Department of Orthodontics and Dentofacial Orthopedics

SERIAL EXTRACTION

Contents
Introduction Definition Indications Contraindication Diagnosis Methods Advantages Disadvantages Conclusion References

Interceptive Orthodontics
It is that phase of the science and art of orthodontics employed to recognize and eliminate potential irregularities and malpositions in the developing dentofacial complex.

Serial extraction
Diseases of teeth by Robert Bunon(1743) Term coined by Kjellgren(1929) Father of serial extraction Nance(1940) Hotz gave a new term called guidance of eruption(1970)

According to Tweeds it is defined as:- the planned and sequential removal of primary and permanent teeth According to Tandon it is defined as:- The correctly timed and planned removal of certain deciduous and permanent teeth in mixed dentition cases with dentoalveolar disproportion

Indications
Class I malocclusion with arch size tooth size discrepancy of more than 5mm per quadrant, normal eruption sequences as assessed radiographically and a skeletal growth pattern within normal limits

This condition is caused by

Premature loss of deciduous canine Abnormal deciduous canine root resorption Proclined or crowded anteriors Labially blocked out canine Ectopic eruption Extensive proximal caries Premature loss of deciduous tooth

Contraindication
Mild to moderate crowding

Malocclusion

Class II division 2 class III

Spaced dentition
Congenital absence Open bite deep bite

Diagnosis
Study models Assess dental anatomy Assess intercuspation of tooth Assess the arch form & curve of Spee Evaluate occlusion Model analysis Between and post treatment assessment

Radiographs Intraoral periapical radiographs

Lateral cephalograms

 OPG

1. 2. 3. 4. 5. 6. 7. 8.

Detection of congenitally missing teeth Detection of any bony pathosis Undertake radiographic mixed dentition analysis Assess the stage of root development To determine the dental age of patient To assess facial patterns To assess soft tissue changes To assess treatment progress

Photographs
Important for self evaluation Patient motivation Evaluation of changes extra orally To assess any hypo or hyperactivity of muscles

Methods
Tweeds method ( DC4 )

 Dewels method ( CD4 )

 Nances method ( D4C )

Grewes method
Class I malocclusion with premature loss of deciduous mandibular canine ( CD4 )

Class I malocclusion with severe mandibular anterior crowding ( CD4 )

Class I malocclusion where minimal mandibular anterior crowding is present (D4C) Dental class II with normal overjet ( CD4 ) Dental or skeletal class II with slight but minimal overjet ( DE5 )

Advantages
More physiologic treatment Duration of fixed treatment is reduced Health of investing tissue is preserved Lesser retention time required Results are more stable

Disadvantages
Good clinical judgment is required Treatment time is prolonged over 2 to 3 yrs Patient co-operation is required Tendency to develop tongue thrust habit Extraction of buccally placed teeth will cause deep bite Residual space may remain between canine and second premolar Some amount of fixed appliance is usually required at the end of serial extraction

Conclusion
As a coin has two sides so has serial extraction It is upto the clinician to decide which procedure is good for his patient . Because no single approach can be universally applied.

Reference:Graber Profitt Gurkeerat singh