As an early orthodontic treatment Serial extraction.. As an early orthodontic treatment supervised by: Dr. Yaser Omar Baroud Dr. Jamal Naim B.D.S. PhD, Orthodontics AL-Mustansiria University _ Iraq Dean of faculty of dentistry University of Palestine

Definitions and Terms Phase I treatment: Treatment initiated during the primary or mixed dentition with the purpose to prevent, intercept or correct an orthodontic problem, also known as, early treatment.

Definitions and Terms Phase II treatment: Treatment initiated during the permanent dentition with a comprehensive approach to correcting the orthodontic problems, also known as, comprehensive treatment.

Definitions and Terms Early Treatment = Phase I treatment

Definitions and Terms Preventive early treatment: Patient education and maintenance of a favorable orthodontic condition. e.g. patient education of stopping digit sucking habits, space maintenance appliances.

Definitions and Terms Interceptive early treatment: Improvement of an orthodontic problem/condition. e.g. Primary tooth guidance extractions, reduction of excessive overjet, growth modification appliances, space redistribution, space creation, deep bite reduction, habit appliances.

Definitions and Terms Corrective early treatment: Complete or nearly complete correction of an orthodontic problem. e.g. Expansion appliances, growth modification appliances, alignment of anterior teeth.

II. Goals of Early Treatment Overall goal of early treatment: To improve or correct orthodontic problems that would result in: Irreversible damage to the dentition and supporting structures. Progression into a more severe orthodontic problem that would be more difficult to treatment in Phase II.

NON SKELETAL ORTHODONTIC ISSUES Crowding Classification Management Anterior Crossbites Etiology Managemant Eruption Disturbances Ectopic eruption of maxillary first permanent molars Mesiodens

SKELETAL ORTHODONTIC ISSUES Transverse problems Vertical Problems

Classification of Mixed Dentition Crowding Incisor Liability = mild amount of transitional crowding of the permanent incisors in a mixed dentition (~2-3mm). Moderate Transitional Crowding: ~ 4mm of anterior crowding Severe Transitional Crowding: ~ >4mm of anterior crowding

Crowding Management Incisor Liability no intervention required Moderate Transitional Crowding: depends on the situation Severe Transitional Crowding: intervention required

Leeway Space Moyers: Proffit: Used for: 2.5mm per side in Mn 2.0mm per side in Mx Proffit: 1.7mm per side in Mn 0.9mm per side in Mx Used for: Crowding Molar drift

Maintaining of arch perimeter Increase of arch perimeter Crowding Management by moderate crowding Maintaining of arch perimeter No treatment and monitoring Space Maintainers Extract primary canines ± LLHA Increase of arch perimeter Arch width expansion Incisor proclination Distalizers – lip bumpers, headgear etc.

Maintaining of arch perimeter Increase of arch perimeter Crowding Management by moderate crowding Maintaining of arch perimeter No treatment and monitoring Space Maintainers Extract primary canines ± LLHA Increase of arch perimeter Arch width expansion Incisor proclination Distalizers – lip bumpers, headgear etc.

Maintaining of arch perimeter Increase of arch perimeter Crowding Management by moderate crowding Maintaining of arch perimeter No treatment and monitoring Space Maintainers Extract primary canines ± LLHA Increase of arch perimeter Arch width expansion Incisor proclination (Utility or AP) Distalizers – lip bumpers, headgear etc.

Maintaining of arch perimeter Increase of arch perimeter Crowding Management by moderate crowding Maintaining of arch perimeter No treatment and monitoring Space Maintainers Extract primary canines ± LLHA Increase of arch perimeter Arch width expansion Incisor proclination (Utility or AP) Distalizers – lip bumpers, headgear etc.

Maintaining of arch perimeter Increase of arch perimeter Crowding Management by moderate crowding Maintaining of arch perimeter No treatment and monitoring Space Maintainers Extract primary canines ± LLHA Increase of arch perimeter Arch width expansion Incisor proclination (Utility or AP) Distalizers – lip bumpers, headgear etc.

Severe Transitional Crowding Signs: Lack of interdental spaces in primary dentition. >4mm of crowding of permanent incisors. Early loss of primary canine by ectopic eruption of lateral incisor. Ectopic eruption of upper first permanent molars.

Severe Transitional Crowding

Management Serial Extraction: A planned sequence of tooth removal during the transition from primary to permanent dentition to promote eruption of teeth through attached gingiva (keratinized tissue) and reduce the severity of crowding. Eruption sequence of the permanent dentition: Maxilla: 6 1 2 4 5 3 7 8 Mandible: 6 1 2 (3 4) 5 7 8

Serial Extraction Case selection: No skeletal disproportions; balanced AP, V, T dimensions 2. Class I molar relationship 3. Non-retrusive lip profile 4. Normal overbite 5. Coincident midlines 6. Severe crowding warranting extractions.

By the age of 7-8, If the upper and lower incisors erupt in a crowded situation, and one can hope that growth in the arch on in the alveolar process can compensate for this crowding,…..

By the age of 7-8, If the upper and lower incisors erupt in a crowded situation, and one can hope that growth in the arch on in the alveolar process can compensate for this crowding, He is wrong!!!!

In some cases the amount of crowding not exceeding 2 mm can be solved spontaneously by the incisal liability or the force generation coming from the active protruding tongue but not all.

Many authors discovered that: (( Inter canine distance sustain the same or increase very minimal after the eruption of permanent incisors))

procedure: Extraction of Cs as soon as the permanent incisors complete their eruption, such extraction will allow spontaneous relief of crowding.

Procedure… Extraction of Ds, and this is done after an accepted alignment of the incisors. The aim of these extractions is to accelerate the eruption of the permanent first premolar.

Extraction of permanent first premolar as soon as they emerge from the oral mucosa, thus allowing the space for the canines and 2nd premolars to occupy the space mesial to 6s and distal to 2s.

Serial extraction

Phase II full braces for alignment, bite and root parallelism. Serial Extraction

Complications: A complication can occur if the primary first molar is extracted early and the first premolar still does not erupt before the canine. This can lead to impaction of the premolar that requires later surgical removal . Loss of some arch perimeter. Concave profile. Increase in overbite. Not enough to solve the problem ( alone).

Before committing a crime….. A complete diagnostic aids should be taken before starting the S.E. procedure and the patient should have at least beside clinical examination an OPG that can demonstrate the existence of the complete dentition at the beginning of the treatment.

Before committing a crime…………….. All the local factors that worsen the crowding should be avoided during the treatment such as presence of S.N.T, as early loss of primary Es or bad conservative work for the rest of the remaining teeth.

Advantages: Immediate relief of crowding or malocclusion. Less time consuming and low cost especially if at the end, the teeth arranged with good alignment. Simple procedure Less duration of wearing orthodontic appliances.

Disadvantages: Subject the child to multiple extraction visits, which may leave a bad impression toward the dentist. Painful.

To be considered…….. SE should be done at both arches at the same time. SE is very good applied in the upper arch rather in the lower arch because of favorable sequence of eruption. The opinion of starting SE with a patient is not a simple one for all (( orthodontist, parents and patient )).

To be considered…….. In a lot of cases the final outcome of teeth alignment are accepted by the parent, patient and even the dentist. However, an upper and lower fixed appliances are needed to give the final touches…. The appliances are worn for 6-8 months only rather than 2-2.5 years.

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