pre-determined pattern to guide the erupting permenent teeth into a more favourable position. </li></ul>
  4. 4. HISTORY:- <ul><li>Kjellgren (1929) used the term “ Serial extraction” to describe a procedure where some deciduous teeth followed by permenent teeth were extracted to guide the rest of the teeth into normal occlusion. </li></ul><ul><li>Nance during 1940’s popularized this technique in united states of AMERICA, termed it “planned & progressive extraction” & has been called the ‘father’ of Serial extraction philosophy in united states. </li></ul><ul><li>Hotz in 1970 called such a procedure “active supervision” of teeth by extraction. </li></ul>
  5. 5. <ul><li>Serial extraction is based on 2 basic principles:- </li></ul>Physiologic tooth movement RATIONALE:- Arch Length tooth material discrepancy: <ul><li>Whenever there is an excess of tooth material as compared to the arch length a selective extraction of some teeth is done so that rest of the teeth can be guided to normal occlusion. </li></ul><ul><li>Human dentition shows a physiologic tendency to move towards an extraction space. </li></ul><ul><li>Thus by selective removal of some teeth the rest of the teeth which are in the process of eruption are guided by the natural forces into the extraction spaces . </li></ul>
  6. 6. <ul><li>INDICATIONS FOR SERIAL EXTRACTION </li></ul><ul><li>Class I malocclusion showing harmony between skeletal & muscular system. </li></ul><ul><li>Arch length deficiency as compared to the tooth material is the most imp. indication for serial extraction. </li></ul>
  7. 7. <ul><li>Absence of physiologic spacing </li></ul><ul><li>Unilateral or bilateral premature loss of deciduous canines with midline shift. </li></ul><ul><li>Malpositioned or impacted lateral incisors . </li></ul><ul><li>Irregular or crowded upper & lower incisors. </li></ul><ul><li>Localized gingival recession in the lower ant region </li></ul><ul><li>Ectopic eruption of teeth. </li></ul><ul><li>Mesial migration of buccal segment. </li></ul>Arch length deficiency is indicated by the presence of 1 or more of the following features:-
  8. 8. <ul><li>Abnormal eruption pattern & sequence. </li></ul><ul><li>Lower anterior flaring. </li></ul><ul><li>Ankylosis of 1 or more teeth . </li></ul><ul><li>Where growth is not enough to overcome the discrepancy between tooth material & basal bone. </li></ul><ul><li>Patients with straight profile & pleasing appearance. </li></ul>
  9. 9. Contraindications of Serial Extraction <ul><li>Class II & III malocclusion with skeletal abnormalities. </li></ul><ul><li>Space dentition. </li></ul><ul><li>Anodontia/ oligodontia. </li></ul><ul><li>Open bite & deep bite. </li></ul><ul><li>Midline diastema. </li></ul><ul><li>Class I malocclusion with minimal space deficiency. </li></ul><ul><li>Unerupted malformed teeth. Eg. Dilacerations. </li></ul><ul><li>Extensive caries or heavily filled I permenent molars. </li></ul><ul><li>Mild disproportion between arch length & tooth material . </li></ul>
  10. 10. Advantages of Serial Extraction: <ul><li>Treatment is more physiologic as it involves guidance of teeth into normal positions. </li></ul><ul><li>Psychological trauma associated with malocclusion can be avoided by treatment of the malocclusion at an early stage. </li></ul><ul><li>It eliminates the duration of multi-banded fixed treatment. </li></ul><ul><li>Better oral hygiene is possible thereby reducing the risk of caries. </li></ul><ul><li>Health of investing tissue is preserved. </li></ul><ul><li>Lesser retention period is indicated at the completion of treatment. </li></ul><ul><li>More stable results are achieved as the tooth material & arch length are in harmony. </li></ul>
  11. 11. Disadvantages of Serial Extraction: <ul><li>It can not be universally applied to all patients. </li></ul><ul><li>Treatment time is prolonged as the treatment is carried out in stages spread over 2-3 years. </li></ul><ul><li>It requires the patient to visit the dentist thus patient co-operation is needed. </li></ul><ul><li>As the extraction spaces are created that close gradually the patient has a tendency of developing tongue thrust. </li></ul>
  12. 12. <ul><li>Extraction of buccal teeth can result in deepening of the bite. </li></ul><ul><li>If the procedure are not carried out properly there is a risk of arch length reducing by mesial migration of the buccal segment. </li></ul><ul><li>Ditching or space can exist b/w the canine & 2 nd premolar. </li></ul><ul><li>The axial inclination of teeth at the termination of the serial extraction procedure may require correction. </li></ul>
  13. 13. Procedure <ul><li>There are mainly three methods:- </li></ul><ul><ul><ul><li>Dewel’s Method </li></ul></ul></ul><ul><ul><ul><li>Tweed’s Method </li></ul></ul></ul><ul><ul><ul><li>Nance method. </li></ul></ul></ul>
  14. 14. DEWEL’S METHOD <ul><li>Dewel has proposed a 3 step serial extraction procedure. </li></ul><ul><li>In the 1 st Step, the deciduous canines are extracted to create a space for alignment of the incisors. </li></ul><ul><li>This step is carried out at 8-9 years of age. </li></ul>
  15. 15. <ul><li>After 1 years, the deciduous 1st molars are extracted so that the eruption of 1st premolars is accelerated. </li></ul>
  16. 16. <ul><li>This is followed by the extraction of the erupting 1 st premolar to permit the permanent canines to erupt in their place. </li></ul>
  17. 17. <ul><li>In some cases, a Modified Dewel’s Technique is followed where in the 1 st premolar are enucleated at the time of extraction of the 1 st deciduous molars. </li></ul><ul><li>This is frequently necessary in the mandibular arch where the canines often erupt before the 1 st PM </li></ul>
  18. 18. TWEED’S METHOD: <ul><li>This method involves the extraction of the deciduous 1 st molars around 8 years of age. </li></ul><ul><li>This is followed by the extraction of the 1 st premolar & the deciduous canines. </li></ul>
  19. 19. Nance Method: <ul><li>This is similar to the Tweed’s technique & involves the extraction of the deciduous 1st molars followed by the extraction of the 1st Premolars & the deciduous canines. </li></ul>
  20. 20. Problems in the serial extraction <ul><ul><li>Ant. crossbites can broadly classified as :- </li></ul></ul><ul><ul><li>Dento- alveolar ant. crossbites. </li></ul></ul><ul><ul><li>Skeletal ant. crossbites </li></ul></ul><ul><ul><li>Functional ant. crossbites. </li></ul></ul>ANTERIOR CROSSBITES
  21. 21. <ul><li>Dento alvealor ant. Crossbites: </li></ul><ul><li>Ant. crossbite in which 1 or more maxillary teeth are in lingual relation to the mandibular ant. is termed as “Dentoalveolar ant. Crossbites”. </li></ul><ul><li>This is manifested as single tooth crossbite & usually occurs due to over retained deciduous teeth. </li></ul>Functional ant. Crossbites: <ul><li>Also called “Pseudo Class III Malocclusion”. </li></ul><ul><li>Occurs as a result of occlusal prematurities . </li></ul>
  22. 22. Skeletal ant. crossbite <ul><li>These are usually a result of skeletal discrepencies in growth of maxilla or the mandible. </li></ul><ul><li>Ant. cross bite can be a result of maxillary retrognathism or hypoplasia or mandibular prognthism. </li></ul><ul><li>These are treated by use of myofunctional or orthopadic appliances. </li></ul>
  23. 23. References : Textbook of orthodontics : GRABER Textbook of orthodontics : S.I. BHALAJHI