RATIONALE

Serial extraction is based on 2 basic principles:Arch Length tooth material discrepancy:

When ever there is an excess of tooth

material as compared to the arch length a
selective extraction of some teeth is done so
that rest of the teeth can be guided to normal
occlusion.
.

Physiologic tooth movementHuman dentition shows a physiologic

tendency to move towards an extraction
space. Thus by selective removal of some
teeth the rest of the teeth which are in the
process of eruption are guided by the natural
forces into the extraction spaces.

INDICATIONS FOR SERIAL EXTRACTION-

1.Class I malocclusion showing harmony between

skeletal & muscular system.
2.Arch length deficiency as compared to the tooth
material is the most important indication for serial
extraction.

Arch length deficiency is indicated by the

presence of one or more of the following
features:Absence of physiologic spacing.
Unilateral or bilateral premature loss of
deciduous canines with midline shift.
Malpositioned or impacted lateral incisors.
Irregular or crowded upper & lower incisors.
Localized gingival recession in the lower anterior
region.

Ectopic eruption of teeth.

Mesial migration of buccal segment.
Abnormal eruption pattern &
sequence.
Lower anterior flaring.
Ankylosis of one or more teeth.
3.Where growth is not enough to over come the discrepancy
between tooth material & basal bone.
4.Patients with straight profile & pleasing appearance.

Contraindications of Serial Extraction1.ClassII & III malocclusion with skeletal

abnormalities.
2.Space dentition.
3.Anodontia /oligodontia.
4.Openbite & deep bite.

5.Midline diastema.

6.ClassI malocclusion with minimal space

deficiency.
7.Unerupted malformed teeth.
Eg.Dilacerations.

8.Extensive caries or heavily filled I permenent

molars.
9.Mild disproportion between arch length and
tooth can be treated by proximal stripping.

Advantages of Serial Extraction-

Treatment is more physiologic as it involves

guidance of teeth in to normal positions.
Psychological trauma associated with
malocclusion can be avoided by treatment of the
malocclusion at a nearly stage.
It eliminates the duration of multi-banded fixed
treatment.

Better oral hygiene is possible there by reducing

the risk of caries.
Health of investing tissue is preserved.
Lesser retention period is indicated at the
completion of treatment.
More stable results are achieved as the tooth
material & arch length are in harmony.

Disadvantages of Serial Extraction:

It cannot be universally applied to all patients.

Treatment time is prolonged as the treatment is
carried out in stages spread over 2-3 years.
It requires the patient to visit the dentist thus
patient co-operation is needed.

As the extraction spaces are created that

close gradually the patient has a tendency of
developing tongue thrust.
Extraction of buccal teeth can result in
deepening of the bite.

If the procedure are not carried out properly

there is a risk of arch length reducing by mesial
migration of the buccal segment.
Ditching or space can exist b/w the canine &
2nd premolar.
The axial inclination of teeth at the
termination of the serial extraction procedure
may require correction.

DEWELS METHOD
Dewel has proposed a 3 step serial extraction
procedure.
In the 1st Step , the deciduous canines are
extracted to create a space for alignment of the
incisors.
This step is carried out at 8-9 years of age.

After 1 years , the deciduous 1st molars are

extracted so that the eruption of 1st premolars is
accelerated.

This is followed by the extraction of the

erupting 1st premolar to permit the permanent
canines to erupt in their place.
In some cases ,a Modified Dewels Technique is
followed where in the 1st premolar are enucleated
at the time of extraction of the 1st deciduous
molars.
This is frequently necessary in the mandibular
arch where the canines of ten erupt before the 1st
PM.

TWEEDSMETHOD:
This method involves the extraction of the
deciduous 1st molars around 8 years of age.
This is followed by the extraction of the 1st
premolar & the deciduous canines

TWEED METHOD
EXTRACTION OF DECIDUOUS
FIRST MOLAR

EXTRACTION OF DECIDUOUS
CANINE AND PREMOLAR

Nance Method:
This is similar to the Tweeds technique
& involves the extraction of the deciduous
1st molars followed by the extraction of the
1st Premolars & the deciduous canines.