This document discusses different types of tooth extractions performed in orthodontic treatment. It begins by explaining the history of extractions from Angle's philosophy of non-extraction to Tweed and Begg incorporating extractions. Evidence is presented on the effects of extractions on factors like profile, smile width, vertical dimension, and relapse. Types of extractions covered include lower incisors, upper incisors, canines, premolars, and molars. Serial extractions are defined as the timed extraction of primary and secondary teeth to interceptively manage crowding. Factors affecting extraction decisions and guidelines for different malocclusion types are also summarized.
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 various methods for analyzing space in orthodontic treatment planning. It describes the Royal London Space Analysis method in detail, including its two stages: 1) assessing space requirements and 2) creating or utilizing space through treatment mechanics. The method is considered easy to use, reliable, and valid, but it may overestimate crowding and have limited impact on treatment decisions. Alternative space analysis methods and their advantages/disadvantages are also reviewed.
This document discusses the management of low angle cases (skeletal deep bites). It covers the etiology, which can include hereditary factors and horizontal growth patterns. Clinical features include a short square face, upper teeth hidden behind the lips, and decreased interlabial distance. Diagnostic features include decreased facial angles and a horizontal growth pattern seen on cephalograms. Management options discussed include removable appliances, growth modification, magnets, fixed appliances, implants, lingual appliances, Invisalign, and surgery. Stability and retention are also addressed.
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.
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
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
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 various methods for analyzing space in orthodontic treatment planning. It describes the Royal London Space Analysis method in detail, including its two stages: 1) assessing space requirements and 2) creating or utilizing space through treatment mechanics. The method is considered easy to use, reliable, and valid, but it may overestimate crowding and have limited impact on treatment decisions. Alternative space analysis methods and their advantages/disadvantages are also reviewed.
This document discusses the management of low angle cases (skeletal deep bites). It covers the etiology, which can include hereditary factors and horizontal growth patterns. Clinical features include a short square face, upper teeth hidden behind the lips, and decreased interlabial distance. Diagnostic features include decreased facial angles and a horizontal growth pattern seen on cephalograms. Management options discussed include removable appliances, growth modification, magnets, fixed appliances, implants, lingual appliances, Invisalign, and surgery. Stability and retention are also addressed.
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.
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
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 discusses the three orders of tooth movement that can be achieved through bending orthodontic archwires: first, second, and third order bends. First order bends move teeth inwards/outwards and can be used for derotation. Second order bends tip teeth vertically and are used for anchorage. Third order bends torque individual teeth by twisting the wire. Special pliers can help perform specific bends, like step pliers for first order bends and rose pliers for third order torque bends. Proper bending technique is important to avoid wire fractures.
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 utility arches, which are orthodontic appliances used to apply light forces in the dental arch. It provides details on:
- The historical background and development of utility arches based on biomechanical principles.
- Common wire dimensions and materials used, including stainless steel, nickel titanium, and beta titanium alloys.
- The standard design components of utility arches, including molar, vertical, and incisal segments.
- Different types of utility arches like passive arches, intrusion arches, and retraction/protrusion arches and how they are activated to apply specific orthodontic forces.
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 outlines various topics related to orthodontic anchorage. It defines anchorage as the resistance to unwanted tooth movement and discusses optimal force levels in orthodontics. It also assesses factors that influence anchorage demands and describes different types of anchorage including intraoral sources from teeth, soft tissues, bone and the opposing arch as well as extraoral headgear. Methods to reinforce anchorage like headgear are also covered. The document provides an overview of anchorage in orthodontic treatment planning and mechanics.
Utility arches are auxiliary archwires used for orthodontic tooth movement. They are commonly made of blue elgiloy wire and engage the back four teeth (two molars) and front four teeth (incisors), so they are also known as 2x4 appliances. There are different types of utility arches for various tooth movements, including intrusion, retraction, and protrusion. Intrusion utility arches have a step cut anterior to the molar tube to allow slight tooth retraction while intruding incisors with a force of 25 grams per tooth. Adjustments are made intraorally using dental pliers.
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 information presented at a seminar on molar uprighting. It discusses factors that can influence uprighting a molar tipped into an extraction site, including extraction timing, periodontal condition, vertical dimension, number of missing teeth, position of the third molar, and condition of the alveolar ridge. It also reviews appliances that can be used for molar uprighting, including principles of anchorage and attachments, and techniques for uprighting a single molar with or without extrusion. The document provides details on final positioning of the molar and premolars after uprighting is completed.
This document discusses various techniques for positioning orthodontic brackets, including:
1. Standardized methods that use gauges to measure from tooth edges.
2. Andrews' FACC method which uses the central lobe of each tooth crown.
3. Individualized positioning that varies torque, angulation, and position for each tooth.
4. Progressive positioning by Pitts which places brackets more gingivally from posterior to anterior.
It also discusses bracket positioning considerations and modifications for specific tooth anomalies, malocclusions, and treatment plans.
This document summarizes impacted teeth, focusing on commonly impacted teeth like third molars, maxillary third molars, and maxillary cuspids. It discusses causes of impaction like genetic factors, localized obstructions, and systemic issues. Diagnosis involves history, examination, palpation, percussion, and various radiographic techniques. Management depends on the specific tooth and can include no treatment, interceptive extraction, surgical exposure with orthodontics, surgical removal, or transplantation. Maxillary canines, central incisors, and mandibular second premolars are discussed in more depth regarding their presentation, investigation, and treatment approaches.
Moment-to-Force Ratios and Controlling RootNew Microsoft PowerPoint Presentat...Maher Fouda
1. Moment-to-force ratios describe the relationship between an applied orthodontic force and the counterbalancing moment, or rotational force, required to control tooth movement.
2. Altering the ratio of the moment of an applied force to the moment generated by a force couple at the bracket allows for different types of tooth movement, from simple tipping to controlled tipping to bodily movement.
3. Achieving the desired tooth movement depends on manipulating these moments such that their ratio results in the desired movement, whether that be tipping, controlled tipping, or translation without rotation.
The Frankel functional regulator is a removable orthodontic appliance developed by Dr. Rolf Frankel to effect changes in the jaw relationship during mixed and early permanent dentition. It consists of upper buccal shields, lower lip pads, and wires. The shields and pads act to change muscle function and guide jaw growth. Indications include Class II malocclusions with a retruded mandible. Contraindications include severe crowding. The appliance aims to correct jaw positions through muscle adaptation and differential tooth eruption guidance between the arches.
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
Canine Impaction and Its Importance in OrthodonticsAnalhaq Shaikh
Canine Impaction, Its Importance in Orthodontics, Etiology, Diagnosis and Management.
by Dr Analhaq Shaikh, 2nd year Postgraduate student, Sharavathi Dental College and Hospital, Shimoga, Karnataka
Canine Impaction can also be termed as Shy Canine.
Diagnosis & treatment planing /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.
This document discusses the management of occlusal cant, which is asymmetry in the vertical inclination of the occlusal plane. It begins by defining occlusal cant and exploring its causes such as facial asymmetry or asymmetric growth. Methods for evaluating occlusal cant like clinical exams, photos, and imaging are presented. Treatment options include orthodontics using devices like bite blocks or orthodontic surgery to level the occlusal plane. The document concludes that both the etiology and classification of an individual's occlusal cant should be considered to determine the best treatment approach.
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 provides information on using infrazygomatic crest implants (IZC) for orthodontic anchorage. It discusses the history, anatomy, dimensions, indications, placement sites and guidelines for IZC. Case examples demonstrate using a self-drilling IZC screw for asymmetric distalization of the maxillary arch to correct a dental midline. Placement of the IZC screw allowed for full arch distalization without complex appliances. The treatment resulted in a Class I molar and canine relationship bilaterally with an improved dental and soft tissue profile. Complications and failure rates of IZC are also reviewed.
This document discusses the third and final stage of comprehensive orthodontic treatment called "finishing". It defines finishing as correcting prior errors and detailing the case. The document outlines the goals of finishing which include enhancing aesthetics, individual tooth positioning, occlusion, and stability. It describes the standards used by the American Board of Orthodontics for grading case finishing. The document provides details on techniques for correcting tooth alignment, angulation, rotation, and achieving proper gingival levels and tooth sizes during the finishing stage.
