Serial extraction is a planned extraction of a deciduous tooth and a certain permanent tooth in a regular order and a predetermined pattern to guide the erupted permanent teeth to a better position.
Video Serial extraction
History
In 1929, Swedish Kjellgren used the term "serial extraction" for the first time. In the 1940s this technique was popularized in the United States by Hayes Nance as "a planned and progressive extraction". Nance is known as the Father of serial extraction in the United States. In 1970, Hotz in Switzerland called it "active dental surveillance by extraction".
Maps Serial extraction
Procedures
There are no fixed techniques to follow when performing serial extraction. A careful diagnosis and continuous re-evaluation during the treatment is mandatory to achieve the desired result.
However, based on the usual sequence of tooth eruptions, the oldest canine teeth were extracted at the age of 8-9 years to create a suitable dental alignment chamber, followed by the extraction of first deciduous molar a year later so that the first premolar eruption was accelerated. and lastly the first eruption of the first premolars to make room for permanent canine alignment. In some cases the modified technique is followed where the first premolar is enenucleated at the time of first decaying molar extraction. This modification is often required in the arch of the mandible where the canines often erupt before the first premolars.
Selection of the appropriate extraction procedure
Extracting primary canines only - this results in a rapid self-improvement of incisor and aligning teeth that bypass the lingual crossbite development of the lateral incisors.
Extracting the first primary molar only - this approach produces the first premolar premature eruption but reduces the speed and amount of incisor gear leveling. This is the result of main canine retention.
Extracting primary canine teeth and first molars - this is a compromise between the rapid increase in incisor incision and early premature initial early eruption. In some cases, this sequence results in a simultaneous canine eruption and the first premolar, which can cause a permanent deterioration of the permanent canine teeth and the probability of first premolar impaction.
First premolar premarital shoots - it is recommended when the first premolar eruption is behind the canines and the second premolar. This allows maximum distal translation of the erupted canines. This is rarely indicated in the maxillary arch.
Indication
- In the case of class 1 malocclusions that indicate alignment between skeletal and muscle systems
- A case that arises with a long arc deficiency - indicated by the presence of one or more of the following:
- Lack of physiological spacing
- Unilateral or bilateral desidateral decidual decay with midline shift
- Malposition or lateral erectile dental impaction coming out of the lateral arch of the jaw
- Maxillary and mandibular anterieters marked irregular or solid
- Local gingival recession in the anterior region of the mandible
- Ectopic tooth eruption
- The mesial migration of the buccal segment
- The pattern and sequence of abnormal errors
- The anterior burning of the mandible
- Ankilosis of one or more teeth
- Cases with inadequate growth to cope with dental materials - differences in basal bones.
- Patients with straight profiles and pleasing looks.
Contraindications
- Class 2 and grade 3 malocclusion with skeletal disorder.
- Patients with sufficient plant spacing in the teeth
- Anodontia/oligodontia case
- Patients with open bites and deep bites
- In the case of a diamond diastema
- Class 1 malocclusion with minimal space shortage
- Incorrectly erupted teeth for example are laminated
- Large caries or first permanent molars filled with weight
- Mild disproportion between curved length and dental materials that can be treated by proximal stripping
Advantages
- Treatment is more physiological
- Psychological trauma can be avoided with early childhood care
- Reduce the duration of fixed orthodontic treatment Better oral hygiene is possible, thus reducing the risk of caries
- The health of the investment network (periodontium and alveolar process) is maintained, thereby reducing alveolar bone loss
- The retention period is less indicated
- More stable results are achieved
- Less potential of iatrogenic damage
- A normal neuromuscular balance is achieved and maintained
Loss
- There is no single, universally applicable approach for all patients
- Treatment time is extended as treatment is gradually phased out over 2-3 years
- Patients have a tendency to develop tongue urges, due to the creation of gradually closing extraction spaces
- Posterior tooth extraction can cause deepening of the bite
- There is a risk of decreasing the length of the curve due to the mesial migration of the buccal segment
- Small space may exist between the canines and the second premolar
- The axial tendency of teeth may change at the end of serial extraction
Assessment to be done before contemplating serial extraction
Intraoral diagnostic assessment
The diagnosis is based on a comprehensive case history, patient clinical examination, photograph, plaster research model, cephalometric radiography, panoramic and periapical radiography.
