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5.SERIAL EXTRACTION.ppt lecture class.ppt
- 2. Interceptive orthodontics: “that phase of science and art of orthodontics employed to recognize and eliminate potential irregularities and malpositions in the developing dentofacial complex”
- 3. As we learn more about growth & its potentials, influences of function…………, normal mesiodistal position to basal jaw bones and head structures, we will acquire a better understanding of when and how to intervene in the guidance of growth processes so that Nature may better approximate her growth plan for the individual patient……………….. -----CHARLES H. TWEED SERIAL EXTRACTIONS
- 4. DEWEL,1969- DEWEL,1969- “ selected deciduous and permanent teeth in a predetermined sequence” “Correctly timed, planned removal of certain deciduous and permanent teeth in mixed dentition cases with dento-alveolar disproportion in order to Alleviate crowding Guide unerupted teeth Lessen/eliminate period of active appliance therapy “Sequential plan of premature removal of one/more deciduous teeth in order to improve alignment of succedaneous permanent teeth and finally removal of permanent teeth to maintain the proper ratio between tooth size and available bone” Definitions-
- 5. Palsson(1956) Robert Bunon (1743) “ESSAY ON DISEASES OF THE TEETH”- first reference Joseph Fox (1814)- ext of deciduous canine absolutely necessary Linderer(1851)- stripping of canines, premolar extraction. Nance (1940)- “Father of serial extraction” Rudolf Hotz (1948)-article- early planned extractions. Birger Kjellgren (1947) 1st post war congress of EOS- SERIAL EXTRACTIONS Hotz-active supervision of eruption---*guidance of eruption* Serial Extractions: Historical development
- 6. B .F. Dewel (1967) “ growth prediction” Future growth is inadequate. Charles H. Tweed (1969) 8yrs of age. Rudolf P. Hotz (1970) T. M. Graber (1971) eg of multidiscipline approach that exemplifies the best to be gained from team work. Jack G. Dale (1976) Serial extractions: Historical development
- 7. Early mixed dentition. Arch length-tooth material discrepancy Arch length-tooth material discrepancy Physiologic tooth movement Physiologic tooth movement Harmonize the tooth material to arch length Correct the dental irregularities-maintaining the multisystem balance and the best possible facial harmony Serial extractions: Rationale
- 8. Naturally induced movement and alignment Improved health of investing tissues Improved psychologic state & patient compliance Reduced total workload and treatment effort Less potential iatrogenic damage. Better oral hygiene More stable results Chief Benefits of Extraction Guidance:
- 9. Class I malocclusion Arch length deficiency Absence of physiologic spacing Premature loss of primary canine Crowded upper and lower anteriors Mal positioned lateral Localized gingival recession Ectopic eruption of teeth Mesial migration of buccal segment Abnormal eruption pattern & sequence Ankylosis Growth not enough Possible clinical clues for serial extraction Indications:
- 10. Clues for serial extraction :(Dale) hereditary crowding
- 11. Clinical Clues:
- 12. Clinical Clues:
- 15. 1) Deepening of bite (Dewel 1967) 2) Premolars fail to reach their normal occlusal level. 3) Facial esthetics 4) Nose and chin growth (exceeds) important to differentiate b/w authentic serial extraction, & deceptive borderline irregularity Limitations:
- 16. Congenital absence of teeth Mild-moderate crowding Deep bite Severe class II, III of dental/skeletal origin Cleft lip and palate Spaced dentition Contraindications
- 17. Requires clinical judgement Prolonged treatment time Patient compliance Developing tongue thrust Arch length reduction Ditching b/w canine and second premolar Axial inclination Disadvantages:
- 18. Based on proper diagnosis 3-5 yr old period of observation Precautions:
- 19. Dependence on maxillo-mandibular relationship Dewel Dewel “severe class II discrepancy irregularities treated primarily with class II mechanics, with serial extraction more or less an accessory to mechanotherapy” Mayne(1959)…present harmony and balance of two tissue systems, bone and muscle, & varying degree of disharmony in third…. Apical bases located directly one under the other……….produce complimentary facial esthetics
- 21. Incisal liability and the associated changes in the dental arches: Increase in anterior tooth mass G. V. Black (1902)- 7.6mm and 6mm larger respectively Warren Mayne (1969) See child at 7yrs of age- AAO Dental development
- 22. Inter dental spacing of primary teeth Inter canine arch width change Increase in arch length Favorable variation in the ratios b/w size of pri and permanent teeth Factors that allow for or prevent proper alignment of erupting permanent teeth
- 23. Interdental spacing 0-10mm avg 5mm in maxillary arch 0-6mm avg 3mm in mandibular arch First observation
- 24. Early manifestation To overcome: •Greater than avg growth response •Extremely small permanent teeth
- 25. Increase at the time of eruption of permanent incisors Moorrees et al (1965): sexual dimorphism Boys: b/w 2yr -18yr :- 6mm Girls: b/w 2yr-12yrs :-4.5mm Growth of arches?? Graber and Enlow- appositional growth----------during transition to result in a larger arc Intercanine Arch Width Changes:
- 27. Arch length change: John Hunter in 1771 “the jaw still increases in all points till 12months after birth, when the bodies of all 6 teeth are pretty well formed; but it never after increases in length b/w the symphysis and the sixth tooth…...After this time the jaws lengthen only at their posterior ends.
- 28. Reduction in arch length Moorrees (1965)
- 29. •Labial positioning of erupting incisors: -influence arch length Baume: (1950) 2.2mm---maxi anterior positioning 1.3mm---mand anterior positioning
- 30. Variations in the size ratio of primary teeth and their permanent successors
- 31. Leeway space of Nance: Reserved space
- 32. Early & Late Mesial Shift:
- 34. Total dentofacial morphology & the physiologic ramifications of growth and development Diagnostic process involves: Case history Clinical examination Photographs Study models Cephalometric, panoramic, periapical radiographs Assessments to be made before a serial extraction procedure is contemplated: Dynamic working analysis
- 35. Proportional facial analysis Graber (1971) Standard or orthognathic face
- 36. Alveodental protrusion: Class I maxillary mandibular protrusion
- 37. Alveodental protrusion: Class II maxillary alveodental protrusion Only in the maxilla
- 38. Alveodental retrusion Class I maxillary mandibular alveolodental retrusion Not indicated
- 39. Alveodental retrusion: Class II mandibular alveodental retrusion
- 40. Prognathism: Class I maxillary mandibular prognathism
- 41. Prognathism: Class II maxillary prognathism
- 43. Retrognathism: Class II mandibular retrognathism
- 44. Retrognathism: Class II mandibular retrognathism
- 45. Space analysis in mixed dentition Assess the tooth size- arch length relationship Prediction of tooth size of unerupted teeth
- 46. Dental Analysis: Incisors: Favorable situation Precarious situation Impossible situation
- 47. 1. Upper 1st molar emerge before lower 2. Interproximal caries 3. Premature loss of primary molars 4. Ectopic eruption Molars Canines, premolars and 2nd molars • Favourable sequence of eruption • Upper 2nd molar erupt before- class II molar relation • Early exfoliation or prolonged retention of pri 2nd molar
- 49. No single extraction sequence In 1743, Bunon—C-------D------4 Berger, Kjellgren, Rudolf Hotz, John Heath, L.J.Baume, Hayes Nance & Dewel-------over 50yrs D---4----C Only in lower arch Sequence of extractions:
- 50. 1. Extracting primary canines only 2. Extracting the primary first molars only 3. Extracting both primary canines and first molars 4. Enucleation of first premolar buds (danger of knife edging) rarely indicated in maxillary arch Guide to selecting suitable extraction sequence:
- 52. Serial extraction in Class I treatment Group A: Anterior Discrepancy (crowding) Step 1