Maxillary protraction /certified fixed orthodontic courses by Indian dental ...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
The document discusses impacted maxillary canines, including:
- Unerupted canines is a common clinical problem, with prevalence ranging from 0.8-2.8%.
- Normal development involves calcification starting at age 1 and eruption around 11-12 years old.
- Factors that can cause impaction include crowding, prolonged retention of primary canines, abnormal position of tooth buds, and genetic factors.
- Diagnosis involves inspection for delayed/asymmetric eruption, palpation of buds, and diagnostic imaging to determine location, development stage, and other anatomical details of unerupted canines.
1. The document describes the Begg orthodontic appliance and treatment methodology. It discusses the history and philosophy of Begg, the features of the appliance, and outlines the objectives and mechanics of the three stages of Begg treatment.
2. Stage I focuses on intra-arch alignment and leveling as well as overcorrection of overbite and overjet. Light class II elastics are used. Stage II aims to maintain stage I results while closing extraction spaces and correcting dental asymmetries using heavier elastics.
3. Stage III involves uprighting and torquing springs to correct tipping and torque. Uprighting springs may be needed to prevent opening of extraction spaces during torqueing. Finishing
This document discusses the three orders of tooth movement that can be achieved through bending orthodontic archwires: first, second, and third order bends. First order bends move teeth inwards/outwards and can be used for derotation. Second order bends tip teeth vertically and are used for anchorage. Third order bends torque individual teeth by twisting the wire. Special pliers can help perform specific bends, like step pliers for first order bends and rose pliers for third order torque bends. Proper bending technique is important to avoid wire fractures.
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 utility arches, which are orthodontic appliances used to apply light forces in the dental arch. It provides details on:
- The historical background and development of utility arches based on biomechanical principles.
- Common wire dimensions and materials used, including stainless steel, nickel titanium, and beta titanium alloys.
- The standard design components of utility arches, including molar, vertical, and incisal segments.
- Different types of utility arches like passive arches, intrusion arches, and retraction/protrusion arches and how they are activated to apply specific orthodontic forces.
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 outlines various topics related to orthodontic anchorage. It defines anchorage as the resistance to unwanted tooth movement and discusses optimal force levels in orthodontics. It also assesses factors that influence anchorage demands and describes different types of anchorage including intraoral sources from teeth, soft tissues, bone and the opposing arch as well as extraoral headgear. Methods to reinforce anchorage like headgear are also covered. The document provides an overview of anchorage in orthodontic treatment planning and mechanics.
Utility arches are auxiliary archwires used for orthodontic tooth movement. They are commonly made of blue elgiloy wire and engage the back four teeth (two molars) and front four teeth (incisors), so they are also known as 2x4 appliances. There are different types of utility arches for various tooth movements, including intrusion, retraction, and protrusion. Intrusion utility arches have a step cut anterior to the molar tube to allow slight tooth retraction while intruding incisors with a force of 25 grams per tooth. Adjustments are made intraorally using dental pliers.
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 information presented at a seminar on molar uprighting. It discusses factors that can influence uprighting a molar tipped into an extraction site, including extraction timing, periodontal condition, vertical dimension, number of missing teeth, position of the third molar, and condition of the alveolar ridge. It also reviews appliances that can be used for molar uprighting, including principles of anchorage and attachments, and techniques for uprighting a single molar with or without extrusion. The document provides details on final positioning of the molar and premolars after uprighting is completed.
This document discusses various techniques for positioning orthodontic brackets, including:
1. Standardized methods that use gauges to measure from tooth edges.
2. Andrews' FACC method which uses the central lobe of each tooth crown.
3. Individualized positioning that varies torque, angulation, and position for each tooth.
4. Progressive positioning by Pitts which places brackets more gingivally from posterior to anterior.
It also discusses bracket positioning considerations and modifications for specific tooth anomalies, malocclusions, and treatment plans.
This document summarizes impacted teeth, focusing on commonly impacted teeth like third molars, maxillary third molars, and maxillary cuspids. It discusses causes of impaction like genetic factors, localized obstructions, and systemic issues. Diagnosis involves history, examination, palpation, percussion, and various radiographic techniques. Management depends on the specific tooth and can include no treatment, interceptive extraction, surgical exposure with orthodontics, surgical removal, or transplantation. Maxillary canines, central incisors, and mandibular second premolars are discussed in more depth regarding their presentation, investigation, and treatment approaches.
Moment-to-Force Ratios and Controlling RootNew Microsoft PowerPoint Presentat...Maher Fouda
1. Moment-to-force ratios describe the relationship between an applied orthodontic force and the counterbalancing moment, or rotational force, required to control tooth movement.
2. Altering the ratio of the moment of an applied force to the moment generated by a force couple at the bracket allows for different types of tooth movement, from simple tipping to controlled tipping to bodily movement.
3. Achieving the desired tooth movement depends on manipulating these moments such that their ratio results in the desired movement, whether that be tipping, controlled tipping, or translation without rotation.
The Frankel functional regulator is a removable orthodontic appliance developed by Dr. Rolf Frankel to effect changes in the jaw relationship during mixed and early permanent dentition. It consists of upper buccal shields, lower lip pads, and wires. The shields and pads act to change muscle function and guide jaw growth. Indications include Class II malocclusions with a retruded mandible. Contraindications include severe crowding. The appliance aims to correct jaw positions through muscle adaptation and differential tooth eruption guidance between the arches.
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
Canine Impaction and Its Importance in OrthodonticsAnalhaq Shaikh
Canine Impaction, Its Importance in Orthodontics, Etiology, Diagnosis and Management.
by Dr Analhaq Shaikh, 2nd year Postgraduate student, Sharavathi Dental College and Hospital, Shimoga, Karnataka
Canine Impaction can also be termed as Shy Canine.
Diagnosis & treatment planing /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.
This document discusses the management of occlusal cant, which is asymmetry in the vertical inclination of the occlusal plane. It begins by defining occlusal cant and exploring its causes such as facial asymmetry or asymmetric growth. Methods for evaluating occlusal cant like clinical exams, photos, and imaging are presented. Treatment options include orthodontics using devices like bite blocks or orthodontic surgery to level the occlusal plane. The document concludes that both the etiology and classification of an individual's occlusal cant should be considered to determine the best treatment approach.
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 provides information on using infrazygomatic crest implants (IZC) for orthodontic anchorage. It discusses the history, anatomy, dimensions, indications, placement sites and guidelines for IZC. Case examples demonstrate using a self-drilling IZC screw for asymmetric distalization of the maxillary arch to correct a dental midline. Placement of the IZC screw allowed for full arch distalization without complex appliances. The treatment resulted in a Class I molar and canine relationship bilaterally with an improved dental and soft tissue profile. Complications and failure rates of IZC are also reviewed.
This document discusses the third and final stage of comprehensive orthodontic treatment called "finishing". It defines finishing as correcting prior errors and detailing the case. The document outlines the goals of finishing which include enhancing aesthetics, individual tooth positioning, occlusion, and stability. It describes the standards used by the American Board of Orthodontics for grading case finishing. The document provides details on techniques for correcting tooth alignment, angulation, rotation, and achieving proper gingival levels and tooth sizes during the finishing stage.
Maxillary protraction /certified fixed orthodontic courses by Indian dental ...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
The document discusses impacted maxillary canines, including:
- Unerupted canines is a common clinical problem, with prevalence ranging from 0.8-2.8%.
- Normal development involves calcification starting at age 1 and eruption around 11-12 years old.
- Factors that can cause impaction include crowding, prolonged retention of primary canines, abnormal position of tooth buds, and genetic factors.
- Diagnosis involves inspection for delayed/asymmetric eruption, palpation of buds, and diagnostic imaging to determine location, development stage, and other anatomical details of unerupted canines.
