Methods Of Gaining Space
Presented by-Apeksha patil
Guided [Link] sir
Introduction
• The correction of many malocclusions requires space in
order to move teeth into more ideal locations.
• Space is required for correction of crowding, retraction of
proclined teeth, levelling a steep curve of Spee, derotation
of anterior teeth and for correction of unstable molar
relation.
• Planning space is an important aspect of treatment
planning.
Methods of Gaining space
A. Proximal stripping
B. Expansion
C. Extraction
D. Distalization
E. Uprighting of molars
F. Derotation of posterior teeth
G. Proclination of anteriors
Proximal Stripping
• It is a method by which the proximal surfaces of
the teeth are sliced in order to reduce the mesio-
distal width of the teeth.
• It is also known by the synonyms, reproximation,
slenderization, disking and proximal slicing
• Routinely carried out on the lower anteriors it can
also be done on the upper anteriors and buccal
segments of the upper and lower arches.
Diagnostic aids for proximal stripping
• Arch perimeter analysis: Arch perimeter or Carey's analysis
showing a tooth material excess of 0-2.5 mm over the arch
length is a diagnostic criteria favouring reproximation.
• Bolton's analysis: Bolton's analysis revealing an excess of
tooth material in either of the arches is an indication to
reduce tooth material in that arch. Minimal inter-arch tooth
material discrepancies can also be corrected by proximal
stripping
• Intra-oral periapical radiographs: This would give an idea of
the enamel thickness and a rough estimate of the amount of
enamel that can be removed from the proximal surface,
without exposure of the pulp chamber.
Amount of Proximal stripping-
• Not more than 50% of the enamel
thickness should be reduced by proximal
stripping. Whenever reproximation is
undertaken in a segment of an arch, it is
advisable to equally distribute them
over all the teeth.
• When reproximation is undertaken it is
essential that one is conservative and
never remove more than 0.3 mm from
any single tooth surface, creating space
gain of 0.6 mm per two teeth in contact.
• It is vital to calculate how much enamel
can be removed in individual teeth in
order to know which cases can be
slenderised and which require a
different treatment plan
Proximal stripping using (A) Metallic abrasive strips with handles (B) Long thin tapered
fissure burs (C) Hand pieces with strips that have a reciprocal action (D) Safe sided
carborundum discs with safety guard.
INDICATIONS CONTRAINDICATIONS
• 1. when the space required is • 1. In young patients, as they
minimal i.e., 0-2.5 mm. In these
possess large pulp chamber,
cases, it is possible to avoid
which increases the risk of
extraction of teeth by performing
reproximation. pulpal exposure.
• 2. If the Bolton's analysis show mild • 2. Patients who are susceptible
tooth material excess in either of to caries/high caries index.
the arches, it is possible to reduce • [Link] teeth and teeth with
the tooth material by proximal enamel hypoplasia.
stripping.
• [Link] who refuse to accept
• 3. It can be undertaken in the lower
slenderization as a treatment
anterior region as an aid to
option (in- formed consent is
retention.
imperative).
• 4. where individual tooth sizes
prevent a Class I molar and canine • 5. Patients with poor oral
relationship hygiene and high bacterial
• 5. To obtain a more favorable plaque index.
overbite and overjet.
ADVANTAGES DISADVANTAGES
• 1. It is possible to avoid • The stripping procedure creates
extraction in borderline cases roughened proximal surface that
where space requirement is attracts plaque.
minimal. • Caries susceptibility is increased as
• 2. A more favourable over bite part of the enamel is removed,
and overjet can be established leaving behind a roughened area.
by eliminating tooth material • Patients may experience sensitivity
excess in either of the arches. of teeth.
• 3. More stable results can be • Improper procedure at the hands
established by broadening the of in experienced operators can
contact area thereby result in alteration of morphology
eliminating small contact of the teeth, creating an unnatural
points, which can slip and appearance of the teeth.
cause rotation of teeth • Loss of contact between adjacent
teeth may result in food impaction.
Pretreatment
photograph
Post-treatment
photograph
EXPANSION AS A METHOD OF GAINING SPACE
• Expansion is one of the non-invasive methods of gaining
space . It is usually undertaken in patients having constricted
maxillary arch or in patients with unilateral or bilateral cross
bite.
• Expansion can be skeletal or dento-alveolar. Skeletal
expansion involves splitting of the mid-palatal suture while
dento-alveolar expansion produces a dental expansion with
no skeletal change. Expansion is brought about by various
appliances that incorporate jackscrews or by use of springs.
EXTRACTION AS A METHOD OF GAINING
SPACE
• Extraction that is
undertaken as a part of
orthodontic treatment is
called therapeutic
extraction
• Premolars are the most
frequently extractedteeth
as part of orthodontic
treatment
DISTALIZATION
• Distalization procedures are aimed at moving the
molars in a distal direction so as to gain space.
• This approach is becoming popular due to the fact
that extractions can be avoided.
• Distalization of maxillary molars assumes significant
value in the treatment of mild to moderate Class II
molar relation associated with a normal mandible.
• The ideal timing for distalization is during the mixed
dentition period prior to the eruption of the second
permanent molars.
INDICATIONS CONTRAIDICATIONS
• Distalization is best done in • Distalization is contraindicated
moderate maxillary skeletal in severe protrusive profiles and
and/or dento-alveolar protrusion. severe incisor proclination.
• Moderate arch-length • In case of high mandibular
deficiencies can be addressed by plane angle and anterior open
distalization of the molars. bites as these features can
• Distalization is recomended when further worsen.
extraction of the maxillary teeth
• Severe crowding (more then 6
is not indicated.
mm).
• If the mandibular tooth-size/arch
perimeter relationship does not • Patient with insufficient seating
permit mesial movement of the of the Nance button because of
lower molars, then distalization reduced palatal vault
of the maxillary molars may be inclination. In such patients the
considered. anchorage may be insufficient.
• Distalization can be brought about by the following
methods -
[Link]-oral methods -
[Link] methods
• Intra-oral methods –
These appliances are fixed on to the teeth and therefore
produce a continuous effect
• Sagittal appliance
- Molar distalization can be brought about by removable
appliances incorporating jackscrews.
Pendulum appliance-
• It is an intra-oral distalization appliance
introduced by Hilgers that incorporates a modified
Nance button for purpose of anchorage.
• In addition it consists of a stainless steel or TMA
wire with a helix, the distal end of which is
inserted into a sleeve on the palatal aspect of the
molars to be distalized.
• Distalization is produced by opening the helix and
forcefully engaging the distal ends into the sleeves
• The TMA pendulum springs are able to exert a
light, continuous, distalizing force on the molars.
UPRIGHTING OF MOLARS
• Premature loss of a second deciduous
molar or extraction of a second
premolar can cause mesial tipping of
the first permanent molar.
• A mesially tipped molar occupies more
space than an upright molar. Thus by
uprighting these tipped molars, certain
amount of space can be recovered.
Molars can be uprighted using molar
uprighting springs or some form of
space regainer
DEROTATION OF POSTERIOR TEETH
• Rotated posterior teeth
occupy more space than
normally placed posterior
teeth. Derotation of these
teeth hence provides some
amount of arch length .
• Derotation is best achieved
with fixed appliances
incorporating springs or
elastics using a force couple
PROCLINATION OF ANTERIOR TEETH
• Proclination of a retruded anterior tooth
results in gain of arch length. This is usually
indicated in cases where the teeth are
retroclined or in those cases where
protracting the anteriors will not affect the
soft tissue profile of the patient.
