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Introduction
 What is extraction??
 Extract or not to Extract?? Controversy
 Edward Angle – Non extraction
 Calvin Case – extraction
 1940’s Charles Tweed reintroduced
extractions in Orthodontics
Why extractions
 Arch length tooth material discrepancy
 Correction of molar relationship
 Abnormal size and shape, position
 Skeletal jaw malrelations
Arch length tooth material discrepancy
 Ideally arch length and tooth material should be in
harmony with each other.
 Tooth material excess can result in crowding or
proclination of anteriors
 Disproportion can not be treated by increasing the
arch length, thus decreasing the tooth material is the
only alternative
Correction of Sagittal inter arch relationship
 Abnormal sagittal malrelationships such as class II
or III malocclusion may require extractions of teeth
to achieve interarch relation
 Angle’s class I:
 Normal sagittal interarch relation
 Not advisable to discourage development of one arch
over the other
 Preferable to extract in both arches
 Example – Bidental protrusion
 Angle’s class II :
 In most cases upper dental arch is forwardly placed or the
lower arch placed backward
 Extraction of teeth only in upper arch to correct maxillary
protrusion.
 Angle’s class III:
 Beneficial to avoid extraction in upper arch
 Preferably treated with extraction only in lower arch
 ABNORMAL SIZE AND FORM OF TEETH
 Abnormality in tooth size and shape may require extraction to achieve good
occlusion
 Such anomalies may include:
 Macrodontia
 Severly hypoplastic teeth
 Dilaceration
 Abnormal crown morphology
Factors affecting choice of teeth for extraction
 Arch length discrepancy
 Direction and amount of jaw growth
 Profile
 State and position of the teeth
 Age of the patient
General factors for extraction of teeth
 Grossly decayed
 Malformations
 Unfavorably impacted
 Blocked out tooth
 To maintain arch symmetry
 Trauma
 Gingival recession
Incisor extraction
• Unfavourably impacted upper incisor that cant be brought to normal occlusion.
• Buccaly/ lingually blocked out lateral incisor
• Unilteral Congenitally missing lateral incisor, opposite lateral incisor may be
extracted to maintain arch symmetry
• Grossly carious incisor
• Malformations of incisor crown that cannot be restored by prosthesis
• Trauma or irreplaceable damage to incisors by fracture
• Dilacerated roots in incisor
Lower incisors
 Avoided as far as possible
 INDICATIONS :
 Completely blocked out incisor
 Trauma, severe caries, gingival recession, bone loss
 Fan shape flaring out of lower incisors due to severe arch
length deficiency
 Mild class III cases with lower incisor crowding
 Previous loss of premolars in each quadrant with late
lower labial segment crowding in adults
Canine extraction
Extraction of canines are advocated in :
 Ectopic eruption and impaction of canines
 Blocked out canine with good inter dental contact
between remaining teeth
 Premature shedding of deciduous canines indicates
extraction on opposite side
 Extraction of deciduous canines as part of serial
extractions
First premolar
 Reasons why first premolar is
advocated for extraction -
 Location of teeth allows for
correction of both anterior and
posterior segment
 Contact between canines and second
premolars is satisfactory
 Extraction leaves a posterior segment
that offers adequate anchorage for
retraction of anteriors
Second premolar
 Indications:
 Extracted in cases that require mesial
movements of posteriors and to correct
mild crowding in anterior segments
 Unfavorable impaction of second
premolars
 Grossly carious or deeply filled second
premolars
 Premature loss of deciduous molar leads
to migration of permanent molar and thus
inadequate space for 2nd premolar
First molars
 Indications:
 Minimal space requirement for
correction of mild anterior crowding
or proclination
 Grossly decayed or heavily restored
teeth
 Open bite cases may benefit as they
tend to deepen the bite
Wilkinson extraction
• Extraction of all 4 1st permanent molars between the ages 8 ½ - 9 ½ yrs
• This is bases on the fact that these teeth are highly susceptible to caries
• Provides additional space for 3rd molar eruption
• Crowding of arch and risk of caries is minimized.
 Drawbacks:
• Limited space to relieve anterior crowding
• 2nd premolars and molars may tip into extraction space
• Loss of adequate anchorage for orthodontic appliance
Second molars
 Extraction although not common
 Advocated in certain situations:
 To prevent 3rd molar impaction
 Enable distalization of 1st molars
 Open bite cases: extraction of 2nd molars allows for deepening of bite in certain
cases
Extraction without appliance therapy
 Teeth have a natural tendency to shift into
extraction spaces
 The long term effect following extraction of
permanent teeth is the mesial migration of
posterior teeth.
 Extractions of lower 1st premolars are often
associated with spontaneous decrowding by
drifting of teeth. This is called as
DRIFTODONTICS
Balancing extractions
 Removal of tooth from one side of a
dental arch results in a tendency for
rest of the teeth to move towards
extraction space
 These shifts may lead to unwanted
midline discrepancies.
 Hence same tooth is extracted on the
other side of the arch.
Compensating extractions
 Compensating refers to extraction of
teeth in opposite jaws. These are
carried out to preserve the buccal
occlusal relationship.
