This document provides guidelines for extracting first permanent molars in children. It discusses factors that influence extraction decisions such as the condition of surrounding teeth and underlying malocclusions. Ideal timing of extractions is outlined to allow for proper eruption of replacement teeth. Guidelines are given for various malocclusion classes, considering space requirements, optimal eruption timing, and risks of overeruption. Balancing and compensating extractions are generally not recommended except in some Class I cases to relieve crowding. Obtaining an orthodontic opinion is advised when possible.
This document discusses various methods of mixed dentition analysis used to predict the size and space needed for unerupted permanent teeth based on measurements of erupted primary and permanent teeth. It describes Nance analysis, Huckaba's method, Moyer's analysis, Tanaka Johnston analysis, Hixon-Oldfather prediction method, and Staley and Kerber method. The document emphasizes that mixed dentition analysis helps evaluate space availability and plan treatment during the transition from primary to permanent dentition.
Orthognathic surgery and minor procedures like extractions are used in orthodontics to correct dental abnormalities. Major orthognathic surgeries like LeFort I osteotomies and sagittal split osteotomies reposition the jaws to correct dental malocclusions. Minor procedures include extractions of teeth like premolars, as well as surgical exposures of impacted teeth. The decision to use orthodontic camouflage versus surgery must be made early. Adjunctive facial procedures like rhinoplasty and genioplasty are also used to improve aesthetics beyond dental repositioning.
The document discusses various methods for analyzing dental study models, including analyzing models apart and in occlusion. It describes measuring arch length, tooth widths, and relationships to determine discrepancies and classify malocclusions. Mixed dentition analysis methods are also discussed, such as Huckaba's method which uses radiographs to estimate the sizes of unerupted teeth.
This seminar report discusses different types of extractions performed in orthodontics. Extractions are needed to correct arch length discrepancies, sagittal interarch relationships, and relieve crowding. Different extraction procedures include balancing, compensating, phased, enforced, Wilkinson, and serial extractions. The choice of which teeth to extract depends on factors like jaw growth direction, arch and basal bone size, tooth condition and position, facial profile, and patient age. Common teeth extracted are premolars to relieve crowding in the middle of dental arches. Extractions are an important part of orthodontic treatment to achieve the goal of a perfect smile.
This document discusses various types of dental retention appliances. It begins by defining retention and explaining why it is necessary after orthodontic treatment. It then covers theories of retention, keys to eliminating lower retention, and classifications of retainers. The main types of retainers discussed are removable retainers like Hawley retainers, wrap-around retainers, and Essix retainers. Fixed retainers and principles of different retention times are also summarized.
Space regaining involves moving a displaced permanent tooth into its proper position after premature loss of a deciduous tooth. Methods include fixed appliances like open coil springs and removable appliances like Hawley's retainers. Removable appliances are activated gradually over weeks to exert light distal force on molars and regain up to 2mm of space. Fixed appliances can regain space faster but require proper cementation. Space regaining is best done between ages 7-10 years when tooth roots are still developing.
The document discusses orthodontic diagnosis and the essential and supplemental diagnostic aids used. It describes the key components of clinical examination including case history, medical history, dental history, and physical examination of the head, face, lips, nose, and chin. Clinical examination aims to evaluate oral health and function, identify the nature of malocclusions, and determine which diagnostic records are needed for diagnosis and treatment planning.
This document discusses various methods of mixed dentition analysis used to predict the size and space needed for unerupted permanent teeth based on measurements of erupted primary and permanent teeth. It describes Nance analysis, Huckaba's method, Moyer's analysis, Tanaka Johnston analysis, Hixon-Oldfather prediction method, and Staley and Kerber method. The document emphasizes that mixed dentition analysis helps evaluate space availability and plan treatment during the transition from primary to permanent dentition.
Orthognathic surgery and minor procedures like extractions are used in orthodontics to correct dental abnormalities. Major orthognathic surgeries like LeFort I osteotomies and sagittal split osteotomies reposition the jaws to correct dental malocclusions. Minor procedures include extractions of teeth like premolars, as well as surgical exposures of impacted teeth. The decision to use orthodontic camouflage versus surgery must be made early. Adjunctive facial procedures like rhinoplasty and genioplasty are also used to improve aesthetics beyond dental repositioning.
The document discusses various methods for analyzing dental study models, including analyzing models apart and in occlusion. It describes measuring arch length, tooth widths, and relationships to determine discrepancies and classify malocclusions. Mixed dentition analysis methods are also discussed, such as Huckaba's method which uses radiographs to estimate the sizes of unerupted teeth.
This seminar report discusses different types of extractions performed in orthodontics. Extractions are needed to correct arch length discrepancies, sagittal interarch relationships, and relieve crowding. Different extraction procedures include balancing, compensating, phased, enforced, Wilkinson, and serial extractions. The choice of which teeth to extract depends on factors like jaw growth direction, arch and basal bone size, tooth condition and position, facial profile, and patient age. Common teeth extracted are premolars to relieve crowding in the middle of dental arches. Extractions are an important part of orthodontic treatment to achieve the goal of a perfect smile.
This document discusses various types of dental retention appliances. It begins by defining retention and explaining why it is necessary after orthodontic treatment. It then covers theories of retention, keys to eliminating lower retention, and classifications of retainers. The main types of retainers discussed are removable retainers like Hawley retainers, wrap-around retainers, and Essix retainers. Fixed retainers and principles of different retention times are also summarized.
Space regaining involves moving a displaced permanent tooth into its proper position after premature loss of a deciduous tooth. Methods include fixed appliances like open coil springs and removable appliances like Hawley's retainers. Removable appliances are activated gradually over weeks to exert light distal force on molars and regain up to 2mm of space. Fixed appliances can regain space faster but require proper cementation. Space regaining is best done between ages 7-10 years when tooth roots are still developing.
The document discusses orthodontic diagnosis and the essential and supplemental diagnostic aids used. It describes the key components of clinical examination including case history, medical history, dental history, and physical examination of the head, face, lips, nose, and chin. Clinical examination aims to evaluate oral health and function, identify the nature of malocclusions, and determine which diagnostic records are needed for diagnosis and treatment planning.
