Non extraction treatment modality

NON-EXTRACTION
TREATMENT
MODALITY
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
www.indiandentalacademy.comwww.indiandentalacademy.com

Extraction?
OR
Non-extraction?

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, …….

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.

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.

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.

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

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

“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.

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

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.

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

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.

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.

- 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.

- 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.

“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

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.

• 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.

• 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.

- 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.

Pre treatment profile, Age:15yrs

Prakash, 14yrs; skeletal Cl III, concave profile,
crowding in the upper arch, super Cl I molar relation.

Name: Padmini / 10yrs
Severe Class II Div.1
Convex profile

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

Midline distema,
skeletal class I

Nagprasad/21yrs, Sk. Class II, Convex profile,
retroclined upper incisors, proclined lower
incisors, reduced lower facial height.

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.

Thank youThank you
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Non extraction treatment modality

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