Extractions Orthodontics Question And Answers

Extractions

• Their extraction provides additional space for eruption of the third molars, thus impaction of third molars can be avoided.
• Crowding of the arch is minimized.
• Chances of dental caries are reduced because crowding is absent.
• Oral hygiene is effective.

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• Extraction of first molars offers limited space to relieve crowding.
• Second bicuspids and second molars rotate and may tip into the extraction space.
• Mesial tipping of second molar occurs.
• Removal of the first molars deprives the orthodontist of adequate anchorage for any orthodontic appliance.
• Mesial tipping causes improper proximal contact which leads to accumulation of food which causes periodontal problem.

• Extraction in orthodontia includes serial extraction carried out as an interceptive procedure during the mixed dentition period.
• Therapeutic extraction is carried out as a treatment procedure for gaining space.

• Crowding occur due to arch length and tooth material discrepancy, so prior to extraction a careful analysis of tooth size-arch length discrepancy is done.
• In many of the cases tooth material-arch length disproportion is not treated by increase in the arch length. So decrease of tooth material is the only alternative.
• In severe tooth material, arch length discrepancy extraction of one or more teeth should be undertaken to correct the malocclusion.

• In Angle’s Class 1 cases: Extractions should be carried out in both the arches.
• In Angle’s Class 2 cases: It is always possible to reduce the abnormal maxillary proclination by extracting only fist premolars in maxillary arch.
• In Angle’s Class 3 cases: It is always beneficial to avoid extraction in maxillary arch. They are preferably treated by extraction only in the lower arch or by the extraction in both the arches.

• Direction and amount of jaw growth.
• Discrepancy between size of dental arches and basal arches.
• State of soundness, position and eruption of teeth.
• Facial profile.
• Degree of dentoalveolar prognathism.
• Age of patient.
• State of dentition as a whole.

• Wilkinson’s extraction
• Balancing extraction
• Compensating extraction
• Serial extraction
• Extractions in the camouflage treatment
• Driftdontics

• It includes removal of the teeth symmetrically on either side of the arch which is known as balanced extraction.
• Removal of tooth over one side of the arch leads to asymmetry, so to prevent this extractions are balanced to allow equal movement of remaining teeth towards the extraction site over both the sides of arch.

• Extraction of the teeth in opposite jaws or arches is called as compensating extraction.
• This preserves the interarch relationship and also maintains the lateral symmetry.

• The term serial extraction was coined by Kjellgren and Robert Bunon introduced the concept of serial extraction.
• Extraction of certain deciduous and permanent teeth in a sequence to alleviate crowding is known as serial extraction.
• The sequence of extraction is first deciduous canines followed by fist deciduous molars and then permanent first premolars.

• Extraction of mandibular fist premolars is associated with spontaneous decrowding of mandibular anteriors. This is referred to as driftdontics and is less frequent in the maxillary arch.
• These can be the instances when the extraction of permanent tooth is not followed by orthodontic treatment for various reasons such as non-availability of the specialist or the point unsuitable for fied appliance therapy. Such type of extractions is preferable.

• Procedures with reduction of tooth material
• • 1. Proximal stripping or slicing
  • 2. Extraction.
• Procedures without reduction of tooth material
• • Expansion
  • Labial proclination
  • Distalization of molars
  • Derotation of posterior teeth
  • Uprighting.

• An unfavorable impacted maxillary incisor which cannot be fitted into the normal occlusion.
• Buccally or lingually blocked lateral incisor with nice contact between central incisor and canine may be extracted.
• If a congenitally missing lateral incisor is present the opposite side lateral incisor should be extracted.
• Grossly carious incisor which cannot be restored.
• Malformed incisors which cannot be restored.
• Trauma to incisor by fracture.
• Incisor with dilacerated root.

• If one of the incisor is completely out of the arch with good interproximal contacts of other teeth.
• A traumatized mandibular incisor which had undergone dental caries, gingival recession or bone loss should be extracted.
• If severe arch length deficiency is present it causes fanshaped flaring of mandibular incisor crowns. In these cases extraction of single incisor tooth is done which improves crowding and axial inclination of other incisors.
• In mild class 3 malocclusion cases where mandibular incisor crowding is present. Mandibular incisor should be extracted for achieving normal overjet, overbite and also to relieve crowding.
• In cases with tooth size discrepancy.
• In treatment of class 1 cases with moderate mandibular lower labial segment crowing to 5 mm. This is treated with extraction of mandibular incisor.

• Direction and amount of jaw growth.
• Discrepancy between size of dental arches and basal arches.
• State of soundness, position and eruption of teeth.
• Facial profile.
• Degree of dentoalveolar prognathism.
• Age of patient.
• State of dentition as a whole.