Serial Extraction In Orthodontics: Definition, Indications, And Methods

Serial Extraction In Orthodontics: Definition, Indications, And Methods

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Define serial extraction. Explain in detail various serial extraction methods.
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Serial Extraction Definition

“It is a procedure where some deciduous teeth followed by permanent teeth were extracted to guide the rest of teeth into normal occlusion”.

Serial Extraction Indications

• Class 1 malocclusion with presence of space discrepancy.
• In cases where lateral incisor is lingually erupted.
• Lateral incisor displacement causing midline shift
• In cases where primary canine get prematurely lost.
• Crowding associated with proclination.
• In cases where mandibular incisors get labially displaced.
• In cases with gingival recession of labially placed incisors.
• In absence of spacing in deciduous dentition.

Serial Extraction Contraindications

• Class 2 and 3 malocclusion with skeletal abnormalities.
• In spaced dentition
• Anodontia/oligodontia
• Open bite/deep bite
• Mid line diastema
• Class I malocclusion with minimal space deficiency.
• Unerupted malformed teeth (dilacerated)
• Extensive caries or heavily filed fist permanent molar.
• Mild disproportion between arch length and tooth material.

Serial Extraction Advantages

• Treatment is more physiologic: Forces to guide teeth in normal position.
• Psychological trauma is avoided.
• It eliminates or reduces the duration of multibonded fixed treatment.
• Better oral hygiene is possible thus reducing the risk of caries.
• Health of investing tissue is preserved.
• More stable results are achieved.

Serial Extraction Disadvantages

• Serial extraction requires clinical judgement.
• Treatment time is prolonged (2–3 years).
• Patient cooperation is needed.
• Tendency for developing tongue thrust in extraction spaces.
• There is risk of arch length reduction by mesial migration of the buccal segment.
• Extraction of buccal teeth can cause deep bite.
• Axial inclination of teeth after serial extraction treatment requires short-term fixed appliance therapy.

Serial Extraction Diagnosis

• Study model analysis: There should be Carey’s analysis for mandibular arch and arch perimeter analysis for maxillary arch.
• OPG should be done to evaluate eruption status of the dentition.
• Cephalometrics: To assess the skeletal tissues to study the underlying skeletal relationship.
• For soft tissue examination both clinical examination and cephalograms are done.

Serial Extraction Procedure

• Dewel’s method
• Tweed’s method
• Nance method

Dewel’s Method

It is a three-step procedure

• Step 1: Extraction of deciduous canine to create space for alignment of the incisors (8-9 years of age).
• Step 2: Extraction of deciduous fist molar to accelerate the eruption of fist premolar (one year later).
• Step 3: Extraction of erupting fist premolar to permit the permanent canine to erupt.

Modified Dewel’s method

Here fist premolars are enucleated at the time of extraction of first deciduous molar especially in mandibular arch where canine erupts before fist premolars.

Tweed’s Method

• Step 1: Extraction of deciduous fist molar around 8 years of age.
• Step 2: Deciduous canines should be maintained as all the fist premolars are in advanced eruptive stage. Now both the deciduous canine are extracted along with all the four fist premolars.

Nance Method

This is the modified Tweed’s method

• Step 1: Extraction of deciduous fist molar around 8 years of age.
• Step 2: Extraction of all four fist premolars and deciduous canines simultaneously.

Post Extraction Therapy

Many of the cases of serial extraction need fixed orthodontic appliance therapy for correcting axial inclination and detailing of the occlusion.