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Interceptive & Preventive
Orthodontics
Serial Extraction
Submerged Deciduous Tooth
Extractions in Orthodontics
Date : 15/5/2014
Marshitah ,Sakinah,Syafiqah,
Hamzi,Azizul ,Fais ,
Asmat,Fatin ,Fadhila
Serial Extraction
Serial extraction
• Is a form of interceptive orthodontic
treatment which aims to relieve crowding at
an early stage so that the permanent teeth
can erupt into good allignment.
•
It consists of planned sequence of
extractions:
-
Primary canines
First primary molars
First premolars
• Different methods have been described such
as:
– TWEED : DC4
– NANCE : D4C
– DEWEL : CD4
a.
c.
b.
Serial extractions.
(a) Class I occlusion with
incisor crowding in the mixed
dentition.
(b) Improved incisor
alignment following
extraction of primary
canines. The primary first
molars are extracted to
encourage eruption of first
d.
premolars.
(c) First premolars are
extracted on eruption to
relieve crowding of the
permanent canines.
(d) the result following
eruption of the canines.
Indication for serial extraction:
•
•
•
•
•
Significant incisors crowding
Palatal or lingual eruption of lateral incisor
Class I occlusion without a deep overbite.
All permanent teeth are present.
First permanent molars in good condition.
Contraindication or serial extraction:
• Class I malocclusion where the lack of space is
slight and the teeth show only mild crowding.
• Where there is a skeletal discrepancy in the
dental arches.
• When there is a deep overbite or an open
bite, these should be treated before
undertaking serial extraction.
• When there are permanent teeth congenitally
absent from the dental arch.
•
•
•
•
•
•
Contraindication or serial extraction:
Spaced dentition
In patient with cleft lip and palate
Midline diastemia
Dilacerations
Extensive caries
Advantage
Disadvantage
-To minimize or
eliminate the need for
appliances
- Need a space
maintainer following
extraction of the first
premolar if the
crowding is severe.
-reduce cost of treatment
- More stable result
- Multiple episodes of
extractions
trauma to patient.
Submerged deciduous tooth
Extractions in orthodontics
Extraction:
 removal of the teeth from the socket
 most common method to gain space in the
arch
Reason for
Etraction
1) To provide space
- Alignment of teeth/ relief
crowding
- Moving anterior teeth
back
- Moving posterior teeth
back
- Reduce overjet
- Reduce arch form
- Improve patient profile
- Anchorage control
3) Abnormal
size/ shape tooth
-dens
invaginatus/evagi
natus
-peg-shaped
2) Forced extraction
-poor prognosis teeth
-badly carious,
unrestorable, heavily
filled, very mobile,
cracked tooth, perio
condition
-teeth in poor position
Factors to be consider before extraction in
orthodontics
1) Malocclusion
–
–
–
Class II div 1: upper 1st premolars and lower 2nd premolars
Class II div 2: upper 1st premolars only
Class III: upper 2nd premolars and lower 1st premolars
2) Crowding
–
–
–
Mild crowding: non extraction
Moderate: 2nd premolars
Severe: 1st premolars
3) Type of appliances
–
Less anchorage if using removable appliances
4) Caries
–
Heavily restored tooth (>2 surface restoration)
5) Tooth abnormality
Tooth for extraction:
• Central incisors
– Rare
– Avulsed/forced xn
– Lateral incisors as replacement
• Lateral incisors
– Abnormal size & shape
– Poor prognosis (trauma, caries or gingival recession)
• Canines
– Rarely extract
– Extract if totally excluded from arch
– Acceptable 1st premolar replacement in upper arch
• Premolars
– Most common
– Each premolar gives 7mm space with maximum
anchorage
– 2nd premolar provide less anchorage than 1st
premolars
• First molars
– Rarely choice of extraction
– Not relieve anterior crowding
– Problem with anchorage control if 2nd molar not
erupted
– Problem of space closure (could add extra 6 months of
tx time)
– Poor contact between 2nd molar and 2nd premolar
• Second molar
– In mild crowding of posterior teeth
– Severe impaction
– Relief crowding of 3rd molars
– Relief crowding vertically impacted 2nd premolar
• Third molar
– Impacted
– Caries
– Distalization or uprighting molars
Points to consider before extraction
1)
2)
3)
4)
5)
6)
Profile
Face height
Lip competence
Dental arch width
Space analysis
Radiographic analysis
• Problem with extration site if extraction done
too early before orthodontic treatment
– Loss of space and anchorage
– Narrowing of dento alveolus
– Loss of cortical and cancelous bone
– Problem with space closure
– Fenestration of the bone
– Tipping of adjacent teeth
– Problem with miniscrew insertion
Care during extraction
• Please extract the CORRECT tooth
• If in doubt, please contact the referring
orthodontist before extraction
• Control infection
• Gentle pressure
• Preserve buccal and lingual alveolar plate
• Care not to damage adjacent teeth