Serial extraction

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Serial extraction is the planned extraction of certain deciduous teeth and specific permanent teeth in an orderly sequence and predetermined pattern to guide the erupting permanent teeth into a more favorable position.

Contents

History

In 1929, Kjellgren [1] of Sweden used the term "serial extraction" for the first time. [2] [1] In the 1940s the technique was popularised in the United States by Hayes Nance [3] as “planned and progressive extraction”. Nance is known as the Father of serial extraction in the United States. [4] In 1970 Hotz [5] in Switzerland called it active "supervision of teeth by extraction".

Procedure

There is no fixed technique to be followed while carrying out serial extractions. Careful diagnosis and continuous re-evaluation during the course of treatment is mandatory to achieve required results.

However based on the usual eruption sequence of teeth, deciduous canines are extracted at the age of 8–9 years to create space for proper alignment of incisors, followed by extraction of deciduous first molars a year later so that the eruption of first premolars is accelerated and lastly extraction of the erupting first premolars to give space for the alignment of permanent canines. In some cases a modified technique is followed in which the first premolars are enucleated at the time of extraction of the deciduous first molar. This modification is frequently necessary in the mandibular arch where the canines often erupt before the first premolars. [6]

Selection of suitable extraction procedure

Extracting the primary canines only – it produces rapid self-improvement in incisor crowding and alignment intercepting the development of lingual crossbite of the lateral incisors.

Extracting the first primary molars only – this approach produces the earlier eruption of first premolars but reduces the rapidity and amount of incisor alignment. This is the result of retention of primary canines.

Extracting both primary canines and first molars – this is a compromise between rapid improvement in incisor alignment and the desired early eruption of first premolars. In some cases this sequence results in simultaneous eruption of canines and first premolar, which may cause an increased distal translation of the permanent canines and possible impaction of first premolars.

Enucleation of first premolar buds – it is advocated when first premolar eruption is behind that of canines and second premolars. This allows maximal distal translation of the erupting canines.it is rarely indicated in the maxillary arch.

Indications

Contraindications

Advantages

Disadvantages

Assessments to be made before contemplation of serial extraction

Intraoral diagnostic assessment

The diagnosis is based on a thorough case history, clinical examination of the patient, photographs, plaster study models, cephalometric radiographs, panoramic and periapical radiographs.

Growth and development analysis

Periodic growth assessment records should be made in all patients where growth is still going on i.e. made until 14 to 16 year old in girls and 18 to 19 year old in boys.

Functional analysis

Checking various functional movements like swallowing, respiration, speech, opening and closing and excursive movements of the mandible and careful palpation of both temporomandibular jointsis important.

Morphologic assessment

It includes assessment of tooth mass, arch form, arch length, skeletal pattern, skeletal growth potential, orofacial musculature, facial aesthetics, oral habits and hereditary assessment of parents and siblings. The most favorable morphologic factors for serial extraction include class 1 malocclusion, a favorable morphogenetic pattern – one that does not change, a flush terminal plane or a mesial step relationship of the primary second molars, minimum overjet and minimum overbite.

Space analysis

Assessment of the tooth size – arch length relationship in the mixed dentition determines the presence or absence of any future or existing discrepancy, whether it is crowding or spacing. It involves the prediction of tooth size of the unerupted permanent canines and premolars. A caliper or a fine line divider is used to measure the combined width of teeth in each segment using study models. The circumferential measurement is made on the plaster cast from mesial aspect of first molar on one side to the mesial aspect of the first molar on the opposite side, and this measurement is recorded. Combined width of the permanent teeth is taken from intraoral radiographs and compared with the available arch length.

Factors to be considered in space analysis

  • A curve of occlusion formula is used to determine the additional space required to flatten the curve of spee.
  • For every 1 degree of labial or lingual tipping of the mandibular incisors there is 0.8 mm of respective increase or decrease in arch length.
  • The clinical image of the patient involves the interpretation of that individual’s own data because patients represent multiracial origins and therefore a unified norm is difficult to determine.

Factors to consider during serial extraction

See also

Related Research Articles

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<span class="mw-page-title-main">Incisor</span> Front teeth of most mammals

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<span class="mw-page-title-main">Premolar</span> Transitional teeth located between the canine and molar teeth

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<span class="mw-page-title-main">Malocclusion</span> Medical condition

In orthodontics, a malocclusion is a misalignment or incorrect relation between the teeth of the upper and lower dental arches when they approach each other as the jaws close. The English-language term dates from 1864; Edward Angle (1855-1930), the "father of modern orthodontics", popularised it. The word "malocclusion" derives from occlusion, and refers to the manner in which opposing teeth meet.

<span class="mw-page-title-main">Maxillary canine</span>

In human dentistry, the maxillary canine is the tooth located laterally from both maxillary lateral incisors of the mouth but mesial from both maxillary first premolars. Both the maxillary and mandibular canines are called the "cornerstone" of the mouth because they are all located three teeth away from the midline, and separate the premolars from the incisors. The location of the canines reflects their dual function as they complement both the premolars and incisors during mastication, commonly known as chewing. Nonetheless, the most common action of the canines is tearing of food. The canines often erupt in the upper gums several millimeters above the gum line. The canine teeth are able to withstand the tremendous lateral pressure caused by chewing. There is a single cusp on canines, and they resemble the prehensile teeth found in carnivorous animals such as the extinct saber-toothed cat. Though relatively the same, there are some minor differences between the deciduous (baby) maxillary canine and that of the permanent maxillary canine.