1. The document describes the Begg orthodontic appliance and treatment methodology. It discusses the history and philosophy of Begg, the features of the appliance, and outlines the objectives and mechanics of the three stages of Begg treatment.
2. Stage I focuses on intra-arch alignment and leveling as well as overcorrection of overbite and overjet. Light class II elastics are used. Stage II aims to maintain stage I results while closing extraction spaces and correcting dental asymmetries using heavier elastics.
3. Stage III involves uprighting and torquing springs to correct tipping and torque. Uprighting springs may be needed to prevent opening of extraction spaces during torqueing. Finishing
This document provides an overview of extraoral orthodontic appliances. It defines extraoral appliances as those that apply forces from an external source. The document then summarizes the main types of extraoral appliances - headgear with facebow, J hook facebow, asymmetric headgear, and combinations with functional appliances. It also briefly outlines the history, uses, and studies on the effects of headgear, including dental and skeletal effects.
This document discusses the orthodontic management of hypodontia, which is tooth agenesis excluding third molars. It begins by defining hypodontia and classifying it based on the number of missing teeth and inheritance patterns. It then discusses the prevalence of hypodontia based on factors like ethnicity, gender, tooth type, and location. The etiology and clinical presentation are described. Management involves a multidisciplinary team and factors like age, severity, facial profile, and dental relationships are considered. Treatment options include space opening/closure and different appliances used. Challenges in treatment and restoration options to replace missing teeth are also covered.
This document contains a diagnostic summary, clinical examination, radiographic findings, problem list, treatment aims and objectives, cephalometric interpretation, and treatment plan for an orthodontic patient. Key details include that the patient presented with a Class I incisor relationship on a Class II skeletal base with vertical proportions. Clinical findings show good oral hygiene and tooth quality with no pathology. The treatment plan is to use a functional appliance to improve the skeletal relationship, followed by fixed appliances to detail the occlusion. Retention will involve upper and lower retainers.
This document discusses Class 2 Division 1 malocclusion. Key points include:
- It has a prevalence of 27% and is characterized by a distal relationship between the maxillary and mandibular teeth.
- Treatment options include orthodontic camouflage using appliances like upper removable appliances, functional appliances to modify growth, or orthognathic surgery.
- The choice of treatment depends on factors like the patient's age, skeletal pattern, dental development, soft tissue profile, and compliance. Camouflage is generally considered for mild cases, while surgery is used for more severe skeletal discrepancies.
- Outcomes and stability vary depending on the treatment approach and individual patient factors. Early intervention
This document discusses the orthodontic management of deep overbites. It begins with definitions and classifications of overbites. It then covers the prevalence, aetiology, indications for treatment, and principles of overbite reduction. Various treatment methods are described in detail, including removable appliances, fixed appliances, functional appliances, and auxiliary devices. Factors to consider for treatment method selection and mechanics for overbite reduction are also outlined. The document provides a comprehensive overview of deep overbite orthodontic management.
This document provides an overview of functional orthodontic appliances and myofunctional appliances. It defines these appliances as removable or fixed orthodontic devices that use or eliminate forces from muscles and tissues to alter skeletal and dental relationships. The document then covers the history, classification, indications, problems, effects, modes of action, and types of these appliances. It examines issues like rebound of overjet, incisor proclination, and lateral open bite that can occur with functional appliances. It also compares the skeletal effects of different appliances and discusses factors influencing appliance choice and timing of treatment.
This document discusses several types of palatal appliances used in orthodontic treatment, including TPAs (transpalatal arches), Nance appliances, lingual arches, and quadhelix appliances. It describes the design, materials, and indications for passive and active uses of TPAs, including as space maintainers, for arch width stabilization, vertical anchorage, and anterior-posterior anchorage. Studies comparing the anchorage effects of TPAs to other methods like TADs or EOT are summarized. Complications and clinical management of quadhelix appliances are also mentioned.
MBT system in orthodontics /certified fixed orthodontic courses by Indian den...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
This document discusses the management of facial and dental asymmetry. It defines asymmetry and outlines its prevalence in the general population and among orthodontic patients. Asymmetry can be caused by skeletal, functional, muscular, local dental factors or a combination. Diagnosis involves taking a thorough history and conducting examinations of the soft tissues, dentition, occlusion and skeletal structures to determine the underlying causes and classify the type of asymmetry present. Treatment aims to address the specific causes and may involve orthodontics, orthognathic surgery, or both to improve function, occlusion and aesthetics.
This document discusses Class II Division 2 malocclusion. Key points:
- Class II Division 2 is characterized by retroclined upper incisors and a retropositioned lower first molar. The overjet is usually minimal but may be increased.
- It has a prevalence of 1.5-17.7% and is highly associated with impacted canines.
- The etiology involves genetic and environmental factors like soft tissue pressures retroclining the upper incisors.
- Treatment aims to correct the skeletal and dental relationships, overbite, and achieve a functional occlusion. Options include growth modification, fixed appliances, orthognathic surgery, or a combination. Anchorage is
The document discusses arch form and width in orthodontic treatment. It defines arch form as the shape formed by the buccal and facial surfaces of teeth when viewed from above. Factors like ethnicity, malocclusion type, musculature, environment, and treatment influence arch form. Implications of arch form for treatment include aesthetics, periodontal health, treatment planning, mechanics, and stability. Common arch forms described include Bonwill-Hawley, catenary curve, Brader ellipse, conic sections, Andrews, and individualized forms. Arch width changes naturally with growth but appliances can stably expand the arch to a limited degree depending on factors like age and extractions.
This document discusses the aetiology of malocclusion. It states that malocclusion can be caused by both genetic and environmental factors. Genetic factors that may influence malocclusion include homeobox genes, growth factors, and genes related to specific dental anomalies. Evidence for a genetic role comes from twin studies and familial occurrences of certain malocclusions. Environmental factors like soft tissues, habits, and local dental factors can also influence malocclusion development. The interaction between genetics and environment determines the phenotype.
This document discusses the benefits of orthodontic treatment. It outlines 7 main benefits: 1) psychological benefits such as improved self-esteem, 2) improved masticatory efficiency, 3) improved speech, 4) prevention or cure of temporomandibular joint dysfunction, 5) interceptive benefits such as preventing trauma, 6) dental health benefits like increased resistance to caries and periodontal disease, and 7) being an adjunct to other dental treatments. The summary at the end synthesizes several key studies that evaluated these benefits and the evidence regarding their effectiveness.
This document discusses Class II and Class III subdivision malocclusions. It describes two types of Class II subdivisions - Type 1 where the mandibular midline is deviated and Type 2 where the maxillary midline is deviated. Treatment depends on the type and severity of crowding but may involve single or multiple premolar extractions or interarch mechanics. Class III subdivisions can be treated similarly though studies are lacking, and extraction of a mandibular incisor is another option. Early intervention can address asymmetries from early tooth loss or crossbites.
1. The document discusses anterior open bite and high angle cases, defining dental and skeletal open bites. It covers etiology including transitional factors, skeletal factors like genetics and trauma, soft tissue factors like muscles and adenoid size, and habits like digit sucking.
2. Treatment options are discussed ranging from myofunctional therapy and extraoral traction to fixed appliances, molar intrusion, repelling magnets, and orthognathic surgery. Stability, relapse prevention, and difficulties in treatment are also addressed.
3. Key predictors of open bite like Bjork's structural signs, Jarabak ratio, UAFH-LAFH ratio, and decreased overbite depth indicator are summarized. Character
1. Bimaxillary proclination is a malocclusion where the maxillary and mandibular incisors are positioned forward in relation to their dental bases.
2. It is most common in Afro-Caribbean and some Asian populations and can be caused by skeletal, soft tissue, dental, or habitual factors.
3. Treatment depends on the severity and may include space creation through extraction or alignment and retraction of the incisors using techniques like temporary anchorage devices. Stability of results can be challenging.
Arch Form in orthodontics /certified fixed orthodontic courses by Indian dent...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
This document defines orthodontic anchorage (OA) and discusses its early understanding and assessment. It describes factors that influence anchorage demand and different classifications of OA. Theories of optimal force levels and differential anchorage are explained. Various methods to reinforce anchorage are outlined, including using compound anchorage units, anchor bends, tipping and uprighting teeth, extraoral anchorage, and musculature forces. The evidence for the differential force theory is discussed.
