Interceptive & Preventive Orthodontics

Serial ExtractionSubmerged Deciduous ToothExtractions 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

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 premolars.

(c) First premolars are extracted on eruption to relieve crowding of the

permanent canines. (d) the result following eruption of the canines.

a. b.

c. d.

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

-reduce cost of treatment

- More stable result

- Need a space maintainer following extraction of the first premolar if the crowding is severe.

- 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

3) Abnormal size/ shape tooth-dens invaginatus/evaginatus-peg-shaped

2) Forced extraction-poor prognosis teeth-badly carious, unrestorable, heavily filled, very mobile, cracked tooth, perio condition-teeth in poor position

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

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) Profile 2) Face height3) Lip competence4) Dental arch width5) Space analysis6) 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