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SERIAL EXTRACTION

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					  SERIAL
EXTRACTION
   BY ADEYEMI PAUL BOT.
OUTLINE
 INTRODUCTION/
 DEFINITIONS:
        CROWDING
        SERIAL EXTRATION
 HISTORY OF SERIAL EXTRACTION
 RATIONALE
 INDICATIONS
 CONTRAINDICATIONS
 DIAGNOSIS
 PROCEDURE
 ADVANTAGES
 DISADVANTAGES
INTRODUCTION
 Interceptive orthodontics has evolved
  clinically and objectively over the year.
 The word interceptive orthodontics reveals a
  much better understanding of clinical possibility
  and limitation unlike the earlier word
  ‘preventive’ orthodontics used.
 One of the procedure been carried out under
  interceptive orthodontics is serial extraction
     CROWDING
Crowding  of the tooth is
caused by a faulty
relationship between jaw
size,and tooth size.
       CROWDING
The size of the jaw
determines the relationship
of the apices to one another,
the arch perimeter limits
the relationship of the
crowns and the tooth size
comes between the two.
   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 alignment, thus
reducing or avoiding the need for
later appliance therapy
Chronologically,  crowding may
 become manifested at 7 years
 of age on eruption of the
 incisors, at 10 to 12 years on
 eruption of the canines,
 premolars or during the late
 teens in the form of late labial
 segment imbrications
Itis define as a timely planned
 extraction of primary and
 ultimately secondary teeth to
 relief crowding. It is initiated
 when there is crowding
 especially in incisor
 crowding. It was developed in
 Europe as a way of dealing with
 severe space problems.
      HISTORY OF SERIAL
         EXTRACTION.
 Bunon   in 1743 must be credited
  with the original concept but
  Kjellgren and Hotz certainly
  popularized the ideal.
 Kjellgren “serial extraction” and
  Hotz’s “guidance of eruption” were
  terms that emerged simultaneously
  in Europe during the late 1940s
 Nance during the 1940s
  popularized this technique in the
  USA and termed it ‘planned &
  progressive extraction.
               RATIONALE
Serial extraction is based on two principles:
 Arch length-tooth material discrepancy:
   whenever there is an excess of tooth
   material as compared to the arch
   length, it is advisable to reduce the
   tooth material in order to achieve stable
   results. This principle is utilized in
   serial extraction procedure where tooth
   material is reduced by selective
   extraction of the teeth so that the rest of
   the teeth can be guided to normal
   occlusion.
  Physiologic tooth movement:
Human dentition shows a
 physiologic tendency to move
 towards an extraction space.
 Thus by selective removal of
 some teeth the rest of the teeth
 which are in the eruption are
 guided by the natural forces into
 the extraction spaces
INDICATIONS
The  patient should be
 between 8 to 9 years of
 age and the incisor
 crowded
The fundamental arch
 relationship should be
 normal (Angle class I).
 showing harmony between
 skeletal and muscular
 system.
‘’Arch length deficiency as
   compared to tooth material is
   the most important indication
   for serial extraction’’. This is
   indicated by:
1. Absence of physiological spacing
2. Unilateral or bilateral premature
   loss of deciduous canines with
   midline shift.
3. Malpositioned or impacted lateral
   incisor that erupt palatally out of
   the arch
4. Markedly irregular or crowded upper or
  lower anteriors
5. Localized gingival recession in the lower
  anterior region is a xstic feature of arch
  length deficiency
6. Ectopic eruption of teeth
7. Mesial migration of buccal segment
8. Abnormal eruption pattern & sequence
9. Lower anterior flaring
10. Ankylosis of one or more teeth
There  should be normal or
 reduce overbite and all the
 teeth should be present on
 radiograph and in good
 position to erupt.
There should be a large arch
 perimeter deficiency of
 10mm or more.
The   first premolar should be
 more close to eruption than the
 canines
It is rather rare to find a patient
 who fulfils all these criteria to
 the letter. How much latitude
 should be allowed, calls for
 clinical judgment and a
 consultant option.
  CONTRAINDICATION
Serial extraction are contraindicated in a number
  of conditions:
 Class II & III malocclusion with skeletal
  abnormalities
 Spaced dentition
 Anodontia / oligodontial
 Open bite & deep bite
 Class I malocclusion with minimal space
  deficiency
 Unerupted malformed teeth e.g. dilaceration
 Extensive caries or heavily filled first permanent
  molars
 Mild disproportion between arch length and tooth
  material that can be treated by proximal
  striping.
DIAGNOSTIC PROCEDURE
 The 1st step is to assess that a malocclusion exist
  in a clinical examination and the need for
  investigation and collection of diagnostic records .
  Comprehensive assessment of the dental ,
  skeletal and soft tissue is required.
 The investigation required are as follows;