Analysis of growth and development
Periodic growth assessment notes should be made in all patients where growth is ongoing, made up to 14 to 16 years in girls and 18 to 19 years in boys.
Functional analysis
Examine various functional movements such as swallowing, respiration, speaking, opening and closing and the extraordinary movements of safe and careful mandibular palpation of both important temporomandibular joints.
Morphological Assessment
These include assessment of dental mass, arch form, arch length, skeletal pattern, bone growth potential, orofacial muscle, facial aesthetics, oral habits and assessment of offspring of parents and siblings. The most favorable morphological factors for serial extraction include class 1 malocclusions, favorable morphogenetic patterns - unchanged, flush terminal plane or mesial step connection of the second primary molar, minimum overhead and minimum overbite.
Space analysis
Assessment of the size of the tooth - the length of the arch in the mixture determines whether or not there is a difference in the future or that exists, whether it is clustered or distance. This involves predicting the size of the permanent teeth and permanent premolars that have not been erupted. Caliper or fine line border is used to measure the width of the combined teeth in each segment using the research model. The circumferential measurement is performed on the plaster of the mesial aspect of the first molar on one side to the mesial aspect of the first molar on the opposite side, and this measurement is recorded. The combined width of the permanent tooth is taken from the intraoral radiography and compared to the available arch length.
Factors to consider in spatial analysis
- The occlusion formula curve is used to determine the additional space required to flatten the spee curve.
- For every 1 degree of labial or lingual tipping of the mandibular incisors there are 0.8 mm each increase or decrease in the length of the arch.
- The clinical picture of the patient involves interpretation of the individual data itself because the patient represents a multiracial origin and therefore a unified norm is difficult to determine.
Factors to consider during serial extraction
- Serial extraction should be limited basically to class 1 malocclusions with an initial normal sagittal jaw relationship and normal neuromuscular balance. It is the goal of this treatment to maintain a neuromuscular balance.
- With the timeliness of precise diagnostic assessments and careful monitoring, programmed serial extraction procedures are capable of producing large numbers of permanent dental translations. The earlier premolar premolars are removed, the greater the eruption of the permanent canine teeth.
- Too much enlargement on the incisors in the available space can cause too-flat surfaces caused by dishing in the anterior segment. Mandibular anterior teeth should be stabilized to prevent excessive lingual tipping. A fixed mandibular arch of the first permanent left molars to the proper first permanent molar fights may be required.
- The wise reproximation removal of the deciduous tooth without tooth extraction is an occasional option. This decision depends on a lengthy evaluation of the size of the dental arch.
- The number of throngs, the length requirements of the arch, whether they are symmetrical, and the health conditions of the investment network are factors that continue to influence the occlusal guidance program. Sometimes the removal of the second premolar or second premolar of the lower jaw and the maxillary first premolar may be preferred, depending on facial balance, anchorage needs, dental size and other factors.
- Serial extraction is a multi-decisional time process. Annual records such as panoramic radiography, photographs, and research models are essential.
- The most common extreme sequel extraction sequence is the deepening of bite. The protrusion of the incisors and early posterior tooth loss can cause deep bites. A simple palatal bite plates can fix this problem.
- Balancing root gear adjacent to the location of extraction is usually easy with an autonomous approach to various degrees before mechanotherapy.
- The retention demands are significantly less followed by serial extraction. However it is better to follow a regular retention regimen for the first six months on the possibility of relapse from rotation and to allow completion of occlusion. Max Hawillary and mandibular mandibular canine retainers attached to the canine retainer make an efficient storage regimen.
See also
- Retainer (orthodontic)
- Malocclusion
References
Source of the article : Wikipedia
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