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SERIAL EXTRACTION. INTRODUCTION HISTORY RATIONALE INDICATIONS CONTRAINDICATIONS ADVANTAGES DISADVANTAGES DIAGNOSITC PROCEDURE PROBLEMS IN SERIAL EXTRACTION.

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Presentation on theme: "SERIAL EXTRACTION. INTRODUCTION HISTORY RATIONALE INDICATIONS CONTRAINDICATIONS ADVANTAGES DISADVANTAGES DIAGNOSITC PROCEDURE PROBLEMS IN SERIAL EXTRACTION."— Presentation transcript:

1 SERIAL EXTRACTION

2 INTRODUCTION HISTORY RATIONALE INDICATIONS CONTRAINDICATIONS ADVANTAGES DISADVANTAGES DIAGNOSITC PROCEDURE PROBLEMS IN SERIAL EXTRACTION

3 INTRODUCTION :  Serial Extraction is an interceptive orthodontic procedure usually initiated in the early mixed dentition.  It is a procedure that includes the planned extraction of certain deciduous teeth & later specific permenent teeth in an orderly sequence & pre- determined pattern to guide the erupting permenent teeth into a more favourable position.

4 HISTORY:-  Kjellgren (1929) used the term “Serial extraction” to describe a procedure where some deciduous teeth followed by permenent teeth were extracted to guide the rest of the teeth into normal occlusion.  Nance during 1940’s popularized this technique in united states of AMERICA, termed it “planned & progressive extraction” & has been called the ‘father’ of Serial extraction philosophy in united states.  Hotz in 1970 called such a procedure “active supervision” of teeth by extraction.

5  Serial extraction is based on 2 basic principles:- RATIONALE:- Arch Length tooth material discrepancy:  Whenever there is an excess of tooth material as compared to the arch length a selective extraction of some teeth is done so that 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 process of eruption are guided by the natural forces into the extraction spaces.

6 INDICATIONS FOR SERIAL EXTRACTION 1.Class I malocclusion showing harmony between skeletal & muscular system. 2.Arch length deficiency as compared to the tooth material is the most imp. indication for serial extraction.

7 Absence of physiologic spacing Unilateral or bilateral premature loss of deciduous canines with midline shift. Malpositioned or impacted lateral incisors. Irregular or crowded upper & lower incisors. Localized gingival recession in the lower ant region Ectopic eruption of teeth. Mesial migration of buccal segment. Arch length deficiency is indicated by the presence of 1 or more of the following features:-

8 Abnormal eruption pattern & sequence. Lower anterior flaring. Ankylosis of 1 or more teeth. 3. Where growth is not enough to overcome the discrepancy between tooth material & basal bone. 4. Patients with straight profile & pleasing appearance.

9 Contraindications of Serial Extraction  Class II & III malocclusion with skeletal abnormalities.  Space dentition.  Anodontia/ oligodontia.  Open bite & deep bite.  Midline diastema.  Class I malocclusion with minimal space deficiency.  Unerupted malformed teeth. Eg. Dilacerations.  Extensive caries or heavily filled I permenent molars.  Mild disproportion between arch length & tooth material.

10 Advantages of Serial Extraction:  Treatment is more physiologic as it involves guidance of teeth into normal positions.  Psychological trauma associated with malocclusion can be avoided by treatment of the malocclusion at an early stage.  It eliminates the duration of multi-banded fixed treatment.  Better oral hygiene is possible thereby reducing the risk of caries.  Health of investing tissue is preserved.  Lesser retention period is indicated at the completion of treatment.  More stable results are achieved as the tooth material & arch length are in harmony.

11 Disadvantages of Serial Extraction:  It can not be universally applied to all patients.  Treatment time is prolonged as the treatment is carried out in stages spread over 2-3 years.  It requires the patient to visit the dentist thus patient co-operation is needed.  As the extraction spaces are created that close gradually the patient has a tendency of developing tongue thrust.

12  Extraction of buccal teeth can result in deepening of the bite.  If the procedure are not carried out properly there is a risk of arch length reducing by mesial migration of the buccal segment.  Ditching or space can exist b/w the canine & 2 nd premolar.  The axial inclination of teeth at the termination of the serial extraction procedure may require correction.

13 Procedure There are mainly three methods:- Dewel’s Method Tweed’s Method Nance method.

14 DEWEL’S METHOD  Dewel has proposed a 3 step serial extraction procedure.  In the 1 st Step, the deciduous canines are extracted to create a space for alignment of the incisors.  This step is carried out at 8-9 years of age.

15  After 1 years, the deciduous 1st molars are extracted so that the eruption of 1st premolars is accelerated.

16  This is followed by the extraction of the erupting 1 st premolar to permit the permanent canines to erupt in their place.

17  In some cases, a Modified Dewel’s Technique is followed where in the 1 st premolar are enucleated at the time of extraction of the 1 st deciduous molars.  This is frequently necessary in the mandibular arch where the canines often erupt before the 1 st PM

18 TWEED’S METHOD:  This method involves the extraction of the deciduous 1 st molars around 8 years of age.  This is followed by the extraction of the 1 st premolar & the deciduous canines.

19 Nance Method:  This is similar to the Tweed’s technique & involves the extraction of the deciduous 1st molars followed by the extraction of the 1st Premolars & the deciduous canines.

20 Problems in the serial extraction Ant. crossbites can broadly classified as:- Dento- alveolar ant. crossbites. Skeletal ant. crossbites Functional ant. crossbites. ANTERIOR CROSSBITES

21 Dento alvealor ant. Crossbites:  Ant. crossbite in which 1 or more maxillary teeth are in lingual relation to the mandibular ant. is termed as “Dentoalveolar ant. Crossbites”.  This is manifested as single tooth crossbite & usually occurs due to over retained deciduous teeth. Functional ant. Crossbites:  Also called “Pseudo Class III Malocclusion”.  Occurs as a result of occlusal prematurities.

22 Skeletal ant. crossbite  These are usually a result of skeletal discrepencies in growth of maxilla or the mandible.  Ant. cross bite can be a result of maxillary retrognathism or hypoplasia or mandibular prognthism.  These are treated by use of myofunctional or orthopadic appliances.

23 References : Textbook of orthodontics : GRABER Textbook of orthodontics : S.I. BHALAJHI


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