Advantages of serial extraction serial extraction carried out during the mixed dentition and early permanent dentition

periods has a number of advantages: a. treatment is more physiologic as it involves guidance of teeth into normal positions making use of the physiologic forces. b. physiological trauma associated with malocclusion can be avoided by treatment of the malocclusion at an early age. c. it eliminates or reduces the duration of multibanded fixed treatment. d. better oral hygiene is possible thereby reducing the risk of caries. e. health of investing tissues is preserved f. lesser retention perio is indicated at the completion of treatment. g. more stable results obtained as the tooth material and arch length are in harmony. Disadvantages of serial extraction; a. serial extraction requires clinical judgement. There is no single approach that can be universally applied to all patients. Each patient has to be assessed and a suitable extraction timetable planned. b. treatment time is prolonged as the treatment is carried out in stages spread over 2-3 years. c. it requires the patient to visit the dentist often. Thus patient co-operation is needed. d. as extraction spaces are created that close gradually, the patient has a tendency of developing tongue thrust. e. extraction of the buccal teeth can result in deepening of the bite. f. if the procedures are not carried out properly there is a risk of arch length reducing by mesial migration of the buccal segment. Thus a poorly executed serial extraction programme can be worse than none at all. g. ditching or space can exist between the canine and second premolar. h. the axial inclination of teeth at the termination of the serial extraction procedure may require correction. This necessitas short term fixed appliance therapy. Diagnostic procedure The diagnostic exercise prior to treatment should involve comprehenive assessment of the dental, skeletal, and soft tissues. A tooth material arch length discrepancy must ideally exist. According to most authors, an arch length deficiency of not less than 5-7 mm should exist to undertake this procedure. Study model analysis should be carrie out to determine the

arch length discrepancy. Careys analysis in the lower arch and arch perimeter analysis in the upper arch should be carried out. Mixed dentition analysis helps in determining the space required for the erupting buccal teeth. The eruption status of the dentition is evaluated from an o.p.g. The skeletal tissues assessment should involve comprehensive cephalometric examination to study the underlying skeletal relation. serial extraction produces the best results in a class I skeletal pattern. Presence of a class II or class III skeletal pattern are contraindications for serial extraction procedure. The soft tissues assessment by clinical examination and cephalograms help in the diagnosis. serial extraction is generally undertaken in patients exhibiting harmonious soft tissue pattern. Procedure: Dewel has proposoed a 3 step serial extraction procedure. In the first step the deciduoud canines are extracted to create space for the alignment of the incisors. This step is carried out at 8-9 years of age. A year later, the deciduous first molars are extracted so that the eruption of first premolars is accelerated. This is followed by extraction of the erupting first premolars to peermit the permanent canines to erupt in their place. In some cases a modified dewels technique is followed wherein the first premolars are enucleated at the time of extraction of the first deciduous molars. This is frequently necessary in the mandibular arch where the canines often erupt before the first premolars.

This method involves the extraction of the deciduous first molars around 8 years of age. This is folowed by the extraction of the first premolars and the deciduous canines simultaneously. This is similar to the tweeds technique and involves the extraction of the deciduous first molars followed by the extraction of the first premolars and the deciduous canines. Post serial extraction fixed therapy Most cases of serial extraction need fixed appliance therapy for the correction of axial inclination and detailing of the occlusion. Developing anterior cross bite

anterior cross bite is a condition characterized by reverse overjet where in one or more maxillary anterior teeth are in lingual relation to the mandibular teeeth. anterior cross bite should be intercepted and treated at an early stage so as to prevent a minor orthodontic problem from progressing into a major dento facial anomal. An old orthodontic maxim states the best time to treat cross bite is the first time it is seen. anterior cross bite should be treated early for the following reasons: a. this type of malocclusion is self perpetuating i.e. if he cross bite is present in the mixed and permanen dentition as well. b. simple anterior cross bite that are not treated early have the potential of growing into skeletal malocclusion that later need complicated orthodontic treatment combined, at times, with surgical procedures. anterior cross bite can broadly be classified as dento alveolar anterior cross bite, skeletal anterior cross bite, functional anterior cross bite. Dento anterior cross bite in which one or more maxillary anterior teeth are in lingual relation to the mandibular anterior is termed dento alveolar anterior cross bite. This kind of anterior cross bite is often manifested as single tooth cross bite and usually occurs due to over retained deciduous teeth that deflect the erupting permanent teeth into a palatal position. These dentoalveolar cross bite can be effectively treated using tongue blades, catalans appliance and double cantilever springs with posterior bite plate. Functional cross bite Some anterior cross bite are reffred to as functional cross bite. This type of cross bite is the so-called pseudo class III malocclusionj where the mandible is compelled to close in a position forward of its true centric relation. Functional cross bite occur as a result of oculusal prematurities that cause a deflection of the mandible into a forward position during closure. These are to be treated by eliminating the occlusal prematurities. Skeletal anterior cross bite Skeletal anterior cross bite are usually a result of skeletal discrepancies in growth of maxila or the mandible. Anterior cross bite can be a result of maxillary skeletal retrognatihism or

hypoplasia or mandibular prognatism. These are best treated during growth by growth modification procedures by use of myofunctional or orthopaedic appliances. Interception of habits Habits in the orthodontics sense refer to certain actions involving the teeth an other oral or perioral stuctures, which are repeated often enough by some patients to have a profound and deleterious effect on the positions of teeth and occlusion. Some of the habits that can affect the oral structures are thumb sucking, tongue, thrusting and mouth breathing. Thumb sucking One of the habits that is most frequently practiced by children and is capable of producing damaging effects on the dentoalveolar structures is the thumb sucking habit. The presence of this habit up to 2,5-3 years of age is considered quite normal. Persistence of this habit beyond 3,5-4 years of age can have a damaging influence on the dentoalveolar structures and should hence be intercepted. Thumb sucking is intercepted by use of habit breakers that could be of removable type or one that is fixed. Tongue thrust Tongue thrust is defined as acondition in which the tongue makes contact with any teeth anterior to the molar during swallowing. This is deletrious habit that can clinically present with open bite and anterior proclination. The tongue thrust habit should be intercepted by using habit breakers. The patient should be trained and educated on the correct technique of swallowing. Mouth breathing Mouth breathing habit has a profound effect on the dento-facial region. It can be obstructive or habitual in nature. Obstructive Mouth breathing is usually a