This document discusses various methods for gaining space in orthodontic treatment, including non-extraction, extraction, and surgical methods. Non-extraction methods include proximal stripping, arch expansion using removable or fixed expanders, molar distalization using headgear or intraoral appliances, uprighting tilted teeth, derotation of posterior teeth, and proclination of anterior teeth. Extraction methods include balancing, compensating, phased, enforced, Wilkinson, and therapeutic extractions. Surgical methods include orthognathic surgery and distraction osteogenesis. The document provides details on techniques such as proximal stripping, rapid maxillary expansion, and molar distalization. It discusses the indications, contraindications, advantages, and disadvantages of different

1. METHODS OF GAINING
S P A C E
PRESENTED BY – DR. ROKEYA RAHMAN TANI
FCPS Part-II Trainee
Dept. of Orthodontics
Dhaka Dental College & Hospital.

2. For the resolution of a majority of malocclusions, space
is required. Like -
 Alignment of crowded teeth
 Retraction of proclincd teeth
 Correction of molar relationship
 Derotation of anterior teeth
 Leveling the curve of Spee
 Correction of ant. and post. cross bite
 Correction of narrow dental arch
 Intrusion
Why Space Is Required –

3. What are the methods of gaining space –
Space can be gained by
Non Extraction Extraction Surgical
 Proximal stripping
 Arch expansion
 Molar teeth distalization
 Uprighting of tilted
teeth
 Derotation of posterior
teeth
 Proclination of anterior
teeth
 Orthognathig surgery
 Distraction osteogenesis
 Balancing extractions
 Compensating
extractions
 Phased extractions
 Enforced extractions
 Wilkinson extractions
 Therapeutic
extractions

4. Non Extraction methods

5. PROXIMAL STRIPPING
Proximal stripping involves the selective reduction of the
mesiodistal width of certain teeth to create space.
The procedure is also called -
Proximal slicing
Reproximation
Slenderization
INDICATION FOR PROXIMAL STRIPPING
• Done when space requirement is minimal (2.5-
3 mm).( Or when Bolton's tooth material excess less than 2.5 mm).
• Usually when the excess exists in the mandibular
anterior segment.
CONTRAINDICATIONS FOR PROXIMAL STRIPPING
• Patients who are susceptible to caries.
• Avoided in young individual as their teeth may possess large
pulp chambers.

6. The procedure involves three steps –
1. Assessing space requirements.
2. Selecting the teeth and amount of enamel to be
stripped.
Not more than 50% of Enamel thickness to be stripped.
3. Enamel stripping.
Metal abrasive strips
Enamel stripping is generally performed using the following
methods -
PROCEDURE

7. Thin fissure burs
Safe sided corborundum disks
Tungsten carbide or diamond
burs
Perforated diamond disc
Air Rotor Stripping method (ARS)

9. Please note:
After Reproximation there will be sensitivity.
Artificial remineralization is possible by crystal growth.
A low concentration of calcium-fluoride solution produce this
growth in a time dependent fasion.

10. Advantages of proximal stripping
 To avoid extractions in borderline cases where space
requirements are minimal.
 To achieve better interdigitation, overbite and overjet
 To broaden the contacts to add the stability of results
 Localized malalignments can be corrected without
involving too many teeth, especially in adult patients.
Disadvantages of proximal stripping
≠ Sensitivity
≠ Increases caries susceptibility
≠ Difficult to reproduce exact morphology of the tooth.
≠ The shape created may not be as esthetic
≠ Food lodgement

11. Arch expansion
Rapid maxillary
Removable
Fixed
Slow expansion

12. RAPID MAXILLARY EXPANSION (RME) DEVICES
 First reported at 1860 by Emerson C. Angell
 These are the kind of Dentofacial Orthpedic appliance
 Mid palatine suture is mainly used to separate to gain the
space
 15- 19 years of age is more
Sweetable time
 post. teeth are used to transmit
force to the maxilla
 Midline diastema seen primarily
 Open bite is possible

13.  Growing individuals with severely constricted maxillary
arches, Involving airway impairment or mouth breathing
tendencies.
 Posterior cross bites with real or relative maxillary
deficiency
 Cleft patients
 Along with facemask therapy
 Class Ill cases with minor maxillary deficiency
 As part of interceptive orthodontics
Indications for RME use

14. Removable RME appliance
The appliance basically consists of a screw
in the midline with retentive clasps on posterior
Teeth.
More effective when used in the early mixed dentition
phase.
But its efficiency is doubtful.

15. Fixed RME Appliances
I. Tooth Born appliance
II. Tooth-tissue born appliance
Tooth Born appliance are -
1. HYRAX APPLIANCES

16. 2. ISAACSON RME APPLIANCES

17. 1. DERICHSWEILER RME APPLIANCES
2. HASS RME APPLIANCE
Tooth-tissue born appliances are -

18. SLOW EXPANSION DEVICES
Indications of slow expansion
 Correction of unilateral cross bites
 Correction of 'V' shaped arches
 Preparation for bone grafts in cleft cases
 Minimal crowding in the upper arch (1-2 mm)
 Elimination of a displacement

19. 1. Screw Appliances (upper & lower)
2. Coffin Spring
Some of them are removable, some are fixed type -

20. 3. Quad/Tri/Bi -Helix
4. Ni-Ti Expanders

21. 5. The Schwarz Appliance

22. DISTALIZATION OF MOLARS
The main purpose of Distalization is to push
the maxillary and/or mandibular terminal molars
posteriorly.
Usually undertaken before the eruption of the second
permanent molars.
There are 2 types –
I. Extraoral distalizing appliances
II. Intraoral distalizing appliances

23. Extraoral distalizing appliances
The most frequently used extraoral distalizing
appliances are the headgears.
Bilateral as well as unilateral distalization is possible
using headgears.
Distal tipping of molars helps in
- Opening the bite
- Incrising the lower facial heigt
18 to 20 hours of wearing is recomanded for orthodontic
effect.

24. Headgear

25. INTRAORAL METHODS OF DISTALlZING MOLARS
Tooth moving force generators are mainly of –
- Screws
- Open coil springs
- Wire springs with helices

26. Intra oral distalizing appliances are –
• Schwartz plate
• Sagitta1 appliance
• First class
• Veltribilateral and monolateral sagittal screws
• Open coil springs
• Jones jig
• Oistal jet appliance
• Fast back appliance
• Pendulum appliance
• Intraoral magnets
• Jasper jumper
• Lip bumper

27. UPRIGHTING OF TILTED POSTERIOR
TEETH
Uprighting of molars can lead to
an arch length gain of 1-1.5 mm.
Fixed appliances are idealIy used.

28. DEROTATION OF POSTERIOR TEETH
Derotation can be best achieved using a couple force
on the lingual and buccal surfaces of the tooth.
Forces should be equal in magnitude but opposite in
direction.
Fixed appliance system with a two point contact is useful.

29. PROCLlNATION OF ANTERIOR TEETH
Proclination of anteriors is indicated if only –
- They are retroclined
- Soft tissue profile will not be disturbed
- Stability will be achived

30. Thanks for Today