- 53. Class I Anterior Discrepancy (crowding) Step 2
- 54. Class I Anterior Discrepancy (crowding) Step 3
- 55. Class I Anterior Discrepancy (crowding) multi bonded treatment Step 4
- 56. Class I Anterior Discrepancy (crowding) Retention Step 5 Aligned in harmony with the craniofacial skeleton & soft tissue matrix
- 57. Class I Anterior Discrepancy (crowding) Post-Retention (18yrs)
- 58. Group B: Class I Alveodental Protrusion Step 1
- 62. Group C: middle discrepancy- impacted canines Discrepancy -- severe 4’s erupting ahead of canines
- 63. Group C: middle discrepancy- impacted canines
- 64. Group C: middle discrepancy- impacted canines
- 65. Group D: Enucleation in the mandible Maxilla- premolars erupt before canine
- 66. Group E: Enucleation in the maxilla & mandible No opportunity exists to place multibanded appliances
- 67. Group F: alternative to enucleation Least desirable extraction result
- 68. Initial Period of interceptive treatment 1. extract upper D&4 , fixed appliance on E,6,1&2 2. extract lower C. extract D and 4 fixed appliance on lower E,6,1&2 Extraction for Rx of Class II malocclusion Proportional facial type, total space analysis. Period of interceptive guidance Retention appliance, regular recall. Second period of active treatment Serial extraction in Class II
- 69. Trend ---nonextraction Fuller profile. Serial extraction with slight modification In contemporary orthodontics:
- 70. Though serial extraction is a effective method for treating class I crowding with either no or min appliance therapy. But in contemporary orthodontics where there is a trend towards non extraction treatment and a fuller profile, the serial extraction procedure can be used with a slight modification ie extracting C & D as usual and avoid extraction of 4 if possible and use other means of gaining space like expansion, proclination, interproximal red, molar distzn either done alone or in combination as dictated by the individual case
- 71. Orthodontics- Current Principles and Techniques: Graber & Vanarsdall Orthodontic Principles & Practice- T.M. Graber “Serial extraction: A continuous diagnostic and decisional process”- AJO 1971 Dec, vol 60, no.6 -T.M. Graber “Serial extraction in orthdontics; indications, objectives & treatment procedures”- AJO 1954 Dec-B.F. Dewel “Serial extraction: its limitation and contraindication in orthodontic treatment” AJO 1967;53(12) 904-921- Dewel “Prerequisites in serial extraction” AJO 1969;87-93- Dewel References:
- 72. “Guidance of eruption versus serial extraction” AJO,1970;58(1) 1-20- Hotz P.R JCO interviews with Jack Dale on serial extractions- Part 1,2,3: 1976 “A consideration of dental development in serial extraction” Angle Orthod 1963; 33: 44-59- Moorrees et al “Contemporary Orthodontics” –Proffit W.R “Dentistry for child and adolescent” –Mc Donald “A Textbook of Orthodontics”- Samir. E. Bishara References:
Editor's Notes
- #2: American association of orthodontists, council on orthodontic education defines
- #3: The importance was realised as early as 1940’
- #4: Alleviate- relief
- #7: 4 room foundation 5 rooms built on it.compressed transeptal fibres
- #8: Maintainence or oral hygiene- on relieving crowding during growth tooth movement is faster-treatment effort is less
- #18: Patient selection should be careful, proper motivation, doc should have patience
- #20: For diagnosis n trtplanning as related to serisxt it is very imp for the clinician to have a thorough understanding of development of dentition and occlsion. Before we proceed lets briefly summarise the develo
- #33: After this brief overview of dev of dentition & occl , lets see how to diagnse and plan a serial ext treatment
- #34: To have a proper understanding of ; check for heriditary or rule out envirnmental ; dynamic which changes with time- growing patients
- #35: The first step in clinical diagnosis is classifying the facial type of the individual
- #39: Treated with functional appliance foll by fixed without extraction
- #47: The most imp deciding factor is soft –harmonious soft tissues