Critical Issues In Disaster Science And Management Dawn Dawson
This document contains a table of contents for a book that discusses critical issues in disaster science and management. It outlines 12 chapters that each explore an issue from both an academic and practitioner perspective, and provide a section to bridge the divide between the two views. The chapters cover topics such as whole community relationships, volunteers and nonprofits in disaster, public/private partnerships, access and functional needs, public health preparedness, planning and improvisation, reflections on the National Incident Management System, long-term recovery, after-action reporting, and the role of social media.
Does online consumer generated media influence attitudes towards brands?Sevil Ozer Crespo
This is my full copy of my dissertation reflecting an early review on social media and its impact on brand perception. Happy to share as after all these years the theory is still true, in fact the impact of social media on brand perception is now more prominent.
The document describes two trails at the University of Limerick campus: the Art Trail and the Flora and Fauna Trail. It provides an overview of the trails and notes that a mobile application will be developed to guide users along the trails, identifying points of interest and providing information. The application will allow users to view the trails on maps, like and share content, and access location services to find their position on the trails.
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2. Table of Contents
Why we take teeth out...........................................................................................................5
History .................................................................................................................................5
Angle time.............................................................................................................................5
Case......................................................................................................................................6
Tweed ..................................................................................................................................6
Begg.....................................................................................................................................6
Advantages of non-extraction approach .............................................................................6
Advantages of extraction approach ....................................................................................7
Prevalence of extractions in orthodontics..............................................................................7
Evidences about the detrimental effects of extraction............................................................7
How we can measure crowding...........................................................................................11
Factors affecting the choice of extractions in orthodontics..................................................12
Types of extraction in orthodontics ....................................................................................13
Definition: ..........................................................................................................................14
Extraction Sequence:...........................................................................................................14
Indications:.........................................................................................................................15
Advantages of Serial Extractions........................................................................................15
Disadvantages of Serial Extractions....................................................................................16
Lower Incisors....................................................................................................................17
Indication................................................................................................................................................17
Contraindication.....................................................................................................................................18
Disadvantages.........................................................................................................................................18
If a lower incisor is to be removed, it would be wise to..........................................................................19
Upper central incisors.........................................................................................................19
Upper lateral incisor............................................................................................................20
Indication................................................................................................................................................20
Contraindication.....................................................................................................................................20
Mohammed Almuzian, University of Glasgow, 2013 2
3. Canines...............................................................................................................................20
Indication:...............................................................................................................................................20
Disadvantages.........................................................................................................................................21
First Premolars...................................................................................................................21
Indication................................................................................................................................................21
Advantages ............................................................................................................................................22
Second premolars................................................................................................................22
Indication...............................................................................................................................................22
Disadvantages:........................................................................................................................................23
First Molars........................................................................................................................23
1.Enforced extraction of the first molar...............................................................................23
Incidence ................................................................................................................................................23
Indications .............................................................................................................................................23
Consequences of enforced extraction of the first molar (Gill, 2001)....................................24
Guidelines for forced first molar extraction (RCSEng. Cobourne 2009).............................25
Class I cases with minimal crowding (3mm)...........................................................................................25
Class I cases with crowding.....................................................................................................................25
Class II case with crowding.....................................................................................................................27
Class III cases.....................................................................................................................28
2.Interceptive extractions of the 6's, Wilkinson 1940..........................................................28
Ideal Wilkinson criteria...............................................................................................................................28
Complication of Wilkinson extractions...............................................................................28
3.Elective first molar extractions to provide space for orthodontic purpose.........................29
Indication............................................................................................................................29
Potential problem with first molar extractions to provide space for orthodontic purpose, Sandler 2000..30
Second Molars....................................................................................................................32
Indications..........................................................................................................................32
Contraindication..................................................................................................................33
Mohammed Almuzian, University of Glasgow, 2013 3
5. Extractions in orthodontics
Why we take teeth out
1.General factors like caries, periodontal problems or sever malposition
2.Correction of incisor relationships and OJ
3.Relief of crowding
4.OB (flattening of curve of Spee requires space)
5.Correction of CL problems
6.Facial aesthetic by reducing fullness of the lip eg. Bimax protrusion
7.To allow distalization
8.Tooth size anomalies
9.Provision of anchorage provision of anchorage and allow the use of intermaxillary
elastic
10.Interceptive treatment
11.Stability
History
Angle time
Angle was convinced that
• The human jaw could accommodate a full complement of teeth in an ideal occlusion.
Wollf, the physiologist maintained that bone formation was related to the stress
Mohammed Almuzian, University of Glasgow, 2013 5
6. applied to it and from this Angle assumed that bone would surround teeth and
stabilising them in their new functional position.
• Angle was also very preoccupied with facial aesthetics, maintaining that an ideal
profile would be gained from the ideal positioning of a full complement of teeth.
Case
Criticise Angle for non-extraction since it influence the profile
Tweed
Around the 1930’s Charles Tweed and Raymond Begg, both ex pupils of Angle,
were simultaneously revising their therapies to include extractions after being
dissatisfied with the extent of relapse noted in previous non extraction cases.
Begg
Abandon non extraction due to high relapse and accused the loss of IP abrasion to the
high need of extraction
Advantages of non-extraction approach
1.Less trauma to the child
2.Ease of treatment
3.Consumer demand
4.Short duration
5.Facial fullness to give young full profile
6.Less effect on TMJ
Mohammed Almuzian, University of Glasgow, 2013 6
7. 7.Less effect on the vertical relationship
8.Less effect on smile width
Advantages of extraction approach
1.Stability
2.Less protrusive facial appearance
3.Controllable outcomes
4.Begg philosophy (tooth size reduction required to compensate for dietary change)
5.Little gingival recession
Prevalence of extractions in orthodontics
A. McCaul 2001, found that extraction for orthodontics represents 10% of overall
extraction in dentistry.
B. Weintraub et al (1989) the actual extraction rates is 54% in all orthodontic treatment.
C. There is a wide variation in the use of extractions which had no association with the
year of graduation of the dental school from which the orthodontist graduated from.
D. Bradbury(1985) carried out a survey of the types of teeth extracted by hospital
service orthodontists. The first premolars were the teeth most commonly extracted
(59%) followed by the second premolars (13%), first permanent molars (12%),
second permanent molars (7%), permanent canines (4%), permanent lateral incisors
(3%) and the permanent central incisors (1%).
Evidences about the detrimental effects of extraction
1.Profile
Mohammed Almuzian, University of Glasgow, 2013 7
8. 2.Smile width
3.Vertical Dimension
4.TMD
5.Effect on PD
6.Relapse
7.The outcome of treatment
8.General problems
9.Intra-oral detrimental effect
In details………………..
Effects on
profile
Angle believed that the best
facial appearance for a patient
would be achieved when the
dental arches had been expanded
so that all of the teeth were in an
ideal occlusion.
The upper lip to upper incisor
retraction approximately 1 :0.3
lower lip to lower incisor
relation approximately 1 : 0.59.
(Talass, 1987)
(Bowman and Johnston 1993).
extractions have a minimal
effect on the facial profile, but
that the effect is not deleterious
and should not influence the
extraction pattern prior to
orthodontic treatment
Paquette et al (1992) found the
soft tissue changes has no
detectable aesthetic effects.
Various assessments of the
patients' opinion of the aesthetic
changes in their silhouettes and
facial photographs both before
and after treatment revealed no
Mohammed Almuzian, University of Glasgow, 2013 8
9. difference between the groups.
Extractions
and smile
width
Orthodontic treatment involving
extractions has been accused in
causing larger “dark buccal
corridor”.
However, the study by Johnson
and Smith (1995) found no
evidence of this and also no
evidence that extractions
produced less attractive smiles
in the opinions of lay judges.
The Effect
on Vertical
Dimension
Dewel (1967) expressed worries
that premolar extraction may
tend to deepen the bite and cause
lower incisors to tip lingually as
well as developing TMD.
