2. Outline
Indications:
ِِTo relieve crowding.
To correct anteroposterior dental arch relationship.
To improve facial esthetics.
Consideration in Therapeutic Extraction:
Condition of the teeth.
Position of the teeth.
Degree and position of the crowding.
April 28, 2012
Dr. Ahmed Basyouni
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3. Outline
Choice
of teeth for Extraction:
Incisors:
Canines:
First premolars:
Second premolars:
First permanent molar:
Second permanent molar:
Third molar:
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Dr. Ahmed Basyouni
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4. Indications
A. To relieve crowding
B. To correct anteroposterior dental arch
relationship
C. To improve facial esthetics.
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Dr. Ahmed Basyouni
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5. A. To relieve crowding:
If the dentition is too large to fit in the
dental arch without irregularity, it is necessary
to reduce the dentition size by extraction of
teeth. It is not normally accepted to increase
size of the dental arch, except in certain cases,
because this would not be tolerated by oral
musculature.
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Dr. Ahmed Basyouni
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6. A. To relieve crowding:
CLASS I EXTRACTION CASE
WITH SEVERE CROWDING
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7. B. Extraction for correction anteroposterior
dental arch relationship:
It is frequently necessary to remove teeth to give
space for correction of discrepancies in arch
relationship. For example, in Class II relationship,
when upp. Arch is too far forward in relation to
lower. The upp. anterior segment is moved back
during treatment, after extraction to provide space
for retraction of the anterior teeth.
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Dr. Ahmed Basyouni
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8. B. Extraction for correction anteroposterior dental arch relationship:
CLASS II, div. 1
subdivision right,
MALOCCLUSION
EXTRACTION CASE
EXTRACTION OF
UPPER FIRST PREMOLARS
+
LOWER SECOND
PREMOLARS
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Dr. Ahmed Basyouni
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9. C. Extraction for improvement of facial
esthetics:
It is usually done in cases of Class I Angle’s
malocclusion with bimaxillary dentoalveolar
prognathism.
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Dr. Ahmed Basyouni
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10. C. Extraction for improvement of facial esthetics:
CLASS I EXTRACTION CASE
CROWDING
DENTAL PROTRUSION
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Dr. Ahmed Basyouni
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11. Consideration in Therapeutic Extraction
Condition of the teeth
Position of the teeth
Degree and position of the crowding
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Dr. Ahmed Basyouni
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12.
Condition of the teeth:
Fractured, hypoplastic, badly carious teeth and teeth
with extensive restoration, all more favourable for
extraction than sound healthy teeth. Tooth condition
is the overriding factor, even treatment would be
more difficult or prolonged.
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Dr. Ahmed Basyouni
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13.
Position of the teeth:
Grossly malposed teeth would be difficult to align are
often the teeth of choice for extraction. In particular,
position of the apex of the tooth must be considered,
as it is usually more difficult to move the apex than to
move the crown.
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Dr. Ahmed Basyouni
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14.
Degree and position of the crowding:
If crowding is located in one part of the arch, it would
be more favourable, if extraction carried out in that
part, rather than in remote uncrowded part. However,
this principle is not considered a rule, e.g. crowding
of the incisors is usually relieved by extraction of
premolars. This usually gives more pleasing final
appearance, and occlusal balance than removal of the
incisors.
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Dr. Ahmed Basyouni
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15. Choice of teeth for Extraction
Incisors:
1. Upper central incisors are rarely extracted for relief
of crowding, unless their condition is the overriding
factor (severely fractured). In such cases, lateral
incisors may be aligned and crowned to simulate
missing central incisors.
The usual reason for removing upper lateral incisors
are:
a) Severe malposition of the tooth.
b) Malformation of the tooth.
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Dr. Ahmed Basyouni
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16. Choice of teeth for Extraction
Incisors:
2. Lower incisors, as a rule removal of a lower
incisor from an imbricated arch is to be
avoided as this will result in increased curve of
spee, over-eruption of anterior teeth and
decrease of the inter-canine width. But,
extraction of a lower incisor can be made if it
is the only tooth outside the arch alignment
and / or there is gum stripping and lacking of
supporting alveolar bone around the tooth.
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Dr. Ahmed Basyouni
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17. Choice of teeth for Extraction
Incisors:
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18.
Canines:
Upper canine is removed only, if it is severely
malpositioned or impacted. This may be
developmental malposition or due to severe
crowding. Position of the apex is the prime
consideration.
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Dr. Ahmed Basyouni
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20.
First premolars:
The first premolar is the tooth most commonly
removed for relief of crowding. It is positioned near
the center of each quadrant of the dental arch and is
therefore near the site of crowding. Another
important factor, second premolar has same shape
and makes a similar contact with the canine. So, loss
of the first premolar does not affect quality of contact
between teeth.
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22.
Second premolars:
Removal of second premolar for relief of crowding is
usually undertaken when the tooth is itself
malpositioned through crowding. As it erupts after
first premolar and first permanent molar, it may be
completely blocked out from the dental arch.
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Dr. Ahmed Basyouni
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23. Second premolars:
Class II, Extraction treatment
EXTRACTION OF
UPPER FIRST PREMOLARS +
LOWER SECOND PREMOLARS
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24.
First permanent molar:
Not usually the tooth of choice for extraction. If
extraction is necessary due to caries, two situations
exist which control timing of the extraction:
a) if no space is required for alignment of the anterior
segment, extraction should be carried out before
second molar erupts.
b) if space is required for alignment of the anterior
segment, extraction should be carried out after
eruption of the second molar.
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Dr. Ahmed Basyouni
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26.
Second permanent molar:
The second permanent molar is not often removed for
the relief of crowding. It is sometimes, removed when
first permanent molars have moved forward leaving
insufficient space for eruption of second premolars.
Removal of second molar will allow distal movement
of first molar to increase premolar space. In general,
extraction of second molar does not allow much
spontaneous relief of crowding but may relieve third
molar impaction if third molar is not severely inclined
mesially.
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Dr. Ahmed Basyouni
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27.
Third molar:
Extraction of third molars has been advocated by
some orthodontists to prevent or relief potential
crowding in the dental arch specially in the incisor
area.
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28. Serial Extraction
Indication:
Class I malocclusion with severe crowding of
upper & lower permanent incisors in the mixed
dentition stage.
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31. Serial Extraction
At 9 years old:
Extract
D
D
3
3
For eruption
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32. Serial Extraction
At 10 ½ years old:
Extract
D
For eruption 4
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D
4
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33. Serial Extraction
At 11 years old:
Extract
E
E
For eruption 5
4
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E
E
5
4
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34. Serial Extraction
At 11 ½ years old:
Extract
4
4
For eruption
4
4
3
3
5
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Dr. Ahmed Basyouni
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35. Summary
Indications:
A. To relieve crowding
B. To correct anteroposterior dental arch
relationship
C. To improve facial esthetics.
Consideration in Therapeutic Extraction:
Condition of the teeth
Position of the teeth
Degree and position of the crowding
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Dr. Ahmed Basyouni
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36. Summary
Choice of teeth for Extraction:
Incisors:
Canines:
First premolars:
Second premolars:
First permanent molar:
Second permanent molar:
Third molar:
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Dr. Ahmed Basyouni
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