Tongue thrust and mouth breathing habits in childrenDr. Harsh Shah
Overview on mouth breathing and tongue thrusting in children leading to ill effects
Presented by : Pratiksha Ahire
Guided by : Dr. Rehan Khan
Dept. of Pediatric Dentistry
SDDCH PArbhani
Interceptive orthodontics refers to treatments undertaken when a malocclusion has developed or is developing to prevent it from becoming more severe. Some common procedures include serial extraction to guide erupting teeth, correcting developing crossbites, controlling habits like thumb sucking, and regaining space when primary molars are lost early. Local factors treated interceptively include delayed tooth eruption, retained primary teeth, infraocclusion, diastema, ectopic eruption, hypodontia, and tooth transposition or crowding. The goal is to address developing problems early before they worsen.
Orthodontic study models are three-dimensional plaster reproductions of a patient's teeth and surrounding tissues that are used to accurately diagnose and monitor orthodontic treatment. The document outlines the requirements, uses, and proper procedures for fabricating and trimming study models. Key steps include accurately reproducing the dental anatomy, trimming bases and backs at specific angles, and using wax bites and articulators to achieve proper occlusion. Study models provide a permanent record for treatment planning, evaluation, and legal documentation of a patient's orthodontic condition and progress.
The document summarizes the functional matrix theory of bone growth proposed by Melvin Moss. The theory states that bone growth occurs as a response to functional needs mediated by soft tissues, rather than bones growing independently. Growth involves periosteal matrices altering bone size in response to soft tissue demands, and capsular matrices passively translating bones during expansion. Experiments on rats supported the theory by showing bones altered in size and shape following muscle resection. Clinical implications include functional appliances altering bone growth by changing soft tissue pressures.
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.
This document provides an overview of functional appliances used in orthodontic treatment. It begins with definitions of functional appliances and a brief history of their development. It then discusses the basis, classification, forces, treatment principles, indications, actions, case selection, and common appliances like the activator, frankel regulator, bionator, twin block, and Herbst appliance. It provides details on their design, indications, mode of action, and advantages. In summary, the document serves as a comprehensive guide to functional appliances, their development and use in orthodontic treatment.
Interceptive orthodontics involves procedures undertaken early to eliminate or reduce malocclusions. It prevents full malocclusions requiring long term treatment later. Procedures include serial extraction to guide teeth into normal occlusion, correcting developing crossbites, controlling abnormal habits like thumb sucking and tongue thrusting, regaining lost space, muscle exercises, and intercepting skeletal issues. Interceptive treatment is more physiological and prevents psychological impacts of malocclusions.
This document discusses factors to consider when selecting anterior teeth for dental prosthetics. It describes evaluating the size, form, and color of the new teeth based on the patient's existing anatomy when possible, as well as anthropometric measurements. Size can be estimated using pre-extraction records, the patient's facial features, or theoretical concepts linking tooth dimensions to head or facial proportions. Form follows the patient's facial profile or type. Color selection considers the patient's age, skin tone, and other characteristics to achieve natural harmony with the face. Multiple techniques ensure the new teeth appear appropriately sized, shaped, and colored for a comfortable and aesthetic result.
This document discusses various methods for gaining space in orthodontic treatment, including proximal stripping, arch expansion, extraction, distalization of molars, uprighting tilted molars, derotation of posterior teeth, and proclination/flaring of anterior teeth. It provides details on techniques such as rapid maxillary expansion using devices like Hyrax or bonded expanders, extraction of first premolars, and distalization of molars using appliances like pendulum or Jones Jig. The document also covers indications, advantages, and disadvantages of different space gaining methods.
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.for more details please visit
www.indiandentalacademy.com
This document discusses molar distalization, which is an alternative method for gaining space when treating orthodontic patients with space deficiencies. It provides the history of molar distalization, indications and contraindications for its use, different appliance options, and considerations for appliance selection. Molar distalization involves using orthodontic appliances to distalize or move the molars backwards in the dental arch in order to gain space.
This document summarizes Nance appliances, transpalatal arches, and quad helix appliances. It describes the design, indications, and disadvantages of each appliance. For transpalatal arches, it notes they are used to prevent mesial migration of upper first molars and can provide anchorage, arch width stabilization, and be used as a retainer. Quad helix appliances are used to expand arches and derotate molars through a fan-like sweeping action. Nance appliances maintain posterior tooth positions and can be modified to provide an anterior bite plane.
Transient malocclusions are self-correcting developmental variations that occur during dental development. In the pre-dentate period, infants have a retrognathic mandible that corrects over time. In the primary dentition, children commonly have an anterior open bite, deep anterior bite, spacing between teeth, and an edge-to-edge anterior bite that self-correct. In the mixed dentition, a deep bite and crowding are common but resolve with time. The permanent dentition may show increased overjet and overbite during transition that lessen without treatment.
Extraction Of The First Permanent MolarSashi Manohar
The document discusses guidelines for extracting first permanent molars (FPM). It notes that FPM are susceptible to issues like caries that may require extraction. Extraction timing is important - lower FPM should only be extracted once the lower second molar's roots begin forming around ages 8.5-9.5 years. Consequences of extraction depend on factors like tooth position and occlusion. Treatment planning requires considering issues like a child's age and oral health, as well as input from orthodontists to guide replacement tooth eruption and prevent malocclusion.
The document discusses the classification and design principles of obturators for partially edentulous patients. It presents a 6-class classification system for maxillary defects based on the location and extent of the resection. The classes range from a midline defect (Class I) to a bilateral posterior defect (Class V). Design principles are provided for each class, focusing on support, retention, and stabilization. Support is primarily through rests on abutment teeth and palatal tissues. Retention uses direct and indirect retainers on abutment teeth. Stabilization incorporates guide planes and tripodal/quadrilateral designs when possible. The goal is to distribute forces optimally and minimize movement of the prosthesis.
Functional appliances are either active or passive devices that harness the natural forces of muscles in the mouth and face to guide growth of the jaws and teeth. They work based on Moss's functional matrix theory, which proposes that muscles and other soft tissues influence bone growth. Common functional appliances include the activator, bionator, frankel appliance, and twin block. They can modify jaw growth, alter tooth positions, and improve muscle tone. Functional appliance therapy is most effective when started before puberty to influence jaw growth.
