Mathods of Gaining Space

8/4/2019 Mathods of Gaining Space

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“METHODS OF GAINING SPACE”

Submitted by:- Aamir faiz

(02) (B.D.S. Final year)



“METHODS OF GAINING SPACE” The correction of many malocclusions requires space

in order to move teeth in to more ideal locations.

Space is required for correction of crowding,retraction of proclined teeth, leveling a steep curve of spee, derotation of anterior teeth and for correction of unstable molar relation.



SOME OF THE METHODS OF GAINING SPACE

INCLUDES :

• PROXIMAL STRIPPING

• EXPANSION

• EXTRACTION• DISTALISATION

• UPRIGHTING OF MOLARS

• DEROTATION OF POSTERIOR TEETH

• PROCLINATION OF ANTERIOR TEETH



“PROXIMAL STRIPPING” It is a method by which the proximal surface of the

teeth are sliced in order to reduced the mesiodistal width of the teeth.

Synonyms- reproximation, slenderization, disking,proximal slicing.

Although this procedure is routinely carried out on thelower anterior it can also be done on the upper anteriorand buccal segments of the upper and lower arches.



“INDICATIONS OF PRXIMAL

STRIPPING” When the space required is minimal that is 0- 2.5 mm.

To avoid extractions.

If the bolton’s analysis show mild tooth material excessin either of the arches.

it can be undertaken in the lower anterior region as anaid to retention.



“CONTRAINDICATION” It is not carried out in younger

patients as they possess large pulp

chamber which increase the risk of pulp exposure

Patients who are susceptible tocaries or who have high cariesindex.



“ADVANTAGES” To avoid extraction in border line cases

A more favorable overbite and overjet relation can beestablished by eliminating tooth material excess in

either of the arches. More stable results can be established by broadening

the contact area there by eliminating small contactpoints which can slip and cause rotation of teeth.



“DIAGNOSTIC AIDS” Arch perimeter analysis- arch perimeter or carey’s analysisshowing tooth material excess of 0-2.5mm over the archlength is a diagnostic criteria favoring reproximation.

Bolton’s analysis- it revealing an excess of tooth material ineither of the arches in the indication of tooth material inthat arch. Minimal inter arch tooth material. discrepanciescan also be corrected by proximal stripping

Intra oral periapical radiographs- this would give an idea of the enamel thickness and a rough estimate of the amountof enamel that can be removed from the proximal surface

without exposure to pulp chamber.



“AMOUNT OF PROXIMAL STRIPPING” Not more than 50% of enamel

thickness should be reduced by proximal stripping wheneverreproximation is under taken in a

segment of an arch it is advisable toequally distribute them over all theteeth.



“DISADVANTAGES” This procedure creates roughened proximal surfacethat attracts plaque.

Caries susceptibility is increased.

Sensitivity of teeth.

Improper procedure can result in alteration of morphology of tooth and creating an unnaturalappearance of tooth.

Loss of contact between adjacent teeth may result infood impaction.



“PROCEDURE” Three procedures-

Use of metallic abrasive strips

Safe sided carborundum discs

Long thin tapered fissure burs



“FLOURIDE APPLICATION” The increased cariessusceptibility after

slenderization is managed by acomprehensive flouride

programme following theprocedure.



“EXPANSION” It is usually undertaken in patient havingconstricted maxillary arch or in patients withunilateral or bilateral cross bite.

Expansion can be skeletal or dento-alveolar. Skeletal expansion involves splitting of mid palatal

suture while dento-alveolar expansion produces adental expansion with no skeletal change.

Expansion is brought about by various appliancesthat incorporate jack screw or by use of springs.



“EXTRACTIONS” Extraction that is undertaken as a part of orthodontic

treatment is called therapeutic extraction. Premolars are the most extracted teeth as a part of ortho

treatment.

Extraction of premolars from each quadrant of the jaw

provide sufficient space to correct the confronting problem without unduly hampering function and esthetics.

In addition the location of premolars in the arch is suchthat the space gained by their extraction can be utilized forcorrection in both anterior and posterior segment.

It is not uncommon to extract molars or lower incisors,extraction of canines and upper incisors is avoided.

The answer of the question of which teeth to extract for apatient should be based on sound diagnosis.



“DISTALIZATION” It is the most popular technique in recent time-distalization of molars.

These procedures are aimed at moving the molars

in distal direction so as to gain space. The popularity because of that extraction can be

avoided. The ideal timing for distalization is during the

mixed dentition prior to eruption of the secondpermanent molar. Two methods- * extra oral

* intra oral



“EXTRA ORAL” Head gears deriving anchorage from the cervical orcranial region can be used to distalize the molars.

The head gear assembly consist of a face bow.

Disadvantages –

patients cooperation is essential for timely wear of appliance.

The appliances are usually not worn continually thus they are intermittent in action this results inprolonged treatment time.



“INTRA ORAL” In order to over come the drawback of extra oral

appliance, intra oral appliances are introduced. They are fixed on the teeth and therefore produce

continuous effect on the teeth. Some intra oral devices- Sagittal appliance-molar distalization can be

brought about by removable appliancesincorporating jack screws. The appliance consist of spilt acrylic plate joined together by a jack screw.

These appliances are retained using adam’s clasp

on the molars and pre molars. .



The jack screws are positioned in such a way that their longaxis is parallel to occlusal plane as well as the buccalsurface of molar. These type of appliances can be used fordistalization of only one tooth at a time to avoid unduestrain on the anchorage.

Distalization using intra oral magnets-used to distalize themolars. This consist of repelling magnets placed on themolars to be distalized and the tooth anterior to it. Theanterior anchorage can be reinforced using a nance holdingarch.

pendulum appliance-this is the appliance that incorporates

a modified nance button for purpose of anchorage. Inaddition it consist of stainless steel wire with helix, thedistal end of which is inserted into a sleeve on the palatalaspect of the molars to be distalized .

Distalization is produced by opening the helix and

forcefully engaging the distal ends into the sleeves



“UPRIGHTING OF MOLARS” Premature loss of second deciduous molar or

extraction of a second premolar can cause mesial

tipping of the first permanent molar. A mesially tipped molar occupies more space than

upright molar thus by uprighting these molarscertain amount of space can be recovered.

Molars can be uprighted using molar uprightingsprings or some form space regainers.



“DEROTATION OF POSTERIOR TEETH” Rotated posterior teeth occupies space than normally

placed posterior teeth.

Derotation of these teeth hence provides someamount of arch length.

Derotation is best achieved with fixed appliancesincorporating springs or elastics using a force couple.



“PROCLINATION OF ANTERIOR

TEETH” Proclination of retruded anterior tooth results in gain

of arch length.

This is usually indicated in cases where the teethretroclined or in those cases where protecting theanteriors will not affect the soft tissue profile of thepatient.



“THANK YOU”

Mathods of Gaining Space

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