Seminar report on-

“Extractions In Orthodontics”

Presented by -

Irfan Zunzani

BDS – Final Year

Introduction

Painless removal of teeth from its socket is termed as Extraction. It is one of the most common methods of gaining space in the arch.

Need For Extraction

• Arch length – tooth material discrepancy :-Ideally the arch length and tooth material should be in

harmony with each other. If the dentition is too large to fit in the dental arch without irregularity, it may be necessary to reduce the dentition size by the extraction of teeth. It is not normally acceptable to increase the dental arch size, because the increased dental arch dimension would not be tolerated by the oral musculature.

• Correction of Sagittal Interarch Relationship :-In a Class I malocclusion it is preferable to extract in both the

arches because it is not advisable to discourage the development of only one arch more than the other.

In most Class II cases with abnormal upper proclination, it is advisable to extract teeth only in the upper arch and to retract the maxillary incisors and canines. In case of the lower arch crowding it is advisable to extract in both the arches.

Class III cases are usually treated by extracting teeth only in the lower arch to discourage the forward growth of mandibe.

• Extraction for the Relief of Crowding :-

Condition of the teeth - Fractured, hypoplastic, grossly carious teeth, root canal treated teeth and teeth with large restorations are preferred for extraction over healthy teeth.

Position of the crowding - Crowding in one part of the arch is more readily corrected if extractions are done in that part rather than a remote area of the arch. The first premolar, positioned in the centre of each quadrant, is usually near the area of crowding whether in the anterior or buccal segment. Hence, it is also the tooth most frequently extracted along with orthodontic treatment.

Position of the teeth - Grossly malpositioned teeth which arc difficult to align may often be the teeth of choice for extraction.

DIFFERENT EXTRACTION PROCEDURES

• Balancing extractions

• Compensating extractions

• Phased extractions

• Enforced extractions

• Wilkinson extractions

• Stobies extractions

• Serial extractions

• Driftodontics

• Balancing Extractions :-

Balancing extractions may be defined as

the removal of a tooth on the opposite side of the same arch (although not necessarily the antimere) in order to preserve symmetry.

• Compensating Extractions :-In this procedure extraction of teeth are

carried out in opposing arches to maintain buccal occlusion. In some Class I crowding cases, it is necessary to extract in both the arches to maintain lateral symmetry. Compensating extractions preserve inter-arch relationship by allowing the posterior teeth to drift forward together.

• Phased Extractions :-

It may be possible to effect a change in molar

occlusion by extracting in one arch only, or a few months earlier than in the other. Thus extractions done in phases, so called as Phased Extractions.

• Enforced Extractions :-These extractions are carried out because they

are necessary as in the case of grossly decayed teeth, poor periodontal status, fractured tooth, impacted tooth, etc.

• Wilkinson Extraction :-Wilkinson advocated extraction of all the four first

permanent molars between the age of 8 ½ & 9 years. The basis of it is the fact that first molars are highly susceptible to caries.

The other benefits of extracting first molars at an early age are:-

– To avoid third molar impactions by providing additional space for their eruption.

– To reduce crowding in the arch.

Wilkinson‘s extractions are not usually carried out because of various drawbacks as

—first molar extraction offers limited space for crowding correction.

—2nd bicuspid & 2nd molar rotate & may tip into the extraction space.

• Stobies Extractions :-Extractions of two premolars at the same time.

• Serial Extractions :-Concept was introduced by Kjellgren.

Nance is known as the Father of serial Extractions.It is defined as Extractions of certain deciduous teeth and permanent teeth in selected cases to overcome crowding. Usual sequence of extraction is primary canines, primary first molars & first premolar.

• Driftodontics :-This concept is applicable when extraction of the

permanent teeth are done without appliance therapy. Teeth have a natural tendency to drift into the extraction space.

Extraction of the lower first premolars are often associated with spontaneous decrowding of lower anteriors. Such spontaneous decrowding by drifting of teeth is referred to as Driftodontics, & is less frequent in upper arch.

CHOICE OF TEETH FOR EXTRACTION

Choice of teeth to be extracted depends on local conditions which include:

• Direction and amount of jaw growth.

• Discrepancy between size of dental arches and basal arches.

• State of soundness, position and eruption of teeth.

• Facial profile.

• Degree of dentoalveolar prognathism.

• Age of patient.

• State of dentition as a whole.

Indications For Extraction Of Different Teeth

A

Conclusion

Extractions are done depending upon the choice of treatment by Orthodontist. They are done to give A Perfect Smile.

A PERFECT SMILE

Thank you