continuing dental education for general dentist at MYANMAR.

1. EXTRACTIONS IN
ORTHODONTICS
TED NAING
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3. Reasons for extration
• ( 1) to provide space to align the remaining teeth in
the presence of severe crowding , and
• (2) to allow teeth to be moved(usually, incisors to be
retracted
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4. • . The alternative to extraction in treating dental crowding
is to expand the arches
• the alternative for skeletal problems is to correct the jaw
relationship, by modifing growth or surgery.
• All other things being equal, it is better not to extract-but
in some cases extraction provides the best treatment.
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5. • Wolff's law,
• German anatomist and
surgeon Julius
Wolff (1836–1902) in the
19th century,
• states that bone in a
healthy person or animal
will adapt to the loads
under which it is placed
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6. Two main concept of E H Angle
• . The first concept was that
skeletal growth could be
influenced readily by
external pressures.
• The second concept was
that proper function of the
dentition would be the key
to maintaining teeth in their
correct position.
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8. Non extraction ideal profile of
E.H. Angle
Alexander the Great
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9. THE GREAT EXTRACTION DEBATE
Angle’s thesis was that “there
shall
be a full complement of teeth, and
that each tooth shall be made to
occupy its normal position”.
climax of this conflict was a debate in
1911 at the annual meeting of the
National Dental Association (former
name of the ADA).
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10. ALLEN G BRODIE 1897-1976
• Brodie, who became
Angle’s torchbearer, said,
“If I say it’s OK to extract,
the first thing you know,
• everybody’s going to be
extracting instead of
making a proper
diagnosis. Doctor Angle
told me that and it’s true”.
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12. Re-introduction of extractions
in Mid-20 century
• . Four first premolar teeth
were removed and the
anterior teeth were aligned
and retracted. After the
retreatment,
• Tweed observed that the
occlusion was much more
stable. Tweed's dramatic
public presentation of
consecutively treated cases
with premolar extraction
caused a revolution in
American orthodontic thinking
and led to the widespread
reintroduction of extraction
into orthodontic therapy by
the late 1940s.
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13. Extractions of teeth
for orthodontic reason
By the early 1960s
more than half the American patients undergoing orthodontic treatment had
extraction of some teeth, usually but not always first premolars. Since the
Accepted concept was that orthodontic treatment could not affect facial growth,
extraction was considered necessary to accommodate the teeth to discrepancies
in jaw position as well as to overcome crowding caused by tooth-jaw
discrepancies ,and was done for either or both purposes.
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14. Rate of extractions in orthodontic cases at
UNC in a long term COHORT study
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15. Extraction of first premolars usually is
done
for treatment of crowding/protrusion
extraction of upper first or
upper first/lower second premolars
indicates Class ll camouflage;
other extractions are done for a variety
of purposes related
to impaction a symmetry and tooth-
sized discrepancy Note that
the number of patients with extraction
of four first premolars
Increasesd harply in the r96os,declined
to the 1953 level in 1993,
and has remained at approximately
that level since then. The
number of patients with extraction for
Classll camouflage also
Increased in the 195os and decreased
there after, but did not
change nearly as much. The number of
patients with other all other extractions
has been remarkably constant for 5o
years.
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16. Second premolar extraction
emphasized that closure of extraction spaces
requires “a delicate balance . . . between anterior
anchorage and posterior resistance”.
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CAREY DEWEL