This document discusses space maintainers, which are appliances used to maintain space after premature loss of primary teeth. It defines space maintainers and describes their important functions. The main causes of premature primary tooth loss are caries, trauma, ectopic eruption, and systemic disorders. Premature loss can lead to undesirable tooth movement and malocclusion. The document discusses factors that influence space closure rate and direction, as well as treatment considerations for timely space maintenance. It also outlines types of space maintainers, including fixed and removable, and their advantages and disadvantages.
The document discusses retention and relapse in orthodontics, defining retention as maintaining teeth in their corrected positions and relapse as the loss of correction. It examines various causes of relapse like periodontal ligament traction, abnormal growth patterns, lack of adequate stabilization, and muscular imbalances. The document also outlines different retention methods and factors to consider for proper retention planning to prevent teeth from relapsing back to their original maloccluded positions.
impression techniques in Removable Partial Denture Dr.Richa Sahai
This document discusses impression procedures for removable partial dentures. It defines partial denture impressions and differentiates them from complete denture impressions. Various impression techniques are described including anatomic form impressions, functional impression techniques like McLean's method and the functional reline method. The document reviews literature on modified techniques like the altered cast technique and selective tissue placement impressions. It emphasizes the importance of functional impressions to distribute load and maximize longevity of remaining structures. In summary, the choice of impression technique impacts the support, function and longevity of the resulting removable partial denture.
1. The document discusses pre-prosthetic surgery procedures performed before denture construction and placement. It covers topics like patient evaluation, classification of ridge resorption, characteristics of an ideal denture ridge, and various basic and advanced surgical techniques.
2. Basic techniques include soft tissue operations to address issues like fibrous hyperplasia and frenum attachments. Bony operations recontour ridges and remove exostoses. Advanced techniques augment ridges with grafts and extend them with vestibuloplasties.
3. Ridge augmentation aims to restore ridge height and width through grafts to bone. Mandibular augmentation techniques include superior border grafts to add strength and contour.
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.for more details please visit
www.indiandentalacademy.com
The PADCHI ( Pediatric Dentistry group ) will hold a seminar entitled "Unraveling the Mystery behind MTA, MIH and MI" on Jan. 12, 2010 from 8:00 am to 5:00 pm with Dr. David Manton from the University of Melbourne to be their sole speaker for the day . The seminar will be held at the Lung Center of the Phils. Auditorium.
Tongue thrust and mouth breathing habits in childrenDr. Harsh Shah
Overview on mouth breathing and tongue thrusting in children leading to ill effects
Presented by : Pratiksha Ahire
Guided by : Dr. Rehan Khan
Dept. of Pediatric Dentistry
SDDCH PArbhani
Interceptive orthodontics refers to treatments undertaken when a malocclusion has developed or is developing to prevent it from becoming more severe. Some common procedures include serial extraction to guide erupting teeth, correcting developing crossbites, controlling habits like thumb sucking, and regaining space when primary molars are lost early. Local factors treated interceptively include delayed tooth eruption, retained primary teeth, infraocclusion, diastema, ectopic eruption, hypodontia, and tooth transposition or crowding. The goal is to address developing problems early before they worsen.
Orthodontic study models are three-dimensional plaster reproductions of a patient's teeth and surrounding tissues that are used to accurately diagnose and monitor orthodontic treatment. The document outlines the requirements, uses, and proper procedures for fabricating and trimming study models. Key steps include accurately reproducing the dental anatomy, trimming bases and backs at specific angles, and using wax bites and articulators to achieve proper occlusion. Study models provide a permanent record for treatment planning, evaluation, and legal documentation of a patient's orthodontic condition and progress.
The document summarizes the functional matrix theory of bone growth proposed by Melvin Moss. The theory states that bone growth occurs as a response to functional needs mediated by soft tissues, rather than bones growing independently. Growth involves periosteal matrices altering bone size in response to soft tissue demands, and capsular matrices passively translating bones during expansion. Experiments on rats supported the theory by showing bones altered in size and shape following muscle resection. Clinical implications include functional appliances altering bone growth by changing soft tissue pressures.
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.
This document provides an overview of functional appliances used in orthodontic treatment. It begins with definitions of functional appliances and a brief history of their development. It then discusses the basis, classification, forces, treatment principles, indications, actions, case selection, and common appliances like the activator, frankel regulator, bionator, twin block, and Herbst appliance. It provides details on their design, indications, mode of action, and advantages. In summary, the document serves as a comprehensive guide to functional appliances, their development and use in orthodontic treatment.
Interceptive orthodontics involves procedures undertaken early to eliminate or reduce malocclusions. It prevents full malocclusions requiring long term treatment later. Procedures include serial extraction to guide teeth into normal occlusion, correcting developing crossbites, controlling abnormal habits like thumb sucking and tongue thrusting, regaining lost space, muscle exercises, and intercepting skeletal issues. Interceptive treatment is more physiological and prevents psychological impacts of malocclusions.
This document discusses factors to consider when selecting anterior teeth for dental prosthetics. It describes evaluating the size, form, and color of the new teeth based on the patient's existing anatomy when possible, as well as anthropometric measurements. Size can be estimated using pre-extraction records, the patient's facial features, or theoretical concepts linking tooth dimensions to head or facial proportions. Form follows the patient's facial profile or type. Color selection considers the patient's age, skin tone, and other characteristics to achieve natural harmony with the face. Multiple techniques ensure the new teeth appear appropriately sized, shaped, and colored for a comfortable and aesthetic result.
This document discusses various methods for gaining space in orthodontic treatment, including proximal stripping, arch expansion, extraction, distalization of molars, uprighting tilted molars, derotation of posterior teeth, and proclination/flaring of anterior teeth. It provides details on techniques such as rapid maxillary expansion using devices like Hyrax or bonded expanders, extraction of first premolars, and distalization of molars using appliances like pendulum or Jones Jig. The document also covers indications, advantages, and disadvantages of different space gaining methods.
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.for more details please visit
www.indiandentalacademy.com
This document discusses molar distalization, which is an alternative method for gaining space when treating orthodontic patients with space deficiencies. It provides the history of molar distalization, indications and contraindications for its use, different appliance options, and considerations for appliance selection. Molar distalization involves using orthodontic appliances to distalize or move the molars backwards in the dental arch in order to gain space.