<span class="mw-page-title-main">Tooth eruption</span> Process in tooth development

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<span class="mw-page-title-main">Overjet</span> Medical condition

Overjet is the extent of horizontal (anterior-posterior) overlap of the maxillary central incisors over the mandibular central incisors. In class II malocclusion the overjet is increased as the maxillary central incisors are protruded.

<span class="mw-page-title-main">Crossbite</span> Medical condition

Crossbite is a form of malocclusion where a tooth has a more buccal or lingual position than its corresponding antagonist tooth in the upper or lower dental arch. In other words, crossbite is a lateral misalignment of the dental arches.

<span class="mw-page-title-main">Lingual arch</span>

A lingual arch is an orthodontic device which connects two molars in the upper or lower dental arch. The lower lingual arch (LLA) has an archwire adapted to the lingual side of the lower teeth. In the upper arch the archwire is usually connecting the two molars passing through the palatal vault, and is commonly referred as "Transpalatal Arch" (TPA). The TPA was originally described by Robert Goshgarian in 1972. TPAs could possibly be used for maintaining transverse arch widths, anchorage in extraction case, prevent buccal tipping of molars during Burstonian segmented arch mechanics, transverse anchorage and space maintenance.

Dentition analyses are systems of tooth and jaw measurement used in orthodontics to understand arch space and predict any malocclusion. Example systems of dentition analysis are listed below.

Molar distalization is a process in the field of Orthodontics which is used to move molar teeth, especially permanent first molars, distally (backwards) in an arch. This procedure is often used in treatment of patients who have Class 2 malocclusion. The cause is often the result of loss of E space in an arch due to early loss of primary molar teeth and mesial (forward) migration of the molar teeth. Sometimes molars are distalized to make space for other impacted teeth, such as premolars or canines, in the mouth.

Pendulum is an orthodontic appliance, developed by James J. Hilgers in 1992, that use forces to distalize the upper 1st molars to create space for eruption of impacted teeth or allowing correction of Class 2 malocclusion. This appliance is a fixed type of distalizing appliance that does not depend on the compliance of each patient to work. Hilgers published an article in Journal of Clinical Orthodontics in 1992 describing the appliance.

Intrusion is a movement in the field of orthodontics where a tooth is moved partially into the bone. Intrusion is done in orthodontics to correct an anterior deep bite or in some cases intrusion of the over-erupted posterior teeth with no opposing tooth. Intrusion can be done in many ways and consists of many different types. Intrusion, in orthodontic history, was initially defined as problematic in early 1900s and was known to cause periodontal effects such as root resorption and recession. However, in mid 1950s successful intrusion with light continuous forces was demonstrated. Charles J. Burstone defined intrusion to be "the apical movement of the geometric center of the root (centroid) in respect to the occlusal plane or plane based on the long axis of tooth".

Open bite is a type of orthodontic malocclusion which has been estimated to occur in 0.6% of the people in the United States. This type of malocclusion has no vertical overlap or contact between the anterior incisors. The term "open bite" was coined by Carevelli in 1842 2 as a distinct classification of malocclusion. Different authors have described the open bite in a variety of ways. Some authors have suggested that open bite often arises when overbite is less than the usual amount. Additionally, others have contended that open bite is identified by end-on incisal relationships. Lastly, some researchers have stated that a lack of incisal contact must be present to diagnose an open bite.

An ectopic maxillary canine is a canine which is following abnormal path of eruption in the maxilla. An impacted tooth is one which is blocked from erupting by a physical barrier in the path of eruption. Ectopic eruption may lead to impaction. Previously, it was assumed that 85% of ectopic canines are displaced palatally, however a recent study suggests the true occurrence is closer to 50%. While maxillary canines can also be displaced buccally, it is thought this arises as a result of a lack of space. Most of these cases resolve themselves with the permanent canine erupting without intervention.

Orthodontic indices are one of the tools that are available for orthodontists to grade and assess malocclusion. Orthodontic indices can be useful for an epidemiologist to analyse prevalence and severity of malocclusion in any population.

References

  1. 1 2 Kjellgren, B. (January 1948). "Serial extraction as a corrective procedure in dental orthopedic therapy". Acta Odontol. Scand. 8 (1): 17–43. doi:10.3109/00016354809014459. PMID   18910774.
  2. https://old.amu.ac.in/emp/studym/100013672.pdf [ bare URL PDF ]
  3. Graber, T.M. (1996). Orthodontics principles and practice.
  4. Graber, T. M.; Vanarsdall, R.L. (1994). Orthodontics: Current Principles and Techniques.
  5. Norman, F. (April 1965). "Serial Extraction". Angle Orthod. 35 (35): 149–57. PMID   14280966.
  6. Proffit, William R.; Fields, Henry W.; Sarver, David M. Contemporary Orthodontics (4th ed.).