Paquett et al (1992) there are no
convincing studies which
suggest that vertical dimension
is influenced by extraction or
non extraction treatment.
Extractions
and
Mandibular
Dysfunction
Farrar et al.(1983) suggested
that removal of four premolar
teeth prior to orthodontic
treatment can be detrimental to
the stability of the
temporomandibular joint as a
result of “over retraction” of the
maxillary incisors during space
closure, which displaces the
mandible posteriorly.
Plaquette 1992 found that
extraction has no influence on
TMJ.
Effect of
expansion
and
proclination
on PD
Artun 1987, excessive
proclination of mandibular
incisors may lead to dehiscence
and the overlying gingiva will
become very thin and more
Aziz 2011, no association
between appliance induced
labial movement of mandibular
incisors and gingival recession
was found. Factors that may
Mohammed Almuzian, University of Glasgow, 2013 9
10. susceptible to recession than
thick attached gingivae.
lead to gingival recession after
orthodontic tipping and/or
translation movement were
identified as
• a reduced thickness of the free
gingival margin,
• a narrow mandibular symphysis,
• inadequate plaque control
• Aggressive tooth brushing.
The Effect
on Relapse
Some clinicians argue that
extractions are required to
prevent such relapse.
However, it has been shown
that relapse can happen in both
extraction and non-extraction
and there is no prediction for
relapse. (Little et al 1990).
Paquette et al (1992) Regarding
stability, the Little index in the
lower labial segment at recall
was 2.9 mm in the extraction
group and 3.4 mm in the non-
extraction group. This
difference was again not
significant
The
outcome of
treatment
Ileri 2011 compares the
outcome in treating class I with
extraction of 4s, non-extraction
or extraction of single incisors.
Mohammed Almuzian, University of Glasgow, 2013 10
11. It was a retrospective study. He
found the outcome measured on
the PAR basis was better in
non-extraction gp.
General
problems
• Cost
• Pain,
• Bleeding
• Infection
• Prolong treatment
• Difficulty to close space
Intra-oral
detrimental
effect of
tooth
extraction
• Loss of tooth substance
• Reduction in the arch length
• Reduction in the arch width
• TSD
• Reduction in the tooth inclination
However some of these could
be advantageous in certain
cases. Eg increase in the OB is
beneficial in case of high angle
class II D1
How we can measure crowding
1.Brass wire
2.Microscopic
3.Segemental measurement
4.Visual using clear ruler
Mohammed Almuzian, University of Glasgow, 2013 11
12. • Johal 1997 found that microscopic is better, visual over estimate and bras wire under
estimate.
Factors affecting the choice of extractions in orthodontics
A. General Factors
1.Medical condition
2.Age of patient - more difficult to close space in older pts. Also in young patient other
method of space provision can be used
3.Patient cooperation where other method of space provision can be used
4.Pathology
5.Gross Displacement
6.Abnormal morphology.
B. Factors specific to the malocclusion
1. Patient’s facial aesthetics and profile.
2. The A-P skeletal pattern
3. The vertical skeletal pattern. Extraction avoided in deep bite and vice versa.
4. The transverse relationship of the arches. Will Andrews and Larry Andrews' WALA
line is the band of soft tissue immediately superior to the mucogingival junction in the
mandible. It is at or nearly at the same superior-inferior level as the horizontal centre-
of-rotation of the teeth. Andrews' sees the WALA Ridge as the primary landmark for
arch width and form and for archwire width and form. This is
perhaps a better indicator of mandibular basal bone position than
the pretreatment mandibular arch width.
Mohammed Almuzian, University of Glasgow, 2013 12
13. 5. The degree of crowding.
• Mild , 1 to 4mm, Non extraction or second premolars
• Moderate, 5 to 8 mm, First premolars or second premolars
• Severe, 9+ mm, First premolars
6. Site of crowding
7. Amount of overjet
8. Amount of overbite. Also space might be required to flatten the COS
9. The inclination of the canines.
10. Amount of space needed for correction of the molar relationship.
11. Amount of space for centreline correction.
12. Treatment plan and aim: surgical treatment plan or camoflagable.
13. Treatment mechanics: which determines the anchorage requirements of the proposed
tooth movements.
14. The Diagnostic line or A-P line (Williams., 1969): It was suggested that for a
harmonious facial profile and lip balance, the incisal edge of the lower incisor should
lie near or on the A-P line. It has been used as useful aids in Tip Edge and Begg
technique to determine the need for extraction (Cadman et al., 1975). If the
alignment, levelling, or the mandibular growth result in a potential anterior
positioning of the lower incisor edge in relation to the A-Po line, then it is likely that
extractions or tooth size reduction may be necessary.
Types of extraction in orthodontics
A. Extraction of deciduous canines
Mohammed Almuzian, University of Glasgow, 2013 13
14. 1.Extraction of lower deciduous canines has been suggested for the correction of mild
lower incisor crowding. Houston and Tulley (1989) state that in general terms this
allows some correction of the incisor crowding. Stephens (1989), reported that the
ideal age group for this would be 9-10 years of age to allow full development of the
intercanine width. Proffit (1993) however warns that this may result in the lower
incisors tipping lingually further reducing arch length.
2.Provide space for palatally lateral incisors.
3.Provide space for incisors whose eruption is late due to supernumeries.
4.Serial extraction
5.Balance extraction for maintaining ML integrity
6.Extraction of lower C`s may help in treatment mandibular displacement.
7.Extraction of upper deciduous canines is often suggested in order to attempt to
encourage a palatally placed canine to erupt into a normal position. Research has
shown that this indeed is quite successful with 70% erupting into favourable positions
(Ericsson and Kurol, 1988).
B. Serial Extractions
Definition:
• Timed extraction of 1o
and 2o
teeth for interceptive management of crowding
• Originally advocated by Kjellgren 1947 to avoid the need for orthodontic treatment
but now modified and used as an adjunct to fixed appliance treatment
Extraction Sequence:
1. B`s as centrals erupt
Mohammed Almuzian, University of Glasgow, 2013 14
15. 2. C`s as laterals erupt (8½-9½ yrs)→ allows 1 & 2`s to align + move distally but 5 &
6`s drift mesially
3. D`s when 75% resorbed or 1st premolar roots are ½ to 2/3 formed, in order
encourage 4`s to erupt
• too early extraction > bone formation over D`s hence delays eruption of 4`s
• too late extraction >3`s will erupt before 4`s
4. 4s as the 3`s erupt
• allows 3`s to align
• any residual space will close with mesial drift of 5 & 6`s
Indications:
Sever crowding in:
1. 8-9 yrs old
2. skeletal Class I
3. normal OJ and OB
4. 4`s developmentally ahead of 3`s
5. First permanent molars of good prognosis
6. all permanent teeth present
Advantages of Serial Extractions
1.in theory no appliance treatment needed
2.appliance may be simpler and shorter 50% reduction in the treatment time (Little 1990)
3.Better stability and retention since tooth completes its formation in a site where it will
remain when treatment is completed (Graber, 2011)
Mohammed Almuzian, University of Glasgow, 2013 15
16. Disadvantages of Serial Extractions
1.Exposed to multiple extractions (12 teeth)
2.No guarantee, extractions of D`s can lead to impaction of 4`s if the 3s erupt ahead of
the 4s. Removal of twelve teeth is a traumatic experience and there is no guarantee
that the lower premolar will erupt before the canine and as such the latter may be
impacted. If this occurs extraction of the second deciduous molars may be an option
with Holtz (1970) advocating the provision of a lingual arch retainer for space
maintenance. The latter author also recommends disking of the second deciduous
molars to provide space for premolar teeth.
3.Growth prediction problems: difficult to predict amount of incisor crowding because
ICW ↑ between 8-10yrs i.e. lower incisor crowding may resolve spontaneously
4.Space loss with extractions of C`s and especially D`s, by mesial drift of buccal
segments, lower incisors tip lingually, both of these reduces arch length
5.Tipping of teeth into extractions site especially anterior teeth causing OB increasing.