 In class I relations it is usually
advisable to extract in both the
arches to preserve the buccal occlusal
relationship
Any doubts ???
extractions in the field of orthodontics

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extractions in the field of orthodontics

  • 1.
  • 2. Introduction  What is extraction??  Extract or not to Extract?? Controversy  Edward Angle – Non extraction  Calvin Case – extraction  1940’s Charles Tweed reintroduced extractions in Orthodontics
  • 3. Why extractions  Arch length tooth material discrepancy  Correction of molar relationship  Abnormal size and shape, position  Skeletal jaw malrelations
  • 4. Arch length tooth material discrepancy  Ideally arch length and tooth material should be in harmony with each other.  Tooth material excess can result in crowding or proclination of anteriors  Disproportion can not be treated by increasing the arch length, thus decreasing the tooth material is the only alternative
  • 5. Correction of Sagittal inter arch relationship  Abnormal sagittal malrelationships such as class II or III malocclusion may require extractions of teeth to achieve interarch relation  Angle’s class I:  Normal sagittal interarch relation  Not advisable to discourage development of one arch over the other  Preferable to extract in both arches  Example – Bidental protrusion
  • 6.  Angle’s class II :  In most cases upper dental arch is forwardly placed or the lower arch placed backward  Extraction of teeth only in upper arch to correct maxillary protrusion.  Angle’s class III:  Beneficial to avoid extraction in upper arch  Preferably treated with extraction only in lower arch
  • 7.  ABNORMAL SIZE AND FORM OF TEETH  Abnormality in tooth size and shape may require extraction to achieve good occlusion  Such anomalies may include:  Macrodontia  Severly hypoplastic teeth  Dilaceration  Abnormal crown morphology
  • 8. Factors affecting choice of teeth for extraction  Arch length discrepancy  Direction and amount of jaw growth  Profile  State and position of the teeth  Age of the patient
  • 9. General factors for extraction of teeth  Grossly decayed  Malformations  Unfavorably impacted  Blocked out tooth  To maintain arch symmetry  Trauma  Gingival recession
  • 10. Incisor extraction • Unfavourably impacted upper incisor that cant be brought to normal occlusion. • Buccaly/ lingually blocked out lateral incisor • Unilteral Congenitally missing lateral incisor, opposite lateral incisor may be extracted to maintain arch symmetry • Grossly carious incisor • Malformations of incisor crown that cannot be restored by prosthesis • Trauma or irreplaceable damage to incisors by fracture • Dilacerated roots in incisor
  • 11. Lower incisors  Avoided as far as possible  INDICATIONS :  Completely blocked out incisor  Trauma, severe caries, gingival recession, bone loss  Fan shape flaring out of lower incisors due to severe arch length deficiency  Mild class III cases with lower incisor crowding  Previous loss of premolars in each quadrant with late lower labial segment crowding in adults
  • 12. Canine extraction Extraction of canines are advocated in :  Ectopic eruption and impaction of canines  Blocked out canine with good inter dental contact between remaining teeth  Premature shedding of deciduous canines indicates extraction on opposite side  Extraction of deciduous canines as part of serial extractions
  • 13. First premolar  Reasons why first premolar is advocated for extraction -  Location of teeth allows for correction of both anterior and posterior segment  Contact between canines and second premolars is satisfactory  Extraction leaves a posterior segment that offers adequate anchorage for retraction of anteriors
  • 14. Second premolar  Indications:  Extracted in cases that require mesial movements of posteriors and to correct mild crowding in anterior segments  Unfavorable impaction of second premolars  Grossly carious or deeply filled second premolars  Premature loss of deciduous molar leads to migration of permanent molar and thus inadequate space for 2nd premolar
  • 15. First molars  Indications:  Minimal space requirement for correction of mild anterior crowding or proclination  Grossly decayed or heavily restored teeth  Open bite cases may benefit as they tend to deepen the bite
  • 16. Wilkinson extraction • Extraction of all 4 1st permanent molars between the ages 8 ½ - 9 ½ yrs • This is bases on the fact that these teeth are highly susceptible to caries • Provides additional space for 3rd molar eruption • Crowding of arch and risk of caries is minimized.  Drawbacks: • Limited space to relieve anterior crowding • 2nd premolars and molars may tip into extraction space • Loss of adequate anchorage for orthodontic appliance
  • 17. Second molars  Extraction although not common  Advocated in certain situations:  To prevent 3rd molar impaction  Enable distalization of 1st molars  Open bite cases: extraction of 2nd molars allows for deepening of bite in certain cases
  • 18. Extraction without appliance therapy  Teeth have a natural tendency to shift into extraction spaces  The long term effect following extraction of permanent teeth is the mesial migration of posterior teeth.  Extractions of lower 1st premolars are often associated with spontaneous decrowding by drifting of teeth. This is called as DRIFTODONTICS
  • 19. Balancing extractions  Removal of tooth from one side of a dental arch results in a tendency for rest of the teeth to move towards extraction space  These shifts may lead to unwanted midline discrepancies.  Hence same tooth is extracted on the other side of the arch.
  • 20. Compensating extractions  Compensating refers to extraction of teeth in opposite jaws. These are carried out to preserve the buccal occlusal relationship.  In class I relations it is usually advisable to extract in both the arches to preserve the buccal occlusal relationship