This document summarizes Nance appliances, transpalatal arches, and quad helix appliances. It describes the design, indications, and disadvantages of each appliance. For transpalatal arches, it notes they are used to prevent mesial migration of upper first molars and can provide anchorage, arch width stabilization, and be used as a retainer. Quad helix appliances are used to expand arches and derotate molars through a fan-like sweeping action. Nance appliances maintain posterior tooth positions and can be modified to provide an anterior bite plane.
Transient malocclusions are self-correcting developmental variations that occur during dental development. In the pre-dentate period, infants have a retrognathic mandible that corrects over time. In the primary dentition, children commonly have an anterior open bite, deep anterior bite, spacing between teeth, and an edge-to-edge anterior bite that self-correct. In the mixed dentition, a deep bite and crowding are common but resolve with time. The permanent dentition may show increased overjet and overbite during transition that lessen without treatment.
Extraction Of The First Permanent MolarSashi Manohar
The document discusses guidelines for extracting first permanent molars (FPM). It notes that FPM are susceptible to issues like caries that may require extraction. Extraction timing is important - lower FPM should only be extracted once the lower second molar's roots begin forming around ages 8.5-9.5 years. Consequences of extraction depend on factors like tooth position and occlusion. Treatment planning requires considering issues like a child's age and oral health, as well as input from orthodontists to guide replacement tooth eruption and prevent malocclusion.
The document discusses the classification and design principles of obturators for partially edentulous patients. It presents a 6-class classification system for maxillary defects based on the location and extent of the resection. The classes range from a midline defect (Class I) to a bilateral posterior defect (Class V). Design principles are provided for each class, focusing on support, retention, and stabilization. Support is primarily through rests on abutment teeth and palatal tissues. Retention uses direct and indirect retainers on abutment teeth. Stabilization incorporates guide planes and tripodal/quadrilateral designs when possible. The goal is to distribute forces optimally and minimize movement of the prosthesis.
Functional appliances are either active or passive devices that harness the natural forces of muscles in the mouth and face to guide growth of the jaws and teeth. They work based on Moss's functional matrix theory, which proposes that muscles and other soft tissues influence bone growth. Common functional appliances include the activator, bionator, frankel appliance, and twin block. They can modify jaw growth, alter tooth positions, and improve muscle tone. Functional appliance therapy is most effective when started before puberty to influence jaw growth.
This document discusses space maintainers, which are appliances used to maintain space after premature loss of primary teeth. It defines space maintainers and describes their important functions. The main causes of premature primary tooth loss are caries, trauma, ectopic eruption, and systemic disorders. Premature loss can lead to undesirable tooth movement and malocclusion. The document discusses factors that influence space closure rate and direction, as well as treatment considerations for timely space maintenance. It also outlines types of space maintainers, including fixed and removable, and their advantages and disadvantages.
The document discusses retention and relapse in orthodontics, defining retention as maintaining teeth in their corrected positions and relapse as the loss of correction. It examines various causes of relapse like periodontal ligament traction, abnormal growth patterns, lack of adequate stabilization, and muscular imbalances. The document also outlines different retention methods and factors to consider for proper retention planning to prevent teeth from relapsing back to their original maloccluded positions.
impression techniques in Removable Partial Denture Dr.Richa Sahai
This document discusses impression procedures for removable partial dentures. It defines partial denture impressions and differentiates them from complete denture impressions. Various impression techniques are described including anatomic form impressions, functional impression techniques like McLean's method and the functional reline method. The document reviews literature on modified techniques like the altered cast technique and selective tissue placement impressions. It emphasizes the importance of functional impressions to distribute load and maximize longevity of remaining structures. In summary, the choice of impression technique impacts the support, function and longevity of the resulting removable partial denture.
1. The document discusses pre-prosthetic surgery procedures performed before denture construction and placement. It covers topics like patient evaluation, classification of ridge resorption, characteristics of an ideal denture ridge, and various basic and advanced surgical techniques.
2. Basic techniques include soft tissue operations to address issues like fibrous hyperplasia and frenum attachments. Bony operations recontour ridges and remove exostoses. Advanced techniques augment ridges with grafts and extend them with vestibuloplasties.
3. Ridge augmentation aims to restore ridge height and width through grafts to bone. Mandibular augmentation techniques include superior border grafts to add strength and contour.
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.for more details please visit
www.indiandentalacademy.com
The PADCHI ( Pediatric Dentistry group ) will hold a seminar entitled "Unraveling the Mystery behind MTA, MIH and MI" on Jan. 12, 2010 from 8:00 am to 5:00 pm with Dr. David Manton from the University of Melbourne to be their sole speaker for the day . The seminar will be held at the Lung Center of the Phils. Auditorium.
This document summarizes two case reports of patients with Molar Incisor Hypomineralization (MIH). For the first case, a 9-year-old girl had MIH affecting all four first permanent molars. Her treatment included composite restoration, glass ionomer cement restoration, root canals followed by stainless steel crowns on three molars and extraction of one molar. For the second case, a 10-year-old boy had MIH affecting three molars along with extensive enamel breakdown and bite collapse. His treatment consisted of composite restoration, root canals followed by posts and cores, and stainless steel crowns on three molars along with extraction of two molars. Both cases required management of sensitivity
A 22-year-old female presented with complaints of unpleasant appearance of teeth during smiling and sensitivity in anterior and posterior teeth. Clinical examination revealed hypoplastic defects on the enamel surface of maxillary and mandibular anterior teeth as well as first molars. Differential diagnoses considered were enamel hypoplasia, fluorosis and amelogenesis imperfecta. Enamel hypoplasia was determined to be the most likely diagnosis based on the localized pattern of enamel loss, lack of discoloration and normal tooth size and shape. The treatment plan included nonsurgical therapies like oral hygiene instructions, topical fluoride and direct composite restorations.
The document discusses endodontic materials used for root canal irrigation and as intracanal medicaments. It describes the objectives of root canal therapy and the need for irrigation to clean beyond what instruments can reach. Various irrigants are outlined, including sodium hypochlorite, hydrogen peroxide, chlorhexidine, and EDTA. Ideal properties and functions of irrigants and intracanal medicaments are provided. Delivery techniques for irrigants include manual methods and machine-assisted techniques. Calcium hydroxide and antibiotics are presented as common intracanal medicaments.
