method of space gaining in dental sugery

1. By:
KarishmaAshok
IV/I B.D.S
Roll No: 33

2. Whyspacegaining??
The correcction of many malocclusions require
space in orderto move the teeth into more ideal
locations.
Such as forcorrection of :
⚫Crowding
⚫Proclination
⚫Rotated anteriors
⚫Deep bite
⚫Constricted arches

3. Methods togain space include:
⚫Proximal stripping
⚫Expansion
⚫Extraction
⚫Distalisation
⚫Uprighting of molars
⚫Derotation of posterior teeth
⚫Proclinationof anteriors

4. ⚫Also knownas SLENDERIZATION /
REPROXIMATION / DISKING
⚫Method bywhich proximal surfacesof teeth are sliced
toreduce mesio-distal width of teeth.
⚫This procedureprovidesa maximumof 2.5 mm space

5. Indications:
⚫Carey’sanalysis showing a TTM excess of 0-2.5mm
⚫Bolton’sanalysis showing mild tooth material excess
⚫Forcorrection of minimal interarch tooth material
discrepancy
⚫In loweranteriors toaid retention
⚫In caseswhere individual toothsize preventsclass I
molarrelation
⚫Toobtain favourableoverjetoroverbite
Contraindications:
⚫Young patients
⚫Patientswith high caries index
⚫Patientswith enamel hypoplasia

6. Advantages
Minimizes potential
consequencesof extraction
such as:
⚫Difficulty in completing
spaceclosure
⚫Need forgreater
anchorage
⚫Possibilityof space re-
opening
⚫Difficulty in paralleling
roots next to extraction
sites
Disadvantages
Drawbacks include:
⚫Roughened proximal
surfaces thatatrract
plaque
⚫Increased caries
susceptibility
⚫Sensitivityof teeth

8. ⚫Non-invasive method of spacegaining
⚫Undertaken in patients having constricted arch
Indications:
⚫Crossbite
⚫Crowding
⚫Skeletal class III malocclusion
⚫surgical orthodontics

12. SLOW EXPANSION DEVICES
⚫Coffin spring:
 Designed by Walter Coffin
 Removableappliance
 Dento-alveolarexpansion
 Made up of 1.25mm thick omega shaped wire placed in
mid palatal region
 Freeends of omegaembedded in acrylic
 Activated 1 to 2 mm perweek

13. ⚫Quad helix:
 Described by Ricketts
 Constructed using a 0.038 inch wire
 Incorporates 4 helices, therefore flexibility and range
of application is more

14. ⚫Ni-Ti expanders:
 Developed byArndt
 Fixed-removable tandem loop maxillary expanders
 Has thecapacity torotate,upright,distalizeand expand
theanteriorand posteriorarch
 Dual tempsensitivecomponents
 Anteriorly, fingerspring of 0.032 inch diameterwire
 0.5mm perweek tooth movement

15. Advantages:
⚫Self activated
⚫Automaticallyexpands to pre-determined shape
⚫Requires little manipulation byclinician
⚫Lightcontinuous forces
⚫Easyadaptability in inactivestate

16. Indications:
1. Posteriorcross bite
2. Class II malocclusion
3. Class III malocclusion
4. Constricted arch
5. SARPE
6. Cleftpalate
7. TS-ALD
Contraindications
1. Existing openbite
2. Single toothcross bite
3. Skeletal assymmetry
4. Patent mid palatal
suture
5. Periodontally weak
molars

17. ⚫First tried by Kingsley using headgear
⚫Aimed at moving the molarsdistally togain spoace
⚫Ideal timimg mixed denition period prior toeruption
of second permanent molars
Indications:
⚫Straight profile
⚫Functional :
 Normal, healthy tmj
 Correct maxillo-mandibularrelationship

18. ⚫Skeletal
 class I skeletal relationship
 skeletal closed bite
 brachycephalicgrowth pattern
⚫Dental
 Class II orend on relationship
 Discrepancyof 2 to 3 mm
Contraindications :
 Class I or III malocclusion
 Open bite
 Posteriorcrowding

20. Extraoral: (Using headgears)
 Components:
1. Forcedelivering unit : face bow/ J hook
2. Forcegenerating unit :elasticstrap
3. Anchoring unit: head cap/ neck strap

