1. Marshitah ,Sakinah,Syafiqah, Hamzi,Azizul ,Fais , Asmat,Fatin ,Fadhila
Interceptive & Preventive Orthodontics Serial Extraction Submerged Deciduous Tooth Extractions in Orthodontics Date : 15/5/2014
Marshitah ,Sakinah,Syafiqah,
Hamzi,Azizul ,Fais ,
Asmat,Fatin ,Fadhila

2. Serial Extraction

3. Serial extraction
Is a form of interceptive orthodontic treatment which aims to relieve crowding at an early stage so that the permanent teeth can erupt into good allignment.
It consists of planned sequence of
extractions:
Primary canines
First primary molars
First premolars

4. Different methods have been described such as:
TWEED : DC4
NANCE : D4C
DEWEL : CD4

5. (a) Class I occlusion with incisor crowding in the mixed dentition.b. a.
Serial extractions.
(a) Class I occlusion with incisor crowding in the mixed dentition.
(b) Improved incisor alignment following extraction of primary canines. The primary first molars are extracted to encourage eruption of first premolars.
(c) First premolars are extracted on eruption to relieve crowding of the permanent canines.
(d) the result following eruption of the canines. c. d.

6. Indication for serial extraction:
Significant incisors crowding
Palatal or lingual eruption of lateral incisor
Class I occlusion without a deep overbite.
All permanent teeth are present.
First permanent molars in good condition.

7. Contraindication or serial extraction:
Class I malocclusion where the lack of space is slight and the teeth show only mild crowding.
Where there is a skeletal discrepancy in the dental arches.
When there is a deep overbite or an open bite, these should be treated before undertaking serial extraction.
When there are permanent teeth congenitally absent from the dental arch.

8. Contraindication or serial extraction:
Spaced dentition
In patient with cleft lip and palate
Midline diastemia
Dilacerations
Extensive caries

9. Advantage
Disadvantage
To minimize or
eliminate the need for
appliances
-reduce cost of treatment
- More stable result
Need a space
maintainer following
extraction of the first
premolar if the
crowding is severe.
Multiple episodes of
extractions
trauma to patient.

10. Submerged deciduous tooth

11. Extractions in orthodontics

12. Extraction:
removal of the teeth from the socket
most common method to gain space in the arch

13. Reason for Etraction 3) Abnormal size/ shape tooth
-dens invaginatus/evaginatus
-peg-shaped
To provide space
Alignment of teeth/ relief crowding
Moving anterior teeth back
Moving posterior teeth back
Reduce overjet
Reduce arch form
Improve patient profile
Anchorage control
2) Forced extraction
-poor prognosis teeth
-badly carious, unrestorable, heavily filled, very mobile, cracked tooth, perio condition
-teeth in poor position

14. Factors to be consider before extraction in orthodontics
Malocclusion
Class II div 1: upper 1st premolars and lower 2nd premolars
Class II div 2: upper 1st premolars only
Class III: upper 2nd premolars and lower 1st premolars
Crowding
Mild crowding: non extraction
Moderate: 2nd premolars
Severe: 1st premolars
Type of appliances
Less anchorage if using removable appliances
Caries
Heavily restored tooth (>2 surface restoration)
Tooth abnormality

15. Tooth for extraction: Central incisors Lateral incisors Canines Rare
Avulsed/forced xn
Lateral incisors as replacement
Lateral incisors
Abnormal size & shape
Poor prognosis (trauma, caries or gingival recession)
Canines
Rarely extract
Extract if totally excluded from arch
Acceptable 1st premolar replacement in upper arch

16. Premolars First molars Most common
Each premolar gives 7mm space with maximum anchorage
2nd premolar provide less anchorage than 1st premolars
First molars
Rarely choice of extraction
Not relieve anterior crowding
Problem with anchorage control if 2nd molar not erupted
Problem of space closure (could add extra 6 months of tx time)
Poor contact between 2nd molar and 2nd premolar

17. Second molar Third molar In mild crowding of posterior teeth
Severe impaction
Relief crowding of 3rd molars
Relief crowding vertically impacted 2nd premolar
Third molar
Impacted
Caries
Distalization or uprighting molars

18. Points to consider before extraction
Profile
Face height
Lip competence
Dental arch width
Space analysis
Radiographic analysis

19. Problem with extration site if extraction done too early before orthodontic treatment
Loss of space and anchorage
Narrowing of dento alveolus
Loss of cortical and cancelous bone
Problem with space closure
Fenestration of the bone
Tipping of adjacent teeth
Problem with miniscrew insertion

20. Care during extraction
Please extract the CORRECT tooth
If in doubt, please contact the referring orthodontist before extraction
Control infection
Gentle pressure
Preserve buccal and lingual alveolar plate
Care not to damage adjacent teeth