This simplified lecture will present to you the basic concept of intracanal medicaments, their indication, classification, and their appropriate selection.
Presented to you by Iraqi Dental Academy.
visit us on facebook:
https://www.facebook.com/Iraqi.Dental.Academy/
or Twitter:
https://twitter.com/IQDentalAcademy
Our page on Telegram:
@IraqiDental
Intracanal medicaments /certified fixed orthodontic courses by Indian dental...Indian dental academy
Welcome to Indian Dental Academy
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.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
Intracanal medicaments are agents used as adjuncts to cleaning and shaping teeth during root canal treatment. Their primary functions are antisepsis and disinfection to help prevent or treat apical periodontitis. Secondary functions include controlling pain, exudation, swelling, and resorption during and after treatment by eliminating infection in the root canal system. Common intracanal medicaments include antibiotics, disinfectants like sodium hypochlorite, and calcium hydroxide, which has antibacterial properties due to its high pH and can physically restrict bacterial colonization in the root canal.
1) The document discusses various intracanal medicaments that have been used in endodontics, including phenolics, aldehydes, halides, calcium hydroxide, and antibiotics.
2) It provides classifications of intracanal medicaments according to Grossman and the Dental Council of North America.
3) Common intracanal medicaments discussed in detail include calcium hydroxide, chlorhexidine, iodine potassium iodide, corticosteroid-antibiotic combinations, and Ledermix. Their compositions, applications, and limitations are described.
Extraction of Teeth involves removing teeth from the mouth. There are two main methods - intra-alveolar extraction which uses dental forceps, and trans-alveolar extraction which uses surgical techniques. Proper technique is important to remove the tooth with minimal trauma. Factors like tooth condition, location in the mouth, and related anatomy determine the appropriate tools and extraction method used.
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.
This document outlines the basic technique for simple tooth extraction. It describes the proper positioning of the patient and surgeon, use of instruments like desmotomes and extraction forceps to separate the tooth from soft tissues and bone, and the mechanical principles involved like expansion of the bony socket and use of levers. Key steps include using desmotomes to sever soft tissue attachments, selecting the appropriate extraction forceps based on tooth type, applying steady outward and rotational forces to luxate the tooth from its socket, and removing the tooth with a final outward and occlusal movement. Proper technique helps control forces and avoid trauma during extraction.
Anomalies of tooth formation & eruptionTariq Hameed
The document discusses several anomalies and abnormalities that can occur in tooth formation and eruption. Supernumerary teeth are extra teeth that develop in addition to the normal number. Hypodontia is a congenital absence of one or more teeth. Abnormalities can also occur in tooth size, shape, structure and formation. Some examples provided include taurodontism, dens invaginatus, amelogenesis imperfecta and dentin dysplasia. Many conditions are genetic or due to disruptions during tooth development and may require monitoring or treatments like extractions or root canals.
This document discusses guidelines for extracting teeth in orthodontic treatment. It describes factors to consider when choosing which teeth to extract, such as the amount of crowding, incisor relationship, and anchorage needs. It provides guidance on when extraction of specific teeth is appropriate, such as extracting premolars for moderate to severe crowding over 10mm, and avoiding incisor extractions when possible. It also discusses how extraction of different teeth will impact anchorage and the movement of surrounding teeth. Serial extractions, while once used, are no longer recommended due to requiring multiple procedures under anesthesia and potential mesial drift.
This document discusses dental extractions that may be performed as part of orthodontic treatment. It begins by introducing the topic and establishing that extractions are sometimes needed to achieve normal occlusion and jaw alignment. The main reasons extractions may be necessary include resolving tooth-arch length discrepancies, correcting sagittal jaw relationships, addressing abnormal tooth size or shape, and treating severe skeletal malrelations. Factors in deciding which teeth to extract include the malocclusion, amount of crowding, jaw growth, facial profile, and patient age. First premolars are most commonly extracted due to their positioning and the space gained. Other teeth extracted may include lower incisors, upper incisors, canines, second premolars
This document provides information on Class I malocclusions, including their features, management, and etiology. Key points include:
- Class I malocclusions have a normal anteroposterior incisor relationship but may have discrepancies within the arches.
- Common etiologies are skeletal, soft tissue, and dental factors like tooth size discrepancies leading to crowding or spacing.
- Crowding is the most frequent dental factor and can be managed through extractions, while spacing is usually due to hypodontia.
- Late lower incisor crowding is often due to mandibular growth and soft tissue changes. Early loss of first molars requires consideration of second molar eruption
Interceptive orthodontics aims to eliminate or reduce developing malocclusions by treating problems early in the deciduous or mixed dentition stages. Issues like anterior and posterior crossbites, increased overjet, and crowding are best addressed interceptively to guide proper eruption of permanent teeth and reduce need for future treatment. Common interceptive techniques include removing supernumerary teeth or retained primary teeth, grinding occlusal interferences, and using removable or fixed appliances with components like springs, screws, or bite planes to correct crossbites or expand arches. Serial extraction of primary and permanent teeth may also be used to relieve severe crowding in some cases.
it explain need for extraction, choice of teeth for extraction, Wilkinson extraction, extraction of permanent teeth without appliance therapy, balance extractions, compensating extractions, additional factor to consider in extraction of teeth.
The document discusses treatment planning in orthodontics. It emphasizes that treatment planning should consider both the treatment aims and treatment plan. The treatment aims identify what needs to be accomplished, such as reducing overjet. The treatment plan then considers how this will be achieved, such as creating space and selecting the appliance system. Key aspects of treatment planning discussed include evaluating oral health, assessing the lower and upper arches, correcting the buccal occlusion, and choosing the appropriate appliance.
Serial extraction of class i malocclusionMaherFouda1
This document provides information on serial extraction techniques for correcting Class I malocclusions. It defines serial extraction as the planned extraction of deciduous teeth and sometimes permanent teeth to encourage spontaneous correction of irregularities. The document discusses the historical development of serial extraction, pioneers who developed the concept, and Dewel's technique in particular. It outlines the rationale, indications, contraindications, and timing of extractions in the serial extraction process. The goal is to utilize growth and tooth movement principles to align teeth and reduce malocclusion without extensive orthodontic treatment.
Extraction in orthodontics /certified fixed orthodontic courses by Indian den...Indian dental academy
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.