17. Esthetic plane and soft tissue balance
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20. Authors and their inventions
author Disease of teeth
Robert
Bunon(1743)
First reference to extraction of primary
teeth to facilitate alignment of
permanent teeth
Kjellgren(1929) First coined the term serial extraction
Nance(1940) Popularized the procedure consider
father of serial extraction technique
Hotz(1970) Argued against the term serial
extraction to call it guidance of eruption
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21. DEWEL’s method; CD4
steps Tooth extracted purpose
Step 1 Extractions of
deciduous canines
Alignment of incisors
Step 2 Extraction of
deciduous first
molars
To facilitate the eruption of
first premolar ahead of
canines
Step 3 Extractions of first
premolars
To facilitate eruption of
permanent canines
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22. TWEED’s method ;D &4+C
• This method involves the extractions
of deciduous first molars at 8 yrs of
age.
• This is followed by the extractions of
first premolars and the deciduous
canines simultaneously.
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23. NANCE’s method; D4C
• Nance method of serial extraction is a
modification of Tweed’s method
which involves the extraction of the
deciduous first molars followed by the
extraction of the first premolars and
the deciduous canines.
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24. Indications for serial extractions
• In cases of class 1 malocclusion that show harmony between skeletal
and muscular system
• Cases which present with arch length deficiency – indicated by the
presence of one or more of the following:
• Absence of physiologic spacing
• Unilateral or bilateral premature loss of deciduous canines with midline shift
• Malpositioned or impacted lateral incisors that erupt palatally out of the arch
• Markedly irregular or crowded maxillary and mandibular anteriors
• Localized gingival recession in the mandibular anterior region
• Ectopic eruption of teeth
• Mesial migration of buccal segment
• Abnormal eruption pattern and sequence
• Mandibular anterior flaring
• Ankylosis of one or more teeth
• Cases with insufficient growth to overcome the tooth material – basal
bone discrepancy.
• Patients with straight profile and pleasing appearance
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25. Contraindications for serial extractions
• Class 2 and class 3 malocclusion with skeletal
abnormalities.
• Patients with adequate spacing in dentition
• Cases of anodontia/oligodontia
• Patients with open bite and deep bite
• In cases of midline diastema
• Class 1 malocclusion with minimal space deficiency
• Unerupted malformed teeth e.g. dilacerations
• Extensive caries or heavily filled first permanent molars
• Mild disproportion between arch length and tooth material
that can be treated by proximal stripping
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26. Assessments to be made before
contemplation of serial extraction
• Intraoral diagnostic assessment
• Growth and development analysis
• Functional analysis
• Morphologic assessment
• Space analysis
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37. ROBERT E MOYERS’ probability chart
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41. • In treating growing children, the
orthodontist must always keep in
mind that patients are "moving
targets." Whether an extraction or
a nonextraction case, the patient is
a new person at every
appointment.
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42. Choice of teeth for extraction
• The amount of tooth material excess in relation to arch
length, (degree of discrepency and site of crowding.)
• The anteroposterior inter-arch
relationship(molar,canine&incisor relation)
• Profile of the patient.
• Age of the patient and his/her dental developmental
status.
• The direction of jaw growth.
• Carious status of the teeth.
• General health status of the dentition.
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43. Patient examination
• Transverse
• Vertical and
• Antero-posterior
dimension of the face
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44. Emphasize on
both soft and hard tissue of dentofacial
complex
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45. Find the problems
encounterd with the patient
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46. Thinking about norms
and facial balance
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47. Dental irregularities
in 3 planes of space
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48. Aesthetic consideration and smile arc
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49. Discrepency index of ABO
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HISTORY
TAKING
CLINICAL
EXAMINATION
ANALYSIS OF
DIAGNOSIS
RECORDS
Questionaries
and interview
Intra-oral and
extra-oral
Models,photographs,OPG,
Cephalograms,etc
SKELETAL
DENTAL
SOFT
TISSUE
HABIT
FUNCTION
ORTHODONTIC
PROBLEM LISTS
TREATMENT
OBJECTIVES
TREATMENT
PLAN
MECHANICAL PLAN
ANCHORAGE PLAN
CHOICE OF
EXTRACTION
RETENTION PLAN
APPLIANCE DESIGN
TIMMING OF TREATMENT

53. EXTRACTION WIGGLEGRAM
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54. Extractions of specific teeth
LOWER INCISOR
• In general,removal of lower incior should be avoided as
the intercanine width tend to decrease which can result in;
• Upper anterior crowding
• Resulting increase overjet
1.when the lower incisor is grossly displaced out of the arch
2.When ectopic and space is required a greater amount
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55. Extractions of specific teeth
UPPER INCISORS
• Upper incisors are rarely the extraction of choice to treat a
malocclusion
• long term prognosis of the teeth is poor
• Nonvital,dilacerated,abnormal form or root filled incisors
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56. Extractions of specific teeth
UPPER CANINES
• When Ectopic canine did not possible to achieve its
stimulation of eruption
Extraction of canine may compromise the canine guidance
of occlusion,poor contact between lateral incisor and first
premolar
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57. Extractions of specific teeth
PREMOLARS
• Premolars are the ideal choice for extraction to relieve
anterior and or posterior crowding.
• First and second premolars have the same crown form
and the resulting contact may possible when one of
premolars removed.
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58. Extractions of specific teeth
FIRST MOLARS
• First molar extraction require careful planning
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59. Extractions of specific teeth
SECOND MOLARS
• Role of loss of second molars in orthodontics was
presented by Thomas.
• To facilitate the eruption of third molar obviating the need
for surgical removal of last molar in later age
• To allow for relief of premolar crowding
• May prevent crowding in well aligned lower arch
• Distal movement in the upper arch is more reliable and
more stable
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60. CONCLUSION
Many factors influence
the choice of teeth for extraction and
careful treatment planning in conjunction with
good patient cooperation,
appliance selection and management of the
treatment are essential if an acceptible
aesthetics and functional occlusion is to be
achieved.
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61. Dr.Tom Pitts
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62. Birds are fly. Fishes are swim.
Every man should make the history!
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63. REFERENCES
• Contemporary Orthodontics; 5th edition;Proffit,Field and
Server,2005
• History of Orthodontics; by Basavaraj Subhashchandra
Phulari, Jaypee Brothers Medical Publishers (P) Ltd,2013
• Alexander Discipline;by RG Wick Alexander,
Quantessences publishing,2008
• Radiographic Cephalometry ;by Alex Jacobson,
Quantessences publishing,1995
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64. THANK YOU!
THANKYOU!
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