multimedia health education · serial extraction is a procedure in which your dentist plans to...

Disclaimer

This movie is an educational resource only and should not be used to manage your health. All decisions about the management of Serial Extraction must be made in conjunction with your Dental Surgeon or a licensed healthcare provider.

Multimedia Health Education

SERIAL EXTRACTION

MULTIMEDIA HEALTH EDUCATION MANUAL

TABLE OF CONTENTS

SECTION CONTENT

2 . Overview of Serial Extraction a. What is Serial Extraction?

1 . Normal Teeth Occlusiona. Introduction

b. Primary Teeth Occlusion

3 . Treatment Options a. Diagnosis

b. Methods of Serial Extraction

b. Rationale of Serial Extraction c. When is Serial Extraction done?

d. When is Serial Extraction not done?

e. Advantages of Serial Extraction

f. Disadvantages of Serial Extraction

Multimedia Health EducationSERIAL EXTRACTION

INTRODUCTION

The term occlusion in dentistry refers to the way the upper and lower teeth come together when the mouth is closed. An ideal occlusion is the perfect fit between the upper and lower teeth when the jaws are in a fully closed position. An ideal primary or baby teeth occlusion is an indication of future ideal permanent teeth occlusion.


Serial extraction is the planned, selective extraction of teeth over a period of time to reduce crowding. The goal of serial extraction is to develop a perfect and healthy occlusion in the permanent teeth by interceptive treatment in the primary and mixed dentition.

In order to learn more about serial extraction, it is necessary to understand the normal occlusion of the teeth.

Primary Teeth OcclusionWhen the primary first molars appear, the occlusal relationship is established. The mesiolingual cusp of the upper molar occludes in the central fossa of the lower molar. The relation of the distal surface of the upper and lower second primary molars is called the terminal plane.

Unit 1: Normal Teeth Occlusion


It is of three types:

Flush or vertical plane: The distal surfaces of upper and lower teeth are flush and are in the same vertical plane.

Mesial-step: The distal surface of the lower molar is more mesial to that of the upper molar.

Distal –step: The distal surface of the lower molar is more distal to that of the upper molar.

(Refer fig. 1)

(Fig. 1)

Unit 2: Overview of Serial Extraction


What is Serial Extraction?Serial extraction is a procedure in which your dentist plans to extract certain baby teeth, in order to encourage normal eruption of the permanent teeth.

The purpose of serial extraction is to create enough space for the growing permanent teeth and reduce crowding.

Rationale of Serial Extraction:Serial extraction is done based on the following two principles:

Arch length-tooth material discrepancy: When there is an excess of tooth material as compared to the arch length, extraction of some teeth is done to guide the rest of the teeth to normal occlusion.

Physiologic Tooth Movement: There is a physiologic tendency of human teeth to move towards an extraction space. Thus by removing selective teeth, the rest of the teeth can be guided by natural forces into the extraction spaces.

When is Serial Extraction done?

Serial extraction is done in the following cases:

Arch-length deficiency as

compared to the tooth material

Lingually erupted lateral incisors

Canines erupting mesially over lateral incisor

Flaring of teeth Absence of spacing between

teeth

(Refer fig. 2)

(Fig. 2)



When is Serial Extraction not done?

Serial extraction is not recommended in the following cases:

Congenital absence of teeth-anodontia and oligodontia

Mild to moderate crowding of teeth

Deep bite and open bite Severe Class II and Class III malocclusion of skeletal abnormality

Spaced dentition Midline gap between two teeth: diastema

(Fig. 3)

(Continued in next page)



Unerupted malformed teeth such as dilacerations, malformed teeth with a

sharp bend.

Mild disproportion between arch length and tooth material.

(Fig. 3)

Patient has a straight profile and a pleasing appearance

Advantages of Serial Extraction

The treatment is more physiologic since it involves guidance of teeth into normal occlusion.

Malocclusion is treated at an early age, thus reducing any psychological trauma on the child.

It reduces the duration of the fixed appliance treatment.

Better oral hygiene is possible thus reducing the risk of caries (cavities).

Avoids the loss of alveolar bone.

Lesser retention period is sufficient after the treatment is completed.



Disadvantages of Serial Extraction

The treatment duration is prolonged since it is carried out in 3 stages spread over 2-3 years.

It requires the patient to have frequent follow-up visits to dentist.

As extraction spaces are created, which will close down gradually, there is a tendency for the child to develop tongue thrust.

Extraction of the back teeth can cause a deep bite.

If the treatment is not carried out properly, there is a chance of arch length being reduced due to migration of the back teeth forwards.

Unit 3: Treatment Options


Diagnosis

Diagnosis is made based upon the physical examination and radiographs.

Panoramic and cephalometric X-rays, facial photographs and study models are studied in order to determine the treatment plan and make the treatment successful.

Methods of Serial Extraction There are three methods of serial extraction:

Dewel’s Method

Nance’s Method

Tweed’s Method

(Fig. 4)

(Fig. 5)

(Fig. 6)

Dewel’s Method: It involves three stages:

Stage 1: The primary canine is extracted at 8-9 years of age to create space for the lateral incisors.

(Refer fig. 4 to 7)




(Fig. 7)

Stage 2: The primary first molar is extracted at 10 years of age to create space for the first premolar.

(Fig. 8)

(Fig. 9)

(Fig. 10)

(Refer fig. 8 to 11)


(Refer fig. 4 to 7)



(Fig. 11)

Stage 3: The extraction of the erupting first premolar to create space for the permanent canine.

(Fig. 12)

(Fig. 13)

(Fig. 14)





Nance’s Method:

(Fig. 15)

(Fig. 16)

(Fig. 17)

(Fig. 18)

This method involves the extraction of the primary lateral incisors followed by the extraction of the primary canines, primary first molars and finally the first permanent molars.




Tweed’s Method:This involves the extraction of primary first molars around 8 years of age, followed by extraction of first premolars and primary canines.

(Fig. 19)

(Fig. 20)

(Fig. 21)


Unit 3: Disclaimer

Disclaimer

Although every effort is made to educate you on Serial Extraction, there will be specific information that will not be discussed. Talk to your dentist or pedodontist about any concerns you have about Serial Extraction.


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