Early orthodontic intervention indications
1. Posterior & anterior?
2. Ankylosis?
3. Excessive?
4. Severe?
5. Ectopic?
6. Pseudo Class?
7. Cleft?
8. arch length?
- Posterior & anterior crossbites.
- Ankylosed teeth.
- Excessive protrusions and diastemas.
- Severe anterior and lateral open bites.
- Ectopic molars.
- Pseudo Class III patients.
- Cleft palate patients.
- Severe arch length discrepancies
Changes in Arch Dimension for maxilla
Maxillary arch length remains the same
Maxillary intercanine distance increases 4.8mm
Changes in Arch Dimension of mandible
- Mandibular arch length decreases 1.7mm.
- Mandibular intercanine distance increases 3.2mm
what examination is useful for determining extractiomn cases from non-extractions
cephalometrics
is facial profile universal
no, dif among ethnicities
What do we need to analyze in
order to make the decision for
Serial Extraction Therapy?
- ceph
- crowding (MDA)
- profile
- curve of spee
how can curve of spee influence arch length
a flatter curve will increase arch length
deep curve of spee
hidden crowding
To estimate the needed arch length to level the curve of Spee, what is measured?
To estimate the needed arch length to level the curve of Spee, measure the maximum depth of the curve on both sides, get the average measurement and add 0.5mm.
If the mixed dentition analysis predicts that there is not a crowding problem, what is done?
continue with periodic patient observation
If the mixed dentition analysis predicts light crowding (1 - 4 mm.), what is done?
maintain the arch length with any appliance and examine the patient periodically, probably there will be a need for future orthodontic treatment.
If the mixed dentition analysis predicts crowding of more than 4mm, what is done?
most probably the patient will develop crowding in the permanent dentition which will require orthodontic treatment after a thorough evaluation
If the mixed dentition analysis predicts crowding in excess of 6mm, what can benefit the pt man arch?
In the mandibular arch, the patient will benefit form serial extraction therapy.
Serial extraction
Serial extraction is the orderly removal of deciduous and permanent teeth in a determined sequence.
prerequities to serial extraction
1. Skeletal class
2. Dental class
3. Bimax?
4. Dental crowding in excess of?
5. bite pattern?
6. No congenitally missing?
- Skeletal class I.
- Dental class I.
- Bimax dental protrusion.
- Dental crowding in excess of 6mm.
- Light or anterior open bite tendency.
- No congenitally missing second bicuspids
benefits of serial extraction
1. Naturally induced?
2. Health improvement of?
3. Psychological and cooperation?
4. Decrease on?
5. Less?
- Naturally induced movement and
alignment of severely crowded anterior teeth. - Health improvement of the adjacent tissues.
- Psychological and cooperation
improvement, due to the incisor alignment. - Decrease on the orthodontist work load and stress.
- Less iatrogenic damage.
disadvantages of serial extractions
1. Increase of?
2. incisors inclination?
3. tissue on the extraction spaces?
4. excess space?
- Increase of the overbite.
- Lingual inclination of incisors.
- Scaring tissue on the extraction spaces.
- Diastemas with excess space
forms of serial ext
conventional and alternative
Conventional serial extraction:
- Premature extraction of deciduous canines provides the space for the incisors to assume normal position over supporting bone
- Extraction of the first deciduous molars permits the desirable early eruption of the first premolars
- Final extraction of first premolars makes it possible for the canines to erupt in a favorable direction.
conventional serial extraction order
- primary canines
- primary 1st molar
- perm 1st PM and 2nd primary molar
- PLACE FIXED APPLIANCE FOR ALIGNMENT
periodic eval with conventionals serial ext
6mo interval, examine root development for extractions
Prerequisites in alternative serial extraction
1. Borderline?
2. Deciduous teeth present?
3. Moderate loss of?
4. No irregularity on?
5. gingiva?
6. Second deciduous molars in place for?
- Borderline malocclusion (extraction?).
- Deciduous cuspids present.
- Moderate loss of arch length.
- No irregularity on lower incisors.
- No gingival recession.
- Second deciduous molars in place for a long time
alternative serial ext seq
- 1st primary molar
- perm 1st PM
- primary canine and 2nd primary molar
- FIXED APPLIANCE PLACED WHEN EXT DONE