Little 1990
6.There was no difference between the serial extraction sample and a matched sample
extracted and treated after full eruption except shorter time for active orthodontic
treatment (Little 1990)
C. Modified serial extraction
1.Serial extraction has no real role in modern orthodontics
2.Modified form, by applying stage 3+4 only → extraction of Ds and 4s and
D. Removal of the individual tooth types
Below will summarise the thoughts behind individual tooth extractions.
Mohammed Almuzian, University of Glasgow, 2013 16
17. Lower Incisors
Indication
1.Hypoplasia
2.Severe displacement
3.Heavily restored or poor prognosis
4.Impaction or abnormal shape.
5.Traumatised, heavily restored or non-vital lower incisor (Kokich and Shapiro, 1984).
6.Periodontally involved tooth (Canut, 1996).
7.Ectopic eruption of lower lateral incisor or single lower incisor excluded from the arch
and remaining incisors will aligned.
8.Crowding of 5mm (equivalent to a lower incisor) localised in lower labial segment
with buccal segments well intercuspated. (Tuverson, 1980)
9.Excessive size of lower incisor teeth since it can relieve tooth-size discrepancy caused
by microdont 22
10.When reduction of the intercanine width is required
11.Distally tipped canines
12.Adult presenting with full unit class II in the buccal segment and 5mm crowding in
the lower arch (extraction of two premolars in the lower arch may be extremely
challenging).
13.The patient has had previous orthodontic treatment involving removal of upper
premolars producing a well-aligned upper arch, good buccal segment intercuspation
but leaving unacceptable lower incisor crowding
Mohammed Almuzian, University of Glasgow, 2013 17
18. 14.Removal of lower incisor to compensate for the loss of an upper lateral incisor may
be considered.
Contraindication
1. Deep overbite
2. Increased overjet (Hegarty and Hegarty, 1999)
3. Poor buccal segment relationship
4. Mesially inclined canines
5. Poor prognosis of posterior teeth
6. Mild (<3mm) or severe (>7mm) lower incisor crowding
Disadvantages
1. ML problems
2. Treatment must involve fixed appliances.
3. Reduction of the lower intercanine width
4. Increased overbite and overjet.
5. Loss of interdental papillae (Faerovig and Zachrisson, 1999)
6. TSD and poor occlusion.
7. Risk of space opening so fixed bonded lower retainer should be considered (Dacre,
1985)
However, the long term stability more favourable than with premolar extraction.
(Riedel et al., 1992)
Mohammed Almuzian, University of Glasgow, 2013 18
19. If a lower incisor is to be removed, it would be wise to
1.First carry out a Bolton tooth-size analysis and Kesling diagnostic set-up.
2.If this confirms the proposed treatment plan, the majority of facial growth should be
complete before commencing treatment. If this is not possible, there is a greater
potential for relapse of crowding as a result of natural growth changes in this region.
3.Proximal enamel reduction should be carried out prophylactically to avoid black
triangle.
4.It is helpful to place the lower incisor brackets a little more gingivally such that the
incisal edges and canine tips are level.
5.It is also advisable to angulate the brackets of the incisors each side of the extraction
space by a few degrees so that the apices are a little closer together than usual.
6.It is occasionally necessary to remove a little enamel from mesial and distal 'ridges' on
the palatal surface of the upper incisors where the lower canine can contact
Upper central incisors
1.Again upper incisors are rarely the tooth of choice for extraction.
2.Hypoplasia
3.Severe displacement
4.Heavily restored or poor prognosis
5.Impaction or abnormal shape.
6.Again there are problems with reduction of the intercanine width and fitting the lower
labial segment around the upper labial segment.
Mohammed Almuzian, University of Glasgow, 2013 19
20. Upper lateral incisor
Indication
1.Hypoplasia
2.Severe displacement. If lateral incisor is severely crowded and the central and the
canine are in acceptable contact.
3.Heavily restored or poor prognosis
4.Impaction or abnormal shape.
5.If root is severely resorbed from ectopic canine.
6.If contralateral lateral incisor is congenitally absent (2% population).
7.Diminutive size with increased OJ or ML or crowding
Contraindication
1. aesthetic considerations:
If the canine crown is bulbous.
If the canine crown is different shade to the central.
If the canine gingival margin height differs significantly from the central
2. Class III Incisal relationship – unfavourable anchorage balance.
Canines
Indication:
1. Hypoplasia
2. Severe displacement. If lateral incisor is severely crowded and the lateral and the
premolar are in acceptable contact.
Mohammed Almuzian, University of Glasgow, 2013 20
21. 3. Heavily restored or poor prognosis
4. Impaction or abnormal shape.
5. if the lateral and the first premolar are in good contact
6. Patient unwilling a long procedure for aligning an impacted canine.
Disadvantages
1.Aesthetically: Loss of canine eminence & canine can be dark and big
2.Functionally: loss of canine guidance and improper buccal occlusion
First Premolars
Indication
1.Hypoplasia
2.Severe displacement
3.Heavily restored or poor prognosis
4.Moderate to severe crowding,
5.Serial extraction
6.To relieve impaction of canines and second premolars,
7.To relieve moderate to severe crowding of the labial segements
8.To facilitate overjet reduction
9.Anchorage balance.
10.Midline correction
11.Leveling COS
Mohammed Almuzian, University of Glasgow, 2013 21
22. 12.Correction of incisor inclination
Advantages
1.their proximity to the labial and Buccal segments
2.5`s adequately replaces 4`s both aesthetically + functionally
3.good contact point between 5 33 5
4.good anchorage balance
Second premolars
Indication
1.Hypoplasia
2.Severe displacement
3.Heavily restored or poor prognosis
4.Impaction
5.Congenital absence of contralateral second premolars
6.Mild crowding (2-4mm per quadrant). Creekmore (1997), reviewing this subject
concludes that as a rule of thumb, extraction of first premolars provides
approximately 66% of the space for aligning/retracting the anterior teeth, whereas
extraction of second premolars provides approximately half of the space
7.Where space closure by forward movement of the molars rather than retraction of the
labial segments is indicated whilst taking into account the molar relationship.
8.anchorage consolidation
Mohammed Almuzian, University of Glasgow, 2013 22
23. Disadvantages:
1.fixed appliance almost always
2.spontaneous alignment of incisors is less satisfactory
3.mesial tipping of molar tooth
First Molars
1.Hypoplasia
2.Severe displacement
3.Heavily restored or poor prognosis
4.Mild crowding (2-4mm per quadrant).
5.Impaction of the 5 or the 7 keeping in mind that these teeth should be in a favourable
angulation and the degree of their root formation favouring their eruption before
commencing 6 extraction.
6.For balancing or compensating purposes in enforced extraction.
7.Prophylactic treatment of crowding (Wilkinson extractions).
1. Enforced extraction of the first molar
Incidence
12% of Xtn cases referred to Consultant Orthodontists involve first permanent molars
Indications
1.Extensively carious first molars
2.Hypoplastic first molars — linked with MIH (molar-incisor hypoplasia), is a
recognized condition of unknown aetiology seen in around 15% of Caucasian
Mohammed Almuzian, University of Glasgow, 2013 23
24. children, which can significantly affect the long-term prognosis of first permanent
molars in more severe cases
3.Heavily filled first molars where premolars are healthy
4.Apical pathology or root treated first molars
5.Factors to consider when planning extraction of first permanent molars of poor
prognosis:
• The restorative state of the tooth;
• Age of the patient;
• Amount of crowding
• Inter arch relationship
• Developmental status and the inclination of the 7s
• Presence and condition of the other teeth.
• Angulation of the 5s. if the 5s are distally angulated then extraction of the E might be
indicated to prevent distal tipping of the 5s.
Consequences of enforced extraction of the first molar (Gill, 2001)
A. Lower Arch
1. Correct extraction timing:
• The lower labial segment can retroclined, resulting in an increased overbite and
relieving crowding;
• OB increased
• relieving crowding
• successful third molar eruption
2. Early loss: Lower second premolar can become tipped distally or impacted against
second molar , so it is recommended to extract the E at the same time
3. Delayed loss: this results in:
• Incomplete Space closure
Mohammed Almuzian, University of Glasgow, 2013 24
25. • Necking of alveolus can make space closure difficult
• Tendency for lower second molar to tilt mesially and roll lingually.
