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Non extraction treatment modality


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Non extraction treatment modality

  1. 1. NON-EXTRACTION TREATMENT MODALITY INDIAN DENTAL ACADEMY Leader in continuing dental education
  2. 2. Extraction? OR Non-extraction?
  3. 3. Non- Extraction: 1900-1930 Dr.Edward Angle Extraction: 1930-1970 Dr.Tweed,Dr.Beggs 1980’s to Till now. Cetlin, Jasper, James Hilgers, Panchetz, Alexander, …….
  4. 4. Traditionally Begg practitioners were branded as extractionists. Advances in mechanotherapy, and changes in treatment concepts have changed this opinion about the Begg technique and curtailed the need for extraction in contemporary treatment.
  5. 5. The prevalence of indiscriminate extractions in earlier decades can partly be blamed on over use of certain cephalometric norms routinely followed. Secondly, Camouflaged treatment plan for the underlying jaw discrepancies, with little emphasis on growth modulation and still little on orthognathic surgery.
  6. 6. TWEED : Advocated placing mandibular incisors upright over basal bone IMPA-900 + Small Variation to maintain FMIA of 650 -680 STEINERS : Positions for max and mand teeth, determined by lines of NA and NB and varied according to angle ANB.
  7. 7. RICKETTS : Supported Tweeds, Related mandibular incisors to APO line. 1 mm ahead of APO plane (-1 to +3mm and at an Angle of 220 ). The Maxillary incisors were positioned with a 2-2.5mm over bite and over jet and inter incisal angle 1300
  8. 8. The Casko study in 1967 which measured 79 cases with ideal occlusion and acceptable esthetics, found wide range of incisor` positions and jaw relationships. Mandibular plane angle - 150 to 410 Facial angle - 790 to 950 Max incisor to SN - 930 to 1200 Lower incisor to APO - -4mm to +6mm
  9. 9. “These values are all normal in the pleasant faces in which they were found”. Creekmore states these values at current time would classify many of these patients as abnormal and classify them as Class I, Class II, Class III sk pattern’s.
  10. 10. In yet another study by Casko and Walter Shepherd on same Tweeds sample of 95 cases, found wide range of incisor positions and Jaw relationships. Low Mean High FMA 15 24.6 36 IMPA 76 86.9 99 FMIA 56 68.2 80
  11. 11. The basis for selecting the sample was entirely from the standpoint of satisfactory facial esthetics and good facial out line. Inspite of wide variation in his own sample of angle IMPA, Tweed Advocated placing the mandibular incisors upright over basal bone for optimum esthetics and stability.
  12. 12. C.J. Burstone, park AJO 1986 Fallacies of Hard tissue standard in treatment planning. Studied 30 adolescents who were successfully treated with end result as mandibular incisors 1.5mm to A-PO line. Authors have shown even in this uniformly treated group, there was large variation in lip protrusion Rickets Analysis was also built upon mandibular incisor position
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  14. 14. Thus, when antero-posterior Jaw relationships differ greatly from average, Measurements of maxillary and mandibular incisors to the APO plane misrepresents their positions within jaws In Steiners analysis the position of mandibular incisors remains fairly constant, but the position of maxillary incisors varies a great deal to fit with mandibular arch, the concept of which has proved wrong.
  15. 15. In order to achieve these contemporary goals of placing upright lower incisors, clinicians invariably considered extraction of teeth. This indiscriminate extractions in earlier decades can also be attributed to the camouflage treatment for basal jaw discrepancies, with little emphasis on growth modulation or orthognathic surgery procedures.
  16. 16. - Now, the concept of diagnosing and treating a malocclusion depending on the position of lower incisors, has changed. The upper incisor position is being given more importance, along with the soft tissue profile, lip competency, position of chin, and the type of growth pattern. - Clinicians today, agree to err on non-extraction side rather than considering extraction option.
  17. 17. - This swing of the pendulum towards non- extraction was essentially due to the marked advances in diagnosis and mechanotherapy between early 1970’s and the late 1990’s, which has given the clinician lots of options for rethinking the treatment plan.
  18. 18. “Beauty lies in beholder eyes” The concept of beautiful smile is now changing. Toothy broad smile is now more appreciated. Orthodontics has kept in pace to this evolving newer concept of non-extraction with upgrading of more mechanics
  19. 19. Many of this mechanics have evolved embracing the preadjusted edgewise appliance. No doubt present day refined Begg has also evolved in similar path and boost with advantage of retaining its simple approach and yet incorporating all the modern day mechanics in its non-extraction practice.
  20. 20. • Slenderization technique as proposed by Sheridon and popularized by Alexander is now being done based on sound diagnosis. • The whole array of modalities for distal driving of the molars. • The use of expansion devices.
  21. 21. • The early reorganization and correction of malocclusion during the mixed dentition phase. • The multitude of evolving orthopaedic appliances. • Conservation of E-space, Leeway space and correction of molar rotations. • Long-term stability.
  22. 22. - One of the paradoxical but pleasant surprises of Begg non-extraction technique is the Anchorage potential, which is often enhanced if the anchor molars have mesial axial Inclination at the commencement of treatment. The differential force system of controlled tipping of Incisors as against the bodily movement of molars has added to the beauty of anchorage preservation in non- extraction Begg technique.
  23. 23. Pre treatment profile, Age:15yrs
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  31. 31. Prakash, 14yrs; skeletal Cl III, concave profile, crowding in the upper arch, super Cl I molar relation.
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  41. 41. Name: Padmini / 10yrs Severe Class II Div.1 Convex profile
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  49. 49. Anil / 12yrs; Skeletal Class II, Horizontal growth, severe proclination of upper incisors, Molar relation - Left Class I, Right Class II, Mild retroclination of lower incisors, Overjet 13mm, Overbite 5mm
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  56. 56. Midline distema, skeletal class I
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  59. 59. Nagprasad/21yrs, Sk. Class II, Convex profile, retroclined upper incisors, proclined lower incisors, reduced lower facial height.
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  68. 68. Refined Begg has an distinctive advantage of anchorage preservation. The Begg technique, with its modern day concepts and under the guidance of innovative teachers has definitely evolved to its best.
  69. 69. Thank youThank you For more details please visitFor more details please visit