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Method of gaining space
1. METHODS OF GAINING
S P A C E
PRESENTED BY – DR. ROKEYA RAHMAN TANI
FCPS Part-II Trainee
Dept. of Orthodontics
Dhaka Dental College & Hospital.
2. For the resolution of a majority of malocclusions, space
is required. Like -
Alignment of crowded teeth
Retraction of proclincd teeth
Correction of molar relationship
Derotation of anterior teeth
Leveling the curve of Spee
Correction of ant. and post. cross bite
Correction of narrow dental arch
Intrusion
Why Space Is Required –
3. What are the methods of gaining space –
Space can be gained by
Non Extraction Extraction Surgical
Proximal stripping
Arch expansion
Molar teeth distalization
Uprighting of tilted
teeth
Derotation of posterior
teeth
Proclination of anterior
teeth
Orthognathig surgery
Distraction osteogenesis
Balancing extractions
Compensating
extractions
Phased extractions
Enforced extractions
Wilkinson extractions
Therapeutic
extractions
5. PROXIMAL STRIPPING
Proximal stripping involves the selective reduction of the
mesiodistal width of certain teeth to create space.
The procedure is also called -
Proximal slicing
Reproximation
Slenderization
INDICATION FOR PROXIMAL STRIPPING
• Done when space requirement is minimal (2.5-
3 mm).( Or when Bolton's tooth material excess less than 2.5 mm).
• Usually when the excess exists in the mandibular
anterior segment.
CONTRAINDICATIONS FOR PROXIMAL STRIPPING
• Patients who are susceptible to caries.
• Avoided in young individual as their teeth may possess large
pulp chambers.
6. The procedure involves three steps –
1. Assessing space requirements.
2. Selecting the teeth and amount of enamel to be
stripped.
Not more than 50% of Enamel thickness to be stripped.
3. Enamel stripping.
Metal abrasive strips
Enamel stripping is generally performed using the following
methods -
PROCEDURE
9. Please note:
After Reproximation there will be sensitivity.
Artificial remineralization is possible by crystal growth.
A low concentration of calcium-fluoride solution produce this
growth in a time dependent fasion.
10. Advantages of proximal stripping
To avoid extractions in borderline cases where space
requirements are minimal.
To achieve better interdigitation, overbite and overjet
To broaden the contacts to add the stability of results
Localized malalignments can be corrected without
involving too many teeth, especially in adult patients.
Disadvantages of proximal stripping
≠ Sensitivity
≠ Increases caries susceptibility
≠ Difficult to reproduce exact morphology of the tooth.
≠ The shape created may not be as esthetic
≠ Food lodgement
12. RAPID MAXILLARY EXPANSION (RME) DEVICES
First reported at 1860 by Emerson C. Angell
These are the kind of Dentofacial Orthpedic appliance
Mid palatine suture is mainly used to separate to gain the
space
15- 19 years of age is more
Sweetable time
post. teeth are used to transmit
force to the maxilla
Midline diastema seen primarily
Open bite is possible
13. Growing individuals with severely constricted maxillary
arches, Involving airway impairment or mouth breathing
tendencies.
Posterior cross bites with real or relative maxillary
deficiency
Cleft patients
Along with facemask therapy
Class Ill cases with minor maxillary deficiency
As part of interceptive orthodontics
Indications for RME use
14. Removable RME appliance
The appliance basically consists of a screw
in the midline with retentive clasps on posterior
Teeth.
More effective when used in the early mixed dentition
phase.
But its efficiency is doubtful.
15. Fixed RME Appliances
I. Tooth Born appliance
II. Tooth-tissue born appliance
Tooth Born appliance are -
1. HYRAX APPLIANCES
17. 1. DERICHSWEILER RME APPLIANCES
2. HASS RME APPLIANCE
Tooth-tissue born appliances are -
18. SLOW EXPANSION DEVICES
Indications of slow expansion
Correction of unilateral cross bites
Correction of 'V' shaped arches
Preparation for bone grafts in cleft cases
Minimal crowding in the upper arch (1-2 mm)
Elimination of a displacement
19. 1. Screw Appliances (upper & lower)
2. Coffin Spring
Some of them are removable, some are fixed type -
22. DISTALIZATION OF MOLARS
The main purpose of Distalization is to push
the maxillary and/or mandibular terminal molars
posteriorly.
Usually undertaken before the eruption of the second
permanent molars.
There are 2 types –
I. Extraoral distalizing appliances
II. Intraoral distalizing appliances
23. Extraoral distalizing appliances
The most frequently used extraoral distalizing
appliances are the headgears.
Bilateral as well as unilateral distalization is possible
using headgears.
Distal tipping of molars helps in
- Opening the bite
- Incrising the lower facial heigt
18 to 20 hours of wearing is recomanded for orthodontic
effect.
25. INTRAORAL METHODS OF DISTALlZING MOLARS
Tooth moving force generators are mainly of –
- Screws
- Open coil springs
- Wire springs with helices
26. Intra oral distalizing appliances are –
• Schwartz plate
• Sagitta1 appliance
• First class
• Veltribilateral and monolateral sagittal screws
• Open coil springs
• Jones jig
• Oistal jet appliance
• Fast back appliance
• Pendulum appliance
• Intraoral magnets
• Jasper jumper
• Lip bumper
27. UPRIGHTING OF TILTED POSTERIOR
TEETH
Uprighting of molars can lead to
an arch length gain of 1-1.5 mm.
Fixed appliances are idealIy used.
28. DEROTATION OF POSTERIOR TEETH
Derotation can be best achieved using a couple force
on the lingual and buccal surfaces of the tooth.
Forces should be equal in magnitude but opposite in
direction.
Fixed appliance system with a two point contact is useful.
29. PROCLlNATION OF ANTERIOR TEETH
Proclination of anteriors is indicated if only –
- They are retroclined
- Soft tissue profile will not be disturbed
- Stability will be achived