• Lingual rolling may result in the development of a scissor bite
• Upper molar may over and may predispose to TMD
B. Upper Arch
1. Upper second molar rotates around the palatal
2. Faster space closure
3. However it is less critical than L6 extraction cases.
Guidelines for forced first molar extraction (RCSEng. Cobourne 2009)
• A number of general guidelines on treatment planning first permanent molar extraction
cases for a number of malocclusions are available
• As a general rule, if in doubt, get the patient out of pain, try and maintain the teeth and
refer for an orthodontic opinion.
Class I cases
Class I cases with minimal crowding (3mm)
Aim for extraction at the optimal time without balancing extraction
1.If the lower first molar is to be lost, compensating extraction of the upper first molar
should be considered to avoid overeruption of this tooth, unless the lower second
molar has already erupted and the upper first molar is in occlusal contact with it.
2.If the upper first molar is to be lost, do not compensate with extraction of the lower
first molar if it is healthy.
Class I cases with crowding
1.First molar extractions can be delayed until the second molars have erupted and then
the extraction space used for alignment with fixed appliances.
Mohammed Almuzian, University of Glasgow, 2013 25
26. 2.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.
3.If the buccal segment crowding is bilateral, consider balancing extraction to provide
suitable relief and maintain the centreline. Sometime asymmetrical balanced
extraction (extraction of other poorer tooth than 6s) is indicated if there is sever
crowding and if extraction is decided at early age with a risk of CL shift.
Compensating extraction of upper first molars should be considered to prevent
overeruption or relieve premolar crowding
Class II cases
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
•It should be carried out at the ideal time for successful eruption of the second
permanent molar and control of the second premolar. Regarding compensating and
balancing extraction:
a)Compensating and balancing extraction of healthy lower first molars are not indicated.
So that, 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.
b) 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.
c)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.
Mohammed Almuzian, University of Glasgow, 2013 26
27. Upper first molar extraction
•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.
•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 space can then be used to correct the malocclusion with fixed
appliances.
•Alternatively, after extraction of the upper first permanent molars, the second
permanent molars can be allowed to erupt and the incisor relationship corrected then
by the loss of two upper premolars teeth. But as a condition, there should be a
radiographic evidence of third molar development.
Class II case with crowding.
Lower first molar extraction
•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.
Upper first molar extraction
Mohammed Almuzian, University of Glasgow, 2013 27
28. •Space requirements in the upper arch can be significant. 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.
Class III cases
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
cases.
2. Interceptive extractions of the 6's, Wilkinson 1940
Ideal Wilkinson criteria
1.Class I malocclusion seen at between 8.5 and 9.5 years
2.No increase in overbite.
3.Mild anterior segment crowding
4.Moderate posterior crowding
5.all successional teeth present and third molars present
6.lower second molar bifurcation beginning to form,
7.angle between long axis of crypts of 6 and 7 = 15-30 degree and
8.crypt of lower 7 overlaps the root of lower 6
Complication of Wilkinson extractions
1.Black triangle bet 5 and 7
Mohammed Almuzian, University of Glasgow, 2013 28
29. 2.Incomplete closure
3.Rotation
3. Elective first molar extractions to provide space for orthodontic purpose
Indication
1. Extensively carious first molars
2. Hypoplastic first molars
3. Heavily filled first molars where premolars are perfectly healthy
4. Apical pathoses or root treated first molars
5. Crowding at the distal part of the arches and wisdom teeth reasonably positioned
6. High maxillary/mandibular planes angle
7. Anterior open bite cases
8. Extraction of first molars, if they are not restored, can be indicated if the patient
has previous orthodontic treatment with premolar extraction or the premolars are
missing.
“First permanent molar extractions doubling the treatment time and halving the
prognosis” was the phrase coined by Mills 1987.
Mohammed Almuzian, University of Glasgow, 2013 29
30. Potential problem with first molar extractions to provide space for orthodontic
purpose, Sandler 2000
1. Anchorage • 7s provide little
anchorage
• 7s unsuitable for Kloehn
bow EOT
• Palatal arch with a button
• Miniscrew anchorage
2. Overbite
Reduction
• Bite opening curves less
effective
• Less scope for class II
elastics
• Anterior bite plane early in
treatment
• Functional appliance pre SWA
• Miniscrew anchorage
3. Mesial
Tipping
Space closure after
the extraction of the
first permanent molar
teeth has been
studied in some
detail and has led to
conclusions that
satisfactory closure
of spaces was best
achieved on children
and young adults
• Mesial tipping particularly
in the lower arch
• Rotations particularly in
the upper arch
• Do not over tighten lacebacks
• Do not over loading the second
moalrs
• Build up archwires quickly,
particularly in the lower arch,
even if not all anterior teeth are
fully engaged
4. Lower
Second Molar
Lingual
• Initial alignment with rectangular Niti wire
Mohammed Almuzian, University of Glasgow, 2013 30
31. Rolling • Add buccal crown torque in later wires
• Expand lower archform
• Class II or cross elastics from lingual surfaces
• MBT molar tubes (and premolar brackets)
• Nance or lingual arch on the 7s
5. Class II
second
molars
• It is caused by the fast
migration of the U7s
than L7s causing a
class II molar
relationship
• It can be a real problem
and can become
established in a matter
of weeks, even in cases
that are class I or 1/2
unit class II at the
outset. Prevention of
this complication is
highly recommended.
The solutions vary according to
whether the remainder of the
malocclusion is class I or II.
Solutions if the occlusion is
Class I incisors at the start
• Palatal arch with button
• Miniscrew anchorage if
necessary
• Laceback lower but not upper
• Hold back 717 with stopped arch
• Hold back 717 with coil spring
Solutions if the occlusion is
Class II incisors at the start
• Functional appliance
• URA with EOT to premolars if
717 unerupted
Mohammed Almuzian, University of Glasgow, 2013 31
32. • Miniscrew anchorage
Second Molars
Indications
1.Hypoplasia
2.Severe displacement
3.Heavily restored or poor prognosis
4.Facilitate molar distalization to:
• Correct incisors relationship
• OJ reduction
• Correct crowding of lower incisor by providing a mild amount of space after
distalising the first molar with little effect on OB and inclination of the incisors as
well as the profile.
• Relief of premolar crowding in a vertically impacted premolar in the line of the arch
where early extraction indicated for spontaneous correction. Richardson 1992
5.Provide space for the third molars. Richardson 1983
6.Open bite treatment
7.Interceptive treatment of the existing or anticipated arch length deficiency. Extraction
in early permanent dentition may prevent or at least limit late lower arch crowding.
Richardson 1983. Requirements for second molar prophylactic extraction (Lehman,
1979):
• All third molars are present and of normal size and shape.
Mohammed Almuzian, University of Glasgow, 2013 32
33. • Third molars should be of 15 – 30 degrees with the long axis of the second molar and
its root not developed yet.
Contraindication
1. Congenital absence or diminutive 3rd
molar.
2. Lower anterior crowding more than 2 mm.
Advantages
1.May relieve mild ant. crowding 1-2 mm`s
2.May prevent late incisors crowding
3.Space provided with little effect on profile
4.Provides space for crowded 2nd
premolar
5.Facilitates distal movement of buccal segments (6`s) + OB reduction
6.Eliminates 8`s surgery + its complication
7.facilitation of overbite reduction (unsubstantiated)
8.Reduction of treatment time (Lehman, 1979; Richardson and Burden ,1992)
Disadvantages
1. 3rd
molars may erupt into an unsatisfactory position, rarely with proper angulation and
contact relationship in 4% Richardson and Richardson (1993)
2. Difficult to predict which 3rd
molars will erupt unsatisfactory (Thomas and Sandy,
1995).
