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SERIAL EXTRACTION
Contents
Introduction Definition Indications Contraindication Diagnosis Methods Advantages Disadvantages Conclusion References
Interceptive Orthodontics
It is that phase of the science and art of orthodontics employed to recognize and eliminate potential irregularities and malpositions in the developing dentofacial complex.
Serial extraction
Diseases of teeth by Robert Bunon(1743) Term coined by Kjellgren(1929) Father of serial extraction Nance(1940) Hotz gave a new term called guidance of eruption(1970)
According to Tweeds it is defined as:- the planned and sequential removal of primary and permanent teeth According to Tandon it is defined as:- The correctly timed and planned removal of certain deciduous and permanent teeth in mixed dentition cases with dentoalveolar disproportion
Indications
Class I malocclusion with arch size tooth size discrepancy of more than 5mm per quadrant, normal eruption sequences as assessed radiographically and a skeletal growth pattern within normal limits
Contraindication
Mild to moderate crowding
Malocclusion
Spaced dentition
Congenital absence Open bite deep bite
Diagnosis
Study models Assess dental anatomy Assess intercuspation of tooth Assess the arch form & curve of Spee Evaluate occlusion Model analysis Between and post treatment assessment
Lateral cephalograms
OPG
1. 2. 3. 4. 5. 6. 7. 8.
Detection of congenitally missing teeth Detection of any bony pathosis Undertake radiographic mixed dentition analysis Assess the stage of root development To determine the dental age of patient To assess facial patterns To assess soft tissue changes To assess treatment progress
Photographs
Important for self evaluation Patient motivation Evaluation of changes extra orally To assess any hypo or hyperactivity of muscles
Methods
Tweeds method ( DC4 )
Grewes method
Class I malocclusion with premature loss of deciduous mandibular canine ( CD4 )
Advantages
More physiologic treatment Duration of fixed treatment is reduced Health of investing tissue is preserved Lesser retention time required Results are more stable
Disadvantages
Good clinical judgment is required Treatment time is prolonged over 2 to 3 yrs Patient co-operation is required Tendency to develop tongue thrust habit Extraction of buccally placed teeth will cause deep bite Residual space may remain between canine and second premolar Some amount of fixed appliance is usually required at the end of serial extraction
Conclusion
As a coin has two sides so has serial extraction It is upto the clinician to decide which procedure is good for his patient . Because no single approach can be universally applied.