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Marshitah , Sakinah,Syafiqah , Hamzi , Azizul , Fais , Asmat , Fatin , Fadhila

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.

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Marshitah , Sakinah,Syafiqah , Hamzi , Azizul , Fais , Asmat , Fatin , Fadhila

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  1. Interceptive & Preventive OrthodonticsSerial Extraction Submerged Deciduous Tooth Extractions in Orthodontics Date : 15/5/2014 Marshitah ,Sakinah,Syafiqah, Hamzi,Azizul ,Fais , Asmat,Fatin ,Fadhila

  2. Serial Extraction

  3. 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

  4. Different methods have been described such as: • TWEED : DC4 • NANCE : D4C • DEWEL : CD4

  5. b. a. 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. c. d.

  6. 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.

  7. 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.

  8. Contraindication or serial extraction: • Spaced dentition • In patient with cleftlip and palate • Midline diastemia • Dilacerations • Extensive caries

  9. Submerged deciduous tooth

  10. Extractions in orthodontics

  11. Extraction: • removal of the teeth from the socket • most common method to gain space in the arch

  12. Reason for Etraction 3) Abnormal size/ shape tooth -dens invaginatus/evaginatus -peg-shaped • 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 2) Forced extraction -poor prognosis teeth -badly carious, unrestorable, heavily filled, very mobile, cracked tooth, perio condition -teeth in poor position

  13. Factors to be consider before extraction in orthodontics • 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 • Crowding • Mild crowding: non extraction • Moderate: 2nd premolars • Severe: 1st premolars • Type of appliances • Less anchorage if using removable appliances • Caries • Heavily restored tooth (>2 surface restoration) • Tooth abnormality

  14. 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

  15. 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

  16. 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

  17. Points to consider before extraction • Profile • Face height • Lip competence • Dental arch width • Space analysis • Radiographic analysis

  18. 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

  19. 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

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