SERIAL EXTRACTION WITH PROCEDURES

1. FACULTY OF DENTAL SCIENCES

2. SERIAL EXTRACTIONS
Serial extraction is the planned and sequential removal
of certain primary and permanent teeth to intercept
and reduce dental crowding problems.
Kjellgren in 1929 used term “Serial extraction”
Nance in 1940’s Popularized this technique in U.S.A and
termed it “planned & progressive extraction”
Hotz in 1970 ‘active supervision of teeth by extraction’

3. RATIONALE :-
Serial extraction is based on two basic principles:-
1. Arch length – tooth material discrepancy.
2. Physiologic tooth movement .

4. Indications :-
1.Premature loss of deciduous teeth
2. Arch length deficiency and tooth size discrepancy
3.Absence of physiologic spacing
4. Lingual eruption of lateral incisors
5.Unilateral deciduous canine loss and midline shifting
6. Abnormal or assymetric primary canine root resorption

5. 7. Canines erupting mesial to the lateral incisors
8. Mesial drift of buccal segment
9. Abnormal eruption direction and eruption sequence
10. Gingival recession on labially displaced incisors
11. Flaring, ectopic eruption, ankylosis
12. Crowded maxillary and mandibular incisors with extreme
labial proclination

6. 13. Delterious oral habits
14. Class 1 malocclusion showing harmony between
skeletal and muscular system

7. Contra Indication :-
1. Class II & III malocclusions with skeletal abnormalities .
2. Spaced dentition .
3. Anodontia / Oligodontia .
4. Open bite & Deep bite .
5. Midline diastema .

8. 6. Class I malocclusion with minimal space
deficiency
7. Unerupted teeth .
8. Extensive Caries or heavily filled first
permanent molar.
9. Mild disproportion between arch length and
tooth material that can be treated by proximal
slicing .

9. Advantages :-
1. Treatment is more physiologic as it involves the guidance
of teeth into normal positions making use of the
physiologic forces.
2. The removal of deciduous canine allows spontaneous
alignment of crowded incisors which simplify later
appliance treatment.
3. The extraction of 1st premolar before crowding allows
permanent canines to drift into natural alignment without
any appliance.
4. It eliminates or reduces the duration of fixed treatment
and cost of treatment.

10. 9. Better oral hygeine is possible.
10. Health of investing tissue is preserved.
11. Lesser retention period.
12. More stable results .
13. Psychological trauma associated with malocclusion
can be avoided by treatment of the malocclusion at an
early age.

11. Disadvantages:-
1. Cannot be applied in class II and class III malocclusion
cases.
2. Requires clinical judgement.
3. Treatment time is prolonged.
4. Patient cooperation is required .
5. Serial extraction can result in deeping of bite or increase
in overbite.

12. 6. Ditching or space can exist between the canine and
premolar .
7. Psychological trauma-It is unpleasant for the child to
have four teeth extracted each time or at three or four
occasions.
8. As extraction spaces are created that close gradually,
the patient has a tendency of developing tongue thrust.
9. There is no single approach that can be universally
applied to all patients.
10. Lower permanent canines may erupt ahead of 1st
premolar into extraction space of the first deciduous
molar impacting premolar and making its removal
difficult.

13. Diagnostic Procedure :-
1. Study models
2. OPG
3. Cephalometric analysis
4. Evaluation of persisting problems

14. Procedure :-
1. Dewels method
2. Tweeds method
3. Nance method

15. Dewels Method :-
CD4- extraction
Deciduous
canine at 8-9
years
Deciduous first
molar
Erupting first
premolar
Modified Dewels wherein 4 is enucleated at the time of
extraction of D

16. Tweeds Method :-
D4C - extraction

17. Nance Method :-
D4C - extraction

18. THANK YOU