METHODS OF SPACE GAINING

Dr sasikumar M.D.S.,

Calculate the amount of space required Model analysis Method depends on outcome of space analysis

SPACE REQUIRED FOR ALIGNMENT OF CROWDED TEETH RETRACTION OF PROCLINED TEETH CORRECTION OF MOLAR RELATIONSHIP DEROTATION OF ANTERIOR TEETH LEVELING OF CURVE OF SPEE INTRUSION

METHODS OF GAINING SPACE PROXIMAL STRIPPING ARCH EXPANSION DISTALIZATION OF MOLARS UPRIGHTING OF TILTED TEETH DEROTATION OF POSTERIOR TEETH PROCLINATION OF ANTERIOR TEETH EXTRACTION

PROXIMAL STRIPPING Reproximation,slenderization,disking,proxi

mal Slicing, Teeth For Striping Depends Upon

Location of excess tooth material Amount of discrepancy Thickness of enamel present

INDICATION OF PROXIMAL STRIPPING Space requirement is less than 3mm Boltan tooth excess is less thsn 2.5mm

CONTRAINDICATION OF PROXIMAL STRIPPING Susceptible to caries Young individual bigger pulp chamber

Amount of enamel to be stripped Iopa x ray

Methods of stripping Metal abrasive strips Diamond disks Corborundum disks Thin fissure burs

Advantages Tooth extraction can be avoided Broad contacts Localized malalignments can be corrected

disadvantages Sensitivity Caries susceptibility Food impaction Difficult to reproduce exact morphology

ARCH EXPANSION Classification

Rapid palatel expansion Slow expansion

PHILOSOPHY OF RME Dentofacial orthopedic appliance Teeth are used to apply force on suture Splitting of mid palatine suture Bone growth in split gap

Anatomy of suture Effects of RME

Max teeth and alveolar bone Maxillary skeletal effects Mandible Nasal cavity and adjacent bone

MAXILLARY TEETH AND ALVEOLAR BONE Post teeth are used to transmit force on

maxilla Teeth tip buccaly Compression of bone- bending of alveolar

bone Midline diastema

MAXILLARY SKELETAL EFFECTS Palatine process

separate in a triangular fashion

2 dimension Occlusal vertical

EFFECTS ON MANDIBLE Rotates downward and backward

NASAL CAVITY Increase in inter nasal

space The effect is sufficient

sometimes to correct the deviated nasal septum

INDICATIONS FOR RME Posterior crossbite with maxillary

deficiency Cleft palate patients Class III case with mild maxillary

deficiency As part of interceptive orthodontics

TYPES OF RME Tooth borne

Isaacson rme appliance Hyrax rme appliance

Tooth and tissue borne Derichsweiler rme appliance Hass rme appliance

Activation Retention

SLOW EXPANSION DEVICES Coffin spring Quadhelix Niti expanders Schwarz appliance

DISTALIZATION OF MOLARS Pushing molar distally created space Before eruption of second molar Classification

Extra oral Cervical head gear

Intra oral

Intra oral distalizers Schwartz plate First class appliance Open coil spring Jones jig Distel jet appliance Pendulum appliance K-loop appliance Lip bumper

UPRIGHTING Tilted teeth occupy more space Extracted space /missing teeth Space regainers lipbumpers

DEROTATION OF POSTERIOR TEETH Rotated posterior teeth occupy more

space Anterior teeth less space Derotate using couple forces Fixed appliance

PROCLINATION OF ANTERIOR TEETH When teeth are retroclined Class II div 2 cases Fixed appliance

Reverse curve Removable appliance

Z- spring screws

Extraction Common method of gaining space Need for extraction

Arch length tooth material discrepancy crowding

Correction of sagittal inter arch relationship Class I-ext in both arches classII – ext in upper arch Class III-ext in lower arch

DIFFERENT EXTRACTION PROCEDURES Balancing extraction Compensating extraction Phased extraction Enforced extraction Wilkinson extraction therapeutic

extraction

THERAPEUTIC EXTRACTIONS Maxillary incisors Mandibular incisors Canines 1st premolars 2nd premolars Ist molars 2nd molars 3rd molars