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.for more details please visit
www.indiandentalacademy.com
This document discusses extraction procedures in orthodontic treatment. It begins by defining extraction as the painless removal of teeth from their socket. Extractions may be needed to address tooth-arch length discrepancies, correct sagittal inter-arch relationships, or due to abnormal tooth size/form. Different extraction procedures are discussed, including balancing, compensating, enforced, and therapeutic extractions. Factors in choosing which teeth to extract include arch length issues, jaw growth, tooth condition, and facial profile. Common teeth extracted for orthodontic reasons are premolars, as their removal provides space while maintaining occlusion. Other teeth may be extracted depending on the specific orthodontic needs of each case.
Extraction in orthodontics (2) /certified fixed orthodontic courses by Indian...Indian dental academy
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.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Management of the developing dentition 1MaherFouda1
This document discusses the management of anomalies affecting the developing dentition, including early loss of primary teeth and prolonged retention of primary teeth. It describes factors that influence space loss following early primary tooth loss, such as age, existing crowding, and tooth type. Balancing and compensating extractions are discussed as ways to preserve arch symmetry and occlusal relationships. The use of space maintainers to preserve arch length and symmetry is also covered. Prolonged retention of primary teeth can be caused by crowding, an ectopic position of the permanent successor, or agenesis of the permanent tooth. Treatment depends on the condition and position of the permanent successor.
management of the developing dentition part 1MaherFouda1
This document discusses various developmental anomalies that can affect the primary and permanent dentitions, including variations in tooth number, morphology, position, and composition. It focuses on the implications and management of early loss of primary teeth, including potential space loss, crowding, and occlusal disruption depending on factors like age, existing crowding, and tooth type. It also discusses balancing and compensating extractions of primary teeth to preserve arch symmetry and occlusion, as well as the use of space maintainers following early tooth loss. Prolonged retention of primary teeth can occur due to failure of the permanent successor to resorb the primary tooth root or due to conditions like impaction or agenesis of the permanent tooth.
The document discusses different types of extractions that are commonly performed in orthodontics. Extractions are needed to address issues like arch length discrepancies, correction of malocclusions, and relief of crowding. Common extraction procedures include balancing, compensating, phased, enforced, Wilkinson, and serial extractions. The choice of which teeth to extract depends on factors like the direction of jaw growth, dental arch size, the condition and position of teeth, facial profile, and the patient's age. Extractions are an important part of orthodontic treatment used to achieve the goal of a perfect smile.
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
This document summarizes key points about early treatment of tooth eruption disturbances from a presentation by Dr. Juri Kurol. It discusses that early treatment is purportedly easier and less expensive but should not be prescribed automatically without evaluating need and prognosis. Early treatment is recommended to avoid further disturbances during eruption and prevent complications like tooth resorption. Common disturbances requiring early treatment include ectopic maxillary first molars, mesiodens, ankylosed deciduous molars, and palatally erupting canines to prevent root resorption of incisors. Early extraction of palatally erupting canines in ages 10-13 normalized 78% of cases. More evidence is needed to demonstrate benefits of early treatment versus
1. The document discusses different types of space maintainers used to prevent teeth from shifting after premature loss of primary teeth.
2. It outlines indications for space maintainers including loss of primary molars, canines, and factors like arch length and midline. Contraindications include sufficient space or impending permanent tooth eruption.
3. An ideal space maintainer maintains space, does not interfere with eruption, allows tooth movement, preserves arch length, and is aesthetic. Key factors in construction include time since extraction, patient age, bone/tooth development levels.
Similar to A guideline for the enforced extraction of first permanent molars in children rev march 2009 (20)
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
A guideline for the enforced extraction of first permanent molars in children rev march 2009
1. A Guideline for the Extraction of First Permanent Molars in Children.
Introduction
The relative timing of coronal development associated with first permanent molars makes them
susceptible to chronological enamel defects leading to hypo-mineralisation and/or hypoplasia1
;
whilst their eruption at around six years of age makes them vulnerable to the development of
dental caries2
. In addition, combined first permanent molar-incisor hypomineralisation (MIH) is a
recognized condition of unknown aetiology with a prevalence of around fifteen per cent in
Caucasians3
. Currently, the majority of first permanent molars are extracted because of dental
caries4
.
First permanent molars of poor prognosis
A child can often present with a developing dentition affected by one or more first permanent
molars of poor prognosis, which may necessitate enforced extraction; or require some
consideration toward elective extraction in the form of balancing or compensating extractions.
Treatment-planning decisions regarding first permanent molars of poor prognosis should ideally
be made following input from both the general or paediatric dentist and the orthodontist,
although this may not always be possible. These guidelines offer best advice on the
management of this condition in the child. However, it is important to remember that in addition
to the presenting clinical features a number of additional factors may influence the decision-
making process. These include a child's social background, their likely ability to co-operate with
restorative or orthodontic treatment, prevention and oral hygiene practice within the family, as
well as any local difficulties in accessing NHS restorative or orthodontic treatment.
Balancing and compensating extractions
In some circumstances, the enforced extraction of one first permanent molar should be
accompanied by the elective balancing or compensating extraction of another.
• Balancing extraction refers to removal of the first molar from the contra-lateral side of the
same dental arch.
• Compensating extraction refers to removal of the first molar from the same side of the
opposing dental arch.
The principle factors dictating whether a first molar is recommended for either a balancing or
compensating extraction will be:
• Which first molar requires enforced extraction.
• The overall condition and long-term prognosis.
• Teeth present within the developing dentition (particularly third molars).
• The underlying malocclusion.
As a general rule, compensating extraction of an upper first molar is often recommended when
extraction of the lower is required. This is to prevent over-eruption of an unopposed upper first
molar and prevention of mesial movement of the lower second molar. There is, however, little
definitive data with regard to these effects in the literature5
. Balancing the extraction of healthy
first molars is not generally recommended in either arch and there is little evidence that unilateral
extraction will adversely effect the dental centreline6
.
Treatment planning goals
Ideally, first permanent molar extractions should be followed by successful eruption of the
second molars to replace them and ultimately, the third molars to complete the molar dentition.
However, achieving this can be complicated by a number of factors:
• Timing of first molar extraction will have an important influence on the subsequent
eruptive position of the second molar, particularly in the lower arch.