21.  It brings about bodily movementordistal tipping of
the molars in a posteriordirection
 Tipping movement is recommended in case of
horizontal growth pattern and deep bites. In such
cases it helps in opening the biteand also increases
loweranterior facial height.
 Headgears allow bilateral as well as unilateral
distalization. Also, amountof distalization can be
controlled individually

23. Intraoral:
1. Sagittal appliance
 Removableappliance incorporating jackscrews
 Consistsof a splitacrylic plate joined by jackscres
 Acrylic plate is sectioned in such a way that the tooth
to be distalised is isolated and the rest of the arch is
used foranchorage
 Retained using adamsclasps
 Jackscrewsare parallel tosurfaceof molars
 Used for individual toothdistalization

25. Pendulum appliance:
 Intra-oral distalization appliance introduced by Hilgers
 Incorporatesa modified Nance button foranchorageand a
stainless steel wire
 Thewire has a helix thedistal end of which is inserted into
a sleeve at the palatal aspect of the molar to bedistalised
 Activated byopening the helices and engaging thedistal
ends into thesleeves
 Types
I. Heliger’s pendex
II. Heliger’s PhD appliance
III. T-rexappliance

27. Jasper jumper
 Fixed appliance forcorrection of class II skeletal
malocclusion
 Delivers lightcontinuous forces
 Takesanchorage from lowercanine region todistalise
maxillary molars
 Used forsingle toothorentirearch

28. Jones jig
 Opencoil spring
 Placed on buccal aspect;
generates required force when
compressed
Anchorage by Nance’s palatal
buttonand Ni-Ti wire to bring
aboutdistal movement
The assembly is ligated ontod
first molartopreventrolling

29. Distal jetappliance:
 Lingual distalizationappliance
 Activecomponentsare placed palatallywhich provide
more bodily movements
 Consistsof bilateral piston and tubearrangement
 Tube is embedded in modified acrylic
 Anchorage by Nance palatal button thatare bonded to
bandsattached to 1 or 2 premolars
 A Ni-Ti spring and activationcollarare placed near
each tube
 Activationcollar is retracted distally, causing
compression and therebyactivation
 Advg: lessdistal tipping

31. Lip bumpers
 Used in lowerarch; counterpart used in upperarch is
Denholtz appliance
 Uses :
1. Mixed dendition to bring about minordistallization
2. Regain space forunerupted teeth
3. Uprighting mesially tipped mandibular molars
4. Inactive lip bumperused as retentiveappliance

32. Painless removal of tooth from its socket

33. Need forextraction:
1. Arch length toTTM discrepancy
2. Correction of interarch relationship
3. Abnormal size and shapeof teeth
eg: peg shaped laterals, mesiodens , macrodontia

34. 4. Skeletal jaw mal-relations

35. Differentextraction procedures
› Wilkinson’sextraction
› Balancing extraction
› Compensating extraction
› Serial extraction
› Phased extraction
› Enforced extraction
› Atypical extraction

36.  wilkinson’s extraction
 All fourpermanent molars b/w theageof 8-9 years
 Due to highcaries risk
 Advg:
 Additional space forthird molars..thus prevents impaction
 Overcrowding minimzed
 Disadvg:
 Limited space
 Rotation of 1 and 2 premolars
 Subsequent treatment may bedetrimental becauseof lack
of anchorage
 Impropercontact leads to food accumulation

37. Balancing extraction
• Intentional extraction of tooth from theoppositeside
of samearch
• To prevent midlineshift
Compensating extractions
• Intentional extractionof tooth from the samesideof
oppositearch
• To preserve molarrelationship

38.  Serial extractions
 Correctly timed and planned extraction of deciduousand
permanent teeth in mixed dentition
 Purpose :
 Alleviatecrowding
 Allow unerupted teeth toguide themselves into position
 Lessen period of mechanical appliance therapy
 Enforced extractions
Carried out on teeth which aredecayed ,periodontallyweak ,
impacted, in lineof fracture….
 Phased extractions
 Atdifferent times in differentquadrants
 To bring about achange in molar relationship

41. • Premature lossof teeth may result in tipping of the
adjacent teeth
• A tipped teeth occupies morespace
• Therefore uprighting of teeth allows for recoveryof
somespace
• Itcan beachieved by space regainers

42. • Rotated teeth occupy morespace
• De-rotation provides someamountof space
• Can be broughtabout byspace regainers and springs