Methods Of Gaining Space Question And Answers

Methods Of Gaining Space

Write about methods of gaining space in orthodontics.
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Describe briefly various methods of gaining space in orthodontics.
Or
Describe different methods of gaining space in orthodontics.
Or
What are the various methods of gaining space in the arch? Discuss proximal stripping in detail.
Answer. Methods of gaining space are divided into two types:

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• Procedures with reduction of tooth material
  • Proximal stripping or slicing
  • Extraction.
• Procedures without reduction of tooth material
  • Expansion
  • Labial proclination
  • Visualization of molars
  • Derotation

Proximal Stripping

• It is also known as approximation, standardization, disking, and proximal slicing.
• Proximal stripping is a method by which the proximal surfaces of the teeth are sliced to reduce the mesiodistal width of the teeth.

Investigations of Proximal Stripping

Carey’s/Arch Perimeter Analysis

• It provides the amount of arch length deficiency.
• This is indicated in minimum discrepancy cases where arch length tooth size discrepancy is less than 2.5 mm.

Bolton’s Analysis

• Discrepancy between maxillary and mandibular tooth material causes failure of establishment of normal interarch relationship.
• This analysis reveals the area of tooth material excess.
• Depending on the location of the problem, proximal reduction should be done.
• If a discrepancy is normal, then only proximal stripping is done.

Diagnostic Set up

• It helps in the localization of problems.
• It helps in disclosing the amount of enamel reduction
• It helps in locating the site where space is needed.

Intraoral Periapical Radiograph

• It discloses the amount of enamel reduction. The extent of the pulp horn should be studied by using IOPA.

Peck and Peck Ratio

• When the labiolingual and mesiodistal ratio is altered, crowding occurs.
• It is calculated by the Peck and Peck ratio

The procedure of Proximal Stripping

Armamentarium

• Use of metallic abrasive strips
• Safe-sided carborundum or diamond discs
• Long, thi,n tapered fissure burs.

Proximal Stripping Procedure

• It is of two types, i.e., localized reduction and generalized reduction.
• The localized reduction should be carried out in the upper and lower anterior teeth.
• At times, generalized interproximal reduction is done in moderate space discrepancy cases.
• Contact points are converted to contact, taking care to establish proper contact between teeth.
• Not more than 50% of enamel thickness should not be reduced by the method of proximal stripping and is equally distributed all over the teeth.
• Aftinterproximalmal reduction, on topical fluoride application, should be done; this is done to reduce post-proximal slicing sensitivity and to reduce the caries attack.

Proximal Stripping Advantages

• Proximal stripping establishes normal interarelationshipsship in patients with Bolton’s discrepancy.
• As the contact area is wide, lower incisors remain stable in their new position. Contact points should be converted to contact areas which prevent slipping of contact.
• Extractions should be avoided.d
• Minor intraarch problems are corrected by proximal slicing.

Proximal Stripping Disadvantages

• It leads to hypersensitivity.
• Chances for proximal caries are higher.
• Deposition of plaque and calculus causes gingivitis.
• Improper proximal reduction leads to loss of normal contact between teeth, which results in the impaction of food.
• If the e  shape of the tooth is grossly altered, there are altered esthetics.

Proximal Stripping Indications

• It is indicated when the space required is minimum, i.e., 0 to 2.5 mm. In such cases, it is possible to avoid the extraction of teeth by performing approximation.
• If Bolton’s analysis shows mild tooth material excess in either of the arches, it is possible to reduce tooth material by proximal stripping.
• It can be undertaken in the lower anterior region as an aid to retention.
• It is also indicated in cases where the individual tooth size prevents class I molar and canine relationship.
• For obtaining favorable overbite and overjet.

Proximal Stripping Contraindications

• It is not carried in young patients as they have large pulp chambers, which increases the risk of pulpal exposure.
• In patients susceptible to dental caries or those who have high caries index.
• On small teeth and teeth with enamel hypoplasia, slenderization is avoided.
• It is avoided in patients who refuse to accept slenderization as the treatment option.
• In patients with poor oral hygiene and high bacterial plaque index.

Proximal Stripping Expansion

• It is usually a non-invasive method of gaining space.
• It is usually undertaken in patients having constricted maxillary arch or, in some cases, having unilateral or bilateral cross bites.
• Expansion is of two types i.,e. skeletal or dentoalveolar.
• The skeletal expansion involves splitting of the midpalate suture, while the dentoalveolar expansion leads to the dental expansion with no skeletal change.
• Expansion is brought about by various appliances that incorporate jack screws or by use of springs.

Proximal Stripping Extraction

• Extraction of one or more teeth is undertaken as a part of an orthodontic treatment called “therapeutic extraction.”
• Premolars are the most frequently extracted teeth.
• Extraction of one premolar from each quadrant of the jaw provides sufficient space to correct the confronting problem (crowding on proclination).

Proximal Stripping Distalization

• Distalization procedures are aimed at moving the molars in a distal direction to gain space.
• This approach is becoming popular because extraction can be avoided.
• Distalization can be Brought About by Extraoral Method and Intraoral Method.

Proximal Stripping Extraoral Method

• Headgear deriving anchorage from the cervical or cranial region can be used to visualize.
• Headgear consists of an ace bow, which is made up of an inner and an outer bow. The inner bow is attached to the buccal tubes present on molars, and the outer bow is attached to the extraoral head cap or neck strap.

Intraoral Methods

These appliances are fixed on teeth and, therefore, produce a continuous effect, e.g.

• Sagittal appliance—Removable appliances incorporating jack screwThe appliance consists of a split acrylic plate joined together by a jack screw.
  • These appliances are retained using Adam’s clasps on the molar and premolars.
• Visualization using intraoral magnets-
  • These devices consist of a repelling magnet placed on the molar to be distalized and a tooth anterior to it.
• Use of open coil spring to distalize molars, i.e., Pendulum appliance.

Uprighting of Molars

• By uprighting the tipping molar, a certain amount of space can be recovered.
• Molar can be made upright by using molar uprighting springs or some form of space regainer.

Derotation of Posterior Teeth

• Rotated posterior teeth occupy more space than normally placed posterior teeth.
• Derotation is best achieved with fixed appliances incorporating spring or elastics using a force couple.

Proclination of Anterior Teeth

• It is done in patients whose nasolabial angle is obtuse.
• It is also carried out in retroclined incisors.