• Third molar development cannot always be confirmed at the time extraction decisions
have to be made.
2. In addition, consideration also needs to be given to the consequences of first molar extraction
for the developing occlusion, particularly in the presence of an underlying malocclusion.
In many cases, at least one first permanent molar may require enforced extraction because of
its poor condition and unfavourable long-term prognosis. At this stage, a decision should also be
made regarding the need for elective extraction of any other teeth. This decision will be
influenced primarily by their condition and the underlying occlusion. Before any extraction
decisions are made, good quality radiographs are required to show the presence, condition and
developmental stage of all teeth in the dentition. If any teeth in the permanent dentition are
missing or in a poor eruptive position, this can significantly affect the decision-making process.
Ideally, an orthodontic opinion should be obtained, preferably from the orthodontist responsible
for future treatment, whenever this is practically possible.
• In the absence of a definitive opinion and if the use of local anaesthetic is practical,
enforced extraction should be carried out and advice sought regarding further elective
extractions.
• If a general anaesthetic is the only option, advice on elective extractions should be
obtained beforehand, if at all possible, to prevent the risk of multiple anaesthetics.
[SIGN Grade C]
Ideal timing of first permanent molar extraction
In the upper arch, the developmental position of an unerupted second permanent molar
generally ensures that this tooth will achieve a good occlusal position following extraction of the
first permanent molar.
In the lower arch, achieving a good occlusion is more dependent upon the timing of the first
permanent molar extraction.
• Generally, whenever practical the lower first molar should be extracted when there is
radiographic evidence of early dentine calcification within the second molar root
bifurcation. This usually occurs within a chronological age range of 8 to 10 years7,8
.
If the first molar is extracted before the age of eight years, there is often no radiographic
evidence of third molar development. In addition, in the lower arch:
• The second premolar can drift distally into the extraction space, tip and rotate 9
.
• The labial segments can retrocline with an accompanying increase in the overbite9-11
.
If the first molar is extracted during the later stages of second molar eruption:
• The second molar may tip mesially and rotate mesio-lingually, producing spacing and
poor occlusal contacts7
.
• The erupted second premolar can migrate distally.
Extraction of a first permanent molar is rarely the extraction of choice. However, favourable
spontaneous development of the dentition and space closure can be expected in the majority of
cases6
It is also possible to achieve good results following the removal of these teeth using fixed
appliances, although treatment times tend to be increased12,13
. It is not advisable to extract a
healthy premolar for orthodontic purposes if the first permanent molar in the same quadrant is
heavily restored14
.
[SIGN Grade C]
Guidelines for elective first molar extraction
A number of general guidelines on treatment planning first permanent molar extraction cases for
a number of malocclusions are available9,15-20
. As a general rule, if in doubt, get the patient out of
pain, try and maintain the teeth and refer for an orthodontic opinion.
[SIGN Grade C]
3. Class I cases
Class I cases with minimal crowding (≤3mm)
Aim for extraction at the optimal time for eruption of the second molars into a good position.
• Do not balance unilateral first molar extraction in either the upper or lower arches with
healthy first molars.
• If the lower first molar is to be lost, compensating extraction of the upper first molar
should be considered to avoid overeruption of this tooth21
, unless the lower second molar
has already erupted and the upper first molar is in occlusal contact with it.
• If the upper first molar is to be lost, do not compensate with extraction of the lower first
molar if it is healthy.
[SIGN Grade C]
Class I cases with crowding
In the presence of crowding in the buccal segments, extract at the optimal time to allow eruption
of second molars into a good occlusal position and this should provide some relief of any
premolar crowding.
• If the buccal segment crowding is bilateral, consider balancing extraction to provide
suitable relief and maintain the centreline.
• Compensating extraction of upper first molars should be considered to prevent
overeruption or relieve premolar crowding
In the presence of crowding in the labial segments, little spontaneous relief is provided by first
molar extraction.
• First molar extractions can be delayed until the second molars have erupted and then the
extraction space used for alignment with fixed appliances.
• Alternatively, first molars can be extracted at the optimum time and the crowding treated
once in the permanent dentition. If premolar extractions are likely to be required at this
stage, the third molars should be present.
[SIGN Grade B]
Class II cases
The extraction of first permanent molars in Class II cases can be more difficult to plan,
particularly with regard to the timing of upper first molar extraction17
. The main complicating
factors often involve the upper arch because of the need for space to correct the incisor
relationship.
Class II cases with minimal crowding
Lower first molar extraction should be carried out at the ideal time for successful eruption of the
second permanent molar and control of the second premolar. Compensating and balancing
extraction of healthy lower first molars are not indicated.
In the upper arch, space will often be required to correct the incisor relationship:
• If the upper first permanent molars require immediate extraction, orthodontic treatment
may be instituted to correct the incisor relationship. A functional appliance or removable
appliance and headgear can be used to correct the buccal segment relationship, followed
by fixed appliances if required.
• Alternatively, after extraction of the upper first permanent molars, the second permanent
molars can be allowed to erupt and the incisor relationship corrected once this has taken
place. Correction of the malocclusion at this stage can involve any of the methods
described above. In addition, if there is radiographic evidence of third molar
development, then further space for incisor correction could be created by the loss of two
upper premolars teeth.
• If the upper first permanent molars can be temporised or restored, then their extraction
can be delayed until the second permanent molars have erupted. the resultant extraction
4. space can then be used to correct the malocclusion with fixed appliances. If the upper
first molars are to be left unopposed, a simple removable appliance may be required to
prevent their over-eruption, whilst waiting for the second molars to erupt. Alternatively, a
functional appliance can be used immediately to correct the incisor relationship prior to
extraction of the first molars and fixed appliances.
• If the upper first permanent molar is sound, elective extraction may be indicated if it is at
risk of over-erupting; however, the third molars should ideally be present
radiographically. The class II relationship can then be managed as for immediate
extraction of upper first molars with a poor prognosis. If there is no sign of upper third
molar development, an appliance to prevent the over-eruption of sound upper first molars
should be considered and the malocclusion managed following eruption of the second
molars.
[SIGN Grade C]
Class II case with crowding.
Space will also be required in the lower arch for the relief of crowding.
