methods of gaining space in orthodontic treatment procedures

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

2. Why space gaining??
The correcction of many malocclusions require
space in order to move the teeth into more ideal
locations.
Such as for correction of :
 Crowding
 Proclination
 Rotated anteriors
 Deep bite
 Constricted arches

3. Methods to gain space include:
 Proximal stripping
 Expansion
 Extraction
 Distalisation
 Uprighting of molars
 Derotation of posterior teeth
 Proclination of anteriors

4.  Also known as SLENDERIZATION /
REPROXIMATION / DISKING
 Method by which proximal surfaces of teeth are sliced
to reduce mesio-distal width of teeth.
 This procedure provides a maximum of 2.5 mm space

5. Indications:
 Carey’s analysis showing a TTM excess of 0-2.5mm
 Bolton’s analysis showing mild tooth material excess
 For correction of minimal interarch tooth material
discrepancy
 In lower anteriors to aid retention
 In cases where individual tooth size prevents class I
molar relation
 To obtain favourable overjet or overbite
Contraindications:
 Young patients
 Patients with high caries index
 Patients with enamel hypoplasia

6. Advantages
Minimizes potential
consequences of extraction
such as:
 Difficulty in completing
space closure
 Need for greater
anchorage
 Possibility of space re-
opening
 Difficulty in paralleling
roots next to extraction
sites
Disadvantages
Drawbacks include:
 Roughened proximal
surfaces that atrract
plaque
 Increased caries
susceptibility
 Sensitivity of teeth

8.  Non-invasive method of space gaining
 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
 Removable appliance
 Dento-alveolar expansion
 Made up of 1.25mm thick omega shaped wire placed in
mid palatal region
 Free ends of omega embedded in acrylic
 Activated 1 to 2 mm per week

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 by Arndt
 Fixed-removable tandem loop maxillary expanders
 Has the capacity to rotate,upright,distalize and expand
the anterior and posterior arch
 Dual temp sensitive components
 Anteriorly, finger spring of 0.032 inch diameter wire
 0.5mm per week tooth movement

15. Advantages:
 Self activated
 Automatically expands to pre-determined shape
 Requires little manipulation by clinician
 Light continuous forces
 Easy adaptability in inactive state

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

17.  First tried by Kingsley using headgear
 Aimed at moving the molars distally to gain spoace
 Ideal timimg mixed denition period prior to eruption
of second permanent molars
Indications:
 Straight profile
 Functional :
 Normal, healthy tmj
 Correct maxillo-mandibular relationship

18.  Skeletal
 class I skeletal relationship
 skeletal closed bite
 brachycephalic growth pattern
 Dental
 Class II or end on relationship
 Discrepancy of 2 to 3 mm
Contraindications :
 Class I or III malocclusion
 Open bite
 Posterior crowding

20. Extra oral: (Using headgears)
 Components:
1. Force delivering unit : face bow/ J hook
2. Force generating unit :elastic strap
3. Anchoring unit: head cap/ neck strap

21.  It brings about bodily movement or distal tipping of
the molars in a posterior direction
 Tipping movement is recommended in case of
horizontal growth pattern and deep bites. In such
cases it helps in opening the bite and also increases
lower anterior facial height.
 Headgears allow bilateral as well as unilateral
distalization. Also, amount of distalization can be
controlled individually

23. Intra oral:
1. Sagittal appliance
 Removable appliance incorporating jackscrews
 Consists of a split acrylic 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 for anchorage
 Retained using adams clasps
 Jackscrews are parallel to surface of molars
 Used for individual tooth distalization

25. Pendulum appliance:
 Intra-oral distalization appliance introduced by Hilgers
 Incorporates a modified Nance button for anchorage and a
stainless steel wire
 The wire has a helix the distal end of which is inserted into
a sleeve at the palatal aspect of the molar to be distalised
 Activated by opening the helices and engaging the distal
ends into the sleeves
 Types
I. Heliger’s pendex
II. Heliger’s PhD appliance
III. T-rex appliance

27. Jasper jumper
 Fixed appliance for correction of class II skeletal
malocclusion
 Delivers light continuous forces
 Takes anchorage from lower canine region to distalise
maxillary molars
 Used for single tooth or entire arch

28. Jones jig
 Open coil spring
 Placed on buccal aspect;
generates required force when
compressed
 Anchorage by Nance’s palatal
button and Ni-Ti wire to bring
about distal movement
 The assembly is ligated onto d
first molar to prevent rolling

29. Distal jet appliance:
 Lingual distalization appliance
 Active components are placed palatally which provide
more bodily movements
 Consists of bilateral piston and tube arrangement
 Tube is embedded in modified acrylic
 Anchorage by Nance palatal button that are bonded to
bands attached to 1 or 2 premolars
 A Ni-Ti spring and activation collar are placed near
each tube
 Activation collar is retracted distally, causing
compression and thereby activation
 Advg: less distal tipping

31. Lip bumpers
 Used in lower arch; counter part used in upper arch is
Denholtz appliance
 Uses :
1. Mixed dendition to bring about minor distallization
2. Regain space for unerupted teeth
3. Uprighting mesially tipped mandibular molars
4. Inactive lip bumper used as retentive appliance

32. Painless removal of tooth from its socket

33. Need for extraction:
1. Arch length to TTM discrepancy
2. Correction of inter arch relationship
3. Abnormal size and shape of teeth
eg: peg shaped laterals, mesio dens , macrodontia

34. 4. Skeletal jaw mal-relations

35. Different extraction procedures
› Wilkinson’s extraction
› Balancing extraction
› Compensating extraction
› Serial extraction
› Phased extraction
› Enforced extraction
› Atypical extraction

36.  wilkinson’s extraction
 All four permanent molars b/w the age of 8-9 years
 Due to high caries risk
 Advg:
 Additional space for third molars..thus prevents impaction
 Overcrowding minimzed
 Disadvg:
 Limited space
 Rotation of 1 and 2 premolars
 Subsequent treatment may be detrimental because of lack
of anchorage
 Improper contact leads to food accumulation

37. Balancing extraction
• Intentional extraction of tooth from the opposite side
of same arch
• To prevent midline shift
Compensating extractions
• Intentional extraction of tooth from the same side of
opposite arch
• To preserve molar relationship

38.  Serial extractions
 Correctly timed and planned extraction of deciduous and
permanent teeth in mixed dentition
 Purpose :
 Alleviate crowding
 Allow unerupted teeth to guide themselves into position
 Lessen period of mechanical appliance therapy
 Enforced extractions
Carried out on teeth which are decayed ,periodontally weak ,
impacted, in line of fracture….
 Phased extractions
 At different times in different quadrants
 To bring about a change in molar relationship

41. • Premature loss of teeth may result in tipping of the
adjacent teeth
• A tipped teeth occupies more space
• Therefore uprighting of teeth allows for recovery of
some space
• It can be achieved by space regainers

42. • Rotated teeth occupy more space
• De-rotation provides some amount of space
• Can be brought about by space regainers and springs