3. Second course of treatment to orthodontically upright the 3rd
molar may be required
(Orton and Jones, 1987).
Mohammed Almuzian, University of Glasgow, 2013 33
34. Third molars
1. Approximately 15% of patients never develop mandibular 3rd
molars (Robinson and
Vasir, 1993)
2. Approximately 25% of third molars become impacted (Robinson and Vasir, 1993)
Indication
1.No orthodontic indication is present
2.Teeth that present with symptoms
3.Concealed caries in distal surface of second molar.
4.Resorption of the second molar.
5.Follicular cyst.
6.Bone loss due to repeated episode of chronic periodontitis.
7.Effects of early extraction of lower 3rd
molar on late crowding; no significant
difference in incisor crowding between extraction and non-extraction groups
(Harradine et al., 1998; Robinson and Vasir, 1993; Ades etal., 1990). Late lower
incisor crowding is insufficient reason alone to remove mandibular third molars as
lingual nerve and inferior alveolar nerve may be damaged. (Ades, 190 and review by
Bishara, 1999)
Early loss of primary teeth
RCSEng guidelines and Recommendations
Radiographic screening is highly desirable before extracting primary molars to check
for the presence, position and correct formation of the crowns and roots of
successional teeth.
Mohammed Almuzian, University of Glasgow, 2013 34
35. 1. Loss of primary incisors – Early loss of primary incisors has little effect upon
the permanent dentition although it does detract from appearance. It is not necessary
to balance or compensate the loss of a primary incisor.
2. Loss of primary canines– Early loss of a primary canine in all but spaced
dentitions is likely to have most effect on centre lines. The more crowded the
dentition, the more the need for balance.
3. Loss of primary first molars –With regard to a primary first molar, a
balancing extraction may be needed in a crowded arch but compensation is not
needed.
4. Loss of primary second molars – There is no need to balance the loss of a
primary second molar because this will have no appreciable effect on centreline
coincidence. However when a primary second molar has to be extracted
consideration should be given to fitting a space
maintainer
BOS guideline for extraction letter
1.Request should be written
2.Two nomination technique should be used
3.Always rely on the record not the memory
4.In case of supplemental tooth a descriptive method should be used.
5.In case of confusion, better to fax a new letter or speak directly to the clinician. If
doubt then ask to delay the extraction and review the patient again
Mohammed Almuzian, University of Glasgow, 2013 35
36. Summary of the evidences
• Why we take teeth out: Provision of anchorage provision of anchorage and allow the
use of intermaxillary elastic, Stability
• Prevalence of extractions in orthodontics, McCaul 2001, found that extraction for
orthodontics represent 10% of overall extraction in dentistry.
• Artun 1987, excessive proclination of mandibular incisors may lead to dehiscence and
the overlying gingiva will become very thin and more susceptible to recession than
thick attached gingivae.
• Aziz 2011, no association between appliance induced labial movement of mandibular
incisors and gingival recession was found.
• lower lip to lower incisor relation approximately 1 : 0.59.(Talass, 1987)The Effect on
Vertical Dimension
• (Bowman and Johnston 1993). extractions have a minimal effect on the facial profile,
but that the effect is not deleterious and should not influence the extraction pattern
prior to orthodontic treatment
• Paquette et al (1992) found the soft tissue changes has no detectable aesthetic effects.
Various assessments of the patients' opinion of the aesthetic changes in their
silhouettes and facial photographs both before and after treatment revealed no
difference between the groupsThe upper lip to upper incisor retraction approximately
1 :0.3
• Dewel (1967) expressed worries that premolar extraction may tend to deepen the bite
and cause lower incisors to tip
• Paquett et al (1992) there are no convincing studies which suggest that vertical
dimension is influenced by extraction or non extraction treatment.
Mohammed Almuzian, University of Glasgow, 2013 36
37. • Extractions and Mandibular Dysfunction, Farrar et al.(1983) suggested that removal of
four premolar teeth prior to orthodontic treatment can be detrimental to the stability
of the temporomandibular joint as a result of “over retraction” of the maxillary
incisors during space closure, which displaces the mandible, Plaquette 1992 found
that extraction has no influence on TMJ.
• The Effect on Relapse, However, it has been shown that relapse can happen in both
extraction and non-extraction and there is no prediction for relapse. (Little et al
1990).
• Paquett et al (1992) Regarding stability, the Little index in the lower labial segment at
recall was 2.9 mm in the extraction group and 3.4 mm in the non-extraction group.
This difference was again not
• Extractions and smile width, However, the study by Johnson and Smith (1995) found
no evidence of this and also no evidence that extractions produced less attractive
smiles in the opinions of lay judges.
• The outcome of treatment, Ileri 2011 compares the outcome in treating class I with
extraction of 4s, non-extraction or extraction of single incisors. It was a retrospective
study. He found the outcome measured on the PAR basis was better in non-extraction
gp.
• Johal 1997 found that microscopic is better, visual over estimate and bras wire under
estimate.
• The transverse relationship of the arches. Will Andrews and Larry Andrews' WALA
line is the band of soft tissue immediately superior to the mucogingival junction in the
mandible. It is at or nearly at the same superior-inferior level as the horizontal centre-
of-rotation of the teeth. Andrews' sees the WALA Ridge as the primary landmark for
arch width and form and for archwire width and form. This is perhaps a better
indicator of mandibular basal bone position than the pretreatment mandibular arch
Mohammed Almuzian, University of Glasgow, 2013 37
38. width.
• The Diagnostic line or A-P line(Williams., 1969): It was suggested that for a
harmonius facial profile and lip balance the incisal edge of the lower incisor should
lie near or on the A-P line. It has been used as useful aids in TE and Begg technique
by (Cadman., 1975) to determine the need for extraction. If the alignment, levelling ,
or the mandibular growth change the location of LLS incisor edge to the A-Po line, it
is likely that extractions or tooth size reduction may be necessary.
• Extraction of lower deciduous canines has been suggested for the correction of mild
lower incisor crowding. Houston and Tulley (1989) state that in general terms this
allows some correction of the incisor crowding. Stephens (1989), reported that the
ideal age group for this would be 9-10 years of age to allow full development of the
intercanine width. Proffit (1993) however warns that this may result in the lower
incisors tipping lingually further reducing arch length.
• Extraction of upper deciduous canines is often suggested in order to attempt to
encourage a palatally placed canine to erupt into a normal position. Research has
shown that this indeed is quite successful with 70% erupting into favourable positions
(Ericsson and Kurol, 1988).
• Originally advocated by Kjellgren 1947 to avoid the need for orthodontic treatment but
now modified and used as an adjunct to fixed appliance treatment
• Advantages of Serial Extractions, appliance may be simpler and shorter 50% reduction
in the treatment time (Little 1990), Better stability and retention since tooth completes
its formation in a site where it will remain when treatment is completed (Graber,
2011)
• Growth prediction problems: difficult to predict amount of incisor crowding because
Mohammed Almuzian, University of Glasgow, 2013 38
39. ICW between 8-10yrs i.e. lower incisor crowding may resolve spontaneously
• If a lower incisor is to be removed, it would be wise to First carry out a Bolton tooth-
size analysis and Kesling diagnostic set-up.
• Second premolars, Indication, Congenital absence of contralateral second premolars ,
• Mild crowding (2-4mm per quadrant). Creekmore (1997), reviewing this subject
concludes that as a rule of thumb, extraction of first premolars provides
approximately 66% of the space for aligning/retracting the anterior teeth, whereas
extraction of second premolars provides approximately half of the space
• Hypoplastic first molars — linked with MIH (molar-incisor hypoplasia), is a
recognized condition of unknown aetiology seen in around 15% of Caucasian
children, which can significantly affect the long-term prognosis of first permanent
molars in more severe cases
• Consequences of enforced extraction of the first molar (Gill, 2001)
• Guidelines for forced first molar extraction (RCSEng. By Cobourne 2009)
• Interceptive extractions of the 6's, Wilkinson 1940
• Second Molars, Indications, Provide space for the third molars. Richardson 1983
Mohammed Almuzian, University of Glasgow, 2013 39