• If the third molars are present radiographically, lower first molars can be extracted at the
optimum time to allow second molar eruption and then premolars extracted at a later
stage for the correction of crowding. In these cases, fixed appliances will usually be
required.
• Alternatively, first molars can be extracted after second molar eruption and the space
used directly for the correction of crowding with fixed appliances.
• Balancing and compensating extraction of lower first molars are not generally required.
Space requirements in the upper arch can be significant - for the relief of crowding and
correction of the incisor relationship i.e. increased overjet. The upper first permanent molars
should be temporised or restored and the child referred to a specialist orthodontist whenever
possible.
If the upper first permanent molar is unopposed, at risk of over-erupting and third molars are
present radiographically, then extraction of the upper first molar may be indicated. The patient
should be counselled that additional premolar extractions in the upper arch may be required in
the future to create sufficient space for crowding relief and incisor correction.
[SIGN Grade C]
Class III cases
Class III cases are often even more difficult to manage and ideally require the opinion of a
specialist orthodontist before any first permanent molars are extracted. As a general rule,
extraction of maxillary molars should be avoided if at all possible, whilst balancing and
compensating extractions are not recommended in class III cases17
.
[SIGN Grade C]
5. SIGN Classification
The Scottish Intercollegiate Guideline Network (SIGN) classification system indicates whether a
guideline’s recommendations are based on proven scientific evidence or currently accepted
good clinical practice with limited scientific evidence.
Level Type of evidence
Ia Evidence obtained from meta-analysis or randomised control trials.
Ib Evidence from at least one randomised control trial.
IIa Evidence obtained from at least one well-designed control study
without randomisation.
IIb Evidence obtained from at least one other type of well-designed quasi-
experimental study without randomisation.
III Evidence obtained from well-designed non-experimental descriptive
studies, such as comparative studies, correlation studies and case
control studies.
IV Evidence from expert committee reports or opinions and/or clinical
evidence of respected authorities.
Grade Recommendations
A>
(Evidence levels 1a,1b)
Requires at least one randomised controlled trial as part
of the body of literature of overall good quality and
consistency addressing the specific recommendations.
B>
(Evidence levels IIa,IIb,III)
Requires availability of well conducted trials but no
randomised clinical trials on the topic of
recommendation.
C>
(Evidence level IV)
Requires evidence from expert committee reports or
opinions and/or clinical experience of respected
authorities. Indicates absence of directly applicable
studies of good quality.
Dr Martyn Cobourne
Dr Alison Williams
Dr Roslyn McMullan
March 2009
6. References
1. Leppaniemi, A., Lukinmaa, P.L. and Alaluusua, S. 2001. Non-fluoride
hypomineralizations in the permanent first molars and their impact on the treatment
need. Caries Res 35:36-40.
2. Pitts, N.B., Chestnutt, I.G., Evans, D., White, D., Chadwick, B. and Steele, J.G. 2006.
The dentinal caries experience of children in the United Kingdom, 2003. Br Dent J
200:313-320.
3. Koch, G., Hallonsten, A.L., Ludvigsson, N., Hansson, B.O., Holst, A. and Ullbro, C. 1987.
Epidemiologic study of idiopathic enamel hypomineralization in permanent teeth of
Swedish children. Community Dent Oral Epidemiol 15:279-285.
4. Albadri, S., Zaitoun, H., McDonnell, S.T. and Davidson, L.E. 2007. Extraction of first
permanent molar teeth: results from three dental hospitals. Br Dent J 203:E14;
discussion 408-409.
5. Mejare, I., Bergman, E. and Grindefjord, M. 2005. Hypomineralized molars and incisors
of unknown origin: treatment outcome at age 18 years. Int J Paediatr Dent 15:20-28.
6. Jalevik, B. and Moller, M. 2007. Evaluation of spontaneous space closure and
development of permanent dentition after extraction of hypomineralized permanent first
molars. Int J Paediatr Dent 17:328-335.
7. Thilander, B. and Skagius, S. 1970. Orthodontic sequelae of extraction of permanent first
molars. A longitudinal study. Rep Congr Eur Orthod Soc:429-442.
8. Thunold, K. 1970. Early loss of the first molars 25 years after. Rep Congr Eur Orthod
Soc:349-365.
9. Hallett, G.E.M. and Burke, P.H. 1961. Symmetrical extraction of first permenent molars.
Factors controlling results in the lower arch. Trans Eur Orth Soc:238-253.
10. Abu Aihaija, E.S., McSheny, P.F. and Richardson, A. 2000. A cephalometric study of the
effect of extraction of lower first permanent molars. J Clin Pediatr Dent 24:195-198.
11. Richardson, A. 1979. Spontaneous changes in the incisor relationship following
extraction of lower first permanent molars. Br J Orthod 6:85-90.
12. Sandler, P.J., Atkinson, R. and Murray, A.M. 2000. For four sixes. Am J Orthod
Dentofacial Orthop 117:418-434.
13. Taylor, P.J., Kerr, W.J. and McColl, J.H. 1996. Factors associated with the standard and
duration of orthodontic treatment. Br J Orthod 23:335-341.
14. Daugaard-Jensen, I. 1973. Extraction of first molars in discrepancy cases. Am J Orthod
64:115-136.
15. Crabb, J.J. and Rock, W.P. 1971. Treatment planning in relation to the first permanent
molar. Br Dent J 131:396-401.
16. Gill, D.S., Lee, R.T. and Tredwin, C.J. 2001. Treatment planning for the loss of first
permanent molars. Dent Update 28:304-308.
17. Mackie, I.C., Blinkhorn, A.S. and Davies, P.H.J. 1989. The extraction of permanent
molars during the mixed-dentition period - a guide to treatment planning. J Paed Dent
5:85-92.
18. Mordecai, R. 2002. Treatment planning for the loss of first permanent molars. Dent
Update 29:98; author reply 98-99.
19. Penchas, J., Peretz, B. and Becker, A. 1994. The dilemma of treating severely decayed
first permanent molars in children: to restore or to extract. ASDC J Dent Child 61:199-
205.
20. Voss, H. 1971. Extraction of first permanent molars. Quintessence Int (Berl) 2:61-62.
21. Holm, U. 1970. Problems of compensative extraction in cases with loss of permanent
molars. Rep Congr Eur Orthod Soc:409-427.