Extraction in orthodontics

Presented by Bhagiaswari.k Final year part-1

introduction


The philosophy in conjunction with orthodontics treatment is not new

Contd..


establishment of normal functional occlusion in balance with supporting structures occasionally requires the reduction of one more teeth

History
  

A controversial subject two schools of thought considered Extraction to be a crime n termed the orthodontist who removed sound teeth as odontocides for actual benefit for patient ,extraction was permissible and advisable By late 1940s Tweed reintroduced extraction

CharlesTweed

Factors deciding extraction

  

Nature of malocclusion Soft tissue profile Age of the patient

Types of extraction in orthodontics

 

Serial extraction interceptive Therapeutic extraction- treatment

Serial extraction


The selective extraction of deciduous teeth during the stage of mixed dentition in accordance with the shedding and eruption of the teeth. It is done over an extended period to allow autonomous adjustment to relieve crowding of the dental arches during the eruption of the lateral incisors, canines, and premolars, eventually involving the extraction of the first premolar teeth. (12 Dec 1998)

procedure
  

Dewels method Tweeds method Nance method

Serial extraction

Serial extraction video

Serial Extraction Therapy - primary and permanent teeth.flv

Need for extraction



Arch length- tooth material discrepancy

-ideally it should be in harmony Size of dentition and arch length are usually genetically determined Excess tooth material leads to crowding and proclination of anteriors

Tooth material excess

Arch length deficiency

 

Correction of sagittal-inter arch relationship Extraction of teeth impairs forward development of dental arches and alveolar process Extraction in Angles class ii and class iii improves the sagittal relationship

Angles class I
- normal sagittal inter arch relationship

Not advisable to discourage the development of one arch more than other Extraction in both arches indicated

Angless class ii-forwardly placed upper dental arch or lower arch

placed back
-extraction done on upper arch -reduce the abnormal upper procliniation.

For lower arch crowding or if molars are not in full class ii occlusion
-extract both upper and lower arches to achieve

proper inter arch relationship

Angles class iii- extraction in upper arch avoid

- preferably treated with extraction in both arches or only lower arch

    

Abnormal size and form of teeth Macrodontia Hypoplastic teeth abnormal crown morphology dilaceration

   

Skeletal jaw malrelations Mandibular hyperplasia Mandibular hypoplasia Surgical procedures along with extraction is required

Skeletal class iii

     

Maxilla -first premolars for proclination correction Mandibular -not done usually -if needed 2nd premolar

Skelatal class ii
  

   

maxillary arch -2nd premolar if crowding is present Prevents the over retraction of maxillary anterior teeth which would compromise the mandibular advancement Mandibular arch 1st premolar For leveling Correction of proclination

Choice for teeth extraction



 

Decision to extract should be based on a sound diagnostic aid IOPA CEPHALOMETRICS

     

Extraction of upper incisors Very rarely indicated Unfavorably impacted Grossly carious teeth Trauma or unreparable damage Malformations that cant corrected by prosthesis

Dilacerated teeth that cant moved by orthodontic therapy Buccally /lingually blocked out lateral incisors that has good contact with central and canine Congenital missing of one lateral incisors remove the opposite lateral to main inter arch relationship

  

Extraction of lower incisors As far as possible should be avoided Narrowing of inter canine width ,retroclination of lower incisors ,deep bite and reappearance of crowding ..

Single Lower Incisor Extraction.flv

 

Indication If one of the incisors is completely out of arch with good inter dental contact between rest of the teeth Trauma, severe caries ,gingival recession or bone loss with poor prognosis

Severe arch discrepancy characterized by the presence of fan shaped flaring out of lower incisors. Mild class iii with lower incisors crowding ,one of the lower incisor extracted

 

Extraction of canine Flattening of face ,altered facial balance and change in facial expression

 

 

Indication When canine develops far away from their original position . Unfavorably impacted canine Completely out of arch with good contact between lateral and premolar Premature shedding of deciduous canine of one side

In class ii if lower deciduous canine shed early .. In class iii if upper deciduous canine shed early Deciduous canine extracted as a part of serial extraction

    

Extraction first premolars Most commonly extracted teeth Reason-favorable location -good contact between canine & 2nd premolar -good anchorage

 

Indications To relieve moderate to severe anterior crowding for upper and lower arch To correct anterior proclination ..

Maxillary1st premolar

Maxillary First Bicuspid Extraction - Dr. Port & Dr. Klein, Gurnee & Vernon Hills Orthodontists.wmv.flv

 

  

Extraction of second premolars Limited anchorage- mesial movement of posterior teeth Treat mild anterior crowding .. When the space requirement is less Open bite cases- encourages deepening of the bite

 

Grossly carious teeth Second premolar erupts completely out of arch..

  

  

Extraction of first molars Not indicated ---not give adequate space in incisor region Tipping and drifting of second molar Extraction results in deepening of bite Mastication is affected

   

IndicationsIn minimum space requirement cases Grossly decayed certain open bite cases

Wilkinson extraction


Advocated extraction of all first permanent molars between age of 81/2 and 91/2 year Basis for such extractions is the 1st perm molars are highly susceptible to caries benefits: extraction provide additional space for eruption of 3rd molars.. Crowding of the arch is minimized

 

Drawbacks Extraction of 1st molars offers limited space to relieve crowding Second molars and second premolars rotate and may tip into the extraction space Limited anchorage for any further orthodontic treatment

Dis adv of 1st molar extraction

      

Extraction of 2nd molars Not common but indicated for no of reasons To prevent 3rd molar impaction To relieve impaction of 2nd premolar Lower incisor crowding To enable distalization of 1st molar Open bite cases

Impacted 3rd molar

Impacted 2nd premolar

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Extraction of 3rd molar No role in decrowding or reduction of proclination Indication- grossly impacted Malformed 3rd molar interfere normal occlusion

Balancing extraction


Removal of another tooth on opposite side of the same arch Midline integrity

Compensating extraction
 

Extraction of teeth in opposite jaws To preserve buccal occlusal relationship



Rem

U er 1st Prem l rs & L wer 2nd Prem l rs to Reduce Li Fullness. l

 

conclusion


Though Orthodontic extraction is a controversial topic a balanced extraction is always beneficial for the patient

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