 -study model

 -radiograph

 -photograph
           STUDY MODEL

 Assess the dental anatomy of the teeth
 Assess the intercuspation of teeth

 Assess the arch form and curve of occlusion

 Evaluate the occlusion

 Undertake model analysis i.e. arch perimeter
  analysis , Carrey's analysis , mixed dentition
  analysis using tarnaka and Johnston e.t.c.
 Also used between and after treatment.
           RADIOGRAPHS

  Intra oral x-rays e.g. periapicals , occlusal views.
 Extra oral x-rays e.g. cephalometric , panoramic
   views e.t.c.
 The above provide the following information;
1.   Detection of congenitally missing teeth ,
     supernumerary e.t.c.
2.   Detection of any bony pathosis.
3.   To assess the stages of root development and
     the possible eruption pattern.
4.   To determine the dental age of the patient.
5. To assess the different relationship between
  craniofacial structures using cephalometric
  analysis.
6. To assess facial patterns
7. To assess soft tissue matrix
8. To assess changes in mid and post tx
  relationship cephalometrically to monitor
  treatment progress.
             SUMMARY
Diagnostic exercise before treatment involves
 Assessment of the dental, skeletal & soft tissues.
 A tooth material-arch length discrepancy must
  ideally exist.
 According to most authors, an arch length
  deficiency of not <5-7mm should exist.
 Study model analysis should be carried out to
  determine the arch length discrepancies
 Mixed dentition analysis must be done this help
  to determine the space required for the erupting
  buccal teeth
 Skeletal tissue assessment should involve
  comprehensive cephalometric examination to
  study the underlying skeletal relation.
PROCEDURES
 Different procedures has been described by
  different authors such as;
 Tweed’s method 1966;8years [DC4].

 Dewel’s    ,,      1978; 81/2[CD4]
 Nance’s    ,,       1940; D4C
      DEWEL’S METHOD – CD4
 Proposed a 3 serial extraction procedure
 Removal of deciduous canines to create space for
  the alignment of the incisors (btw 8-9 years)
 A year after, the removal of deciduous first
  molars to aid quick eruption of the first
  premolars
 This is followed by the extraction of first
  premolars to permit the permanent canines to
  erupt in their place.
 In some cases a modified Dewel’s
  technique is followed wherein the
  first premolars are enucleated at
  the time of extraction of the first
  deciduous molars
 This is necessary in the mandibular
  arch where the canines often erupt
  before the first premolars
    TWEED’S METHOD -DC4
This method involves the
 extraction of the 1st deciduous
 molars around 8-years of age
This is ffd by the extraction of 1st
 premolars & the deciduous
 canines simultaneously.
Nance method is similar to –
 D4C
Tweed’s method
    ADVANTAGES OF SERIAL
              EXTRACTION
 Treatment   is more physiologic as it
  involves guidance of teeth into normal
  positions making use of physiological
  forces.
 Psychological trauma associated with
  malocclusion can be avoided by treatment
  of the malocclusion at an early age
 Serial extraction can relieve incisor
  crowding and produce reasonably good
  alignment of teeth without any
  orthodontic appliance therapy
 Serial extraction makes later
  comprehensive orthodontic treatment
  easier and quicker
It eliminates or reduces
 the duration of
 multibanded fixed
 treatment.
Better oral hygiene is
 possible thereby reducing
 the risk of caries
Health of investing tissues is
 preserved
More stable results are
 achieved as the tooth
 material and arch length are
 in harmony.
It does not involve mechanical
 treatment
Cost is minimal
It is often within the range of
 general practitioners
Malocclusion can be treated at
 early age
    DISADVANTAGES OF SERIAL
                 EXTRACTION

 Treatment time is prolonged as this is carried out in
  stages spread over 2-3 years .
 It requires the patient to visit the dentist often, thus
  patient co-operation is needed.
 Extraction of the buccal teeth can result in deepening
  of the bite
 As extraction spaces created are closed
  gradually, the patient has tendency of
  developing tongue thrust.
 Child is subject to series of extraction at a
  tender age
  These may well be a child’s first
  experience of dental treatment and might
  cause subsequent psychological problems
  with their attitude to dentistry, especially
  as the experience is to be repeated as the
  programe of extraction proceeds.
Improper  sequence of
 extraction may leads to delay
 eruption of secondary teeth
Lower secondary canine may
 erupt before secondary first
 molar
 There  could be possible loss of space
  after the extraction i.e. if there is a delay.
 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 programe can be worse than
  none at all
 Ditching or space can exist between the canine
  and second premolar
 The axial inclination of teeth at the termination
  of the serial extraction may require correction.
  This necessitates short term fixed appliance
  therapy
       CONCLUSION


A good preventive
techniques will result
in a
reducemalocclusion
7   THANK’S


       FOR

    LISTENING!

				
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