Method of gaining space
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This document discusses various methods for gaining space in orthodontic treatment, including non-extraction, extraction, and surgical methods. Non-extraction methods include proximal stripping, arch expansion using removable or fixed expanders, molar distalization using headgear or intraoral appliances, uprighting tilted teeth, derotation of posterior teeth, and proclination of anterior teeth. Extraction methods include balancing, compensating, phased, enforced, Wilkinson, and therapeutic extractions. Surgical methods include orthognathic surgery and distraction osteogenesis. The document provides details on techniques such as proximal stripping, rapid maxillary expansion, and molar distalization. It discusses the indications, contraindications, advantages, and disadvantages of different
Method of gaining space
- 1. METHODS OF GAINING S P A C E PRESENTED BY – DR. ROKEYA RAHMAN TANI FCPS Part-II Trainee Dept. of Orthodontics Dhaka Dental College & Hospital.
- 2. For the resolution of a majority of malocclusions, space is required. Like - Alignment of crowded teeth Retraction of proclincd teeth Correction of molar relationship Derotation of anterior teeth Leveling the curve of Spee Correction of ant. and post. cross bite Correction of narrow dental arch Intrusion Why Space Is Required –
- 3. What are the methods of gaining space – Space can be gained by Non Extraction Extraction Surgical Proximal stripping Arch expansion Molar teeth distalization Uprighting of tilted teeth Derotation of posterior teeth Proclination of anterior teeth Orthognathig surgery Distraction osteogenesis Balancing extractions Compensating extractions Phased extractions Enforced extractions Wilkinson extractions Therapeutic extractions
- 5. PROXIMAL STRIPPING Proximal stripping involves the selective reduction of the mesiodistal width of certain teeth to create space. The procedure is also called - Proximal slicing Reproximation Slenderization INDICATION FOR PROXIMAL STRIPPING • Done when space requirement is minimal (2.5- 3 mm).( Or when Bolton's tooth material excess less than 2.5 mm). • Usually when the excess exists in the mandibular anterior segment. CONTRAINDICATIONS FOR PROXIMAL STRIPPING • Patients who are susceptible to caries. • Avoided in young individual as their teeth may possess large pulp chambers.
- 6. The procedure involves three steps – 1. Assessing space requirements. 2. Selecting the teeth and amount of enamel to be stripped. Not more than 50% of Enamel thickness to be stripped. 3. Enamel stripping. Metal abrasive strips Enamel stripping is generally performed using the following methods - PROCEDURE
- 7. Thin fissure burs Safe sided corborundum disks Tungsten carbide or diamond burs Perforated diamond disc Air Rotor Stripping method (ARS)
- 9. Please note: After Reproximation there will be sensitivity. Artificial remineralization is possible by crystal growth. A low concentration of calcium-fluoride solution produce this growth in a time dependent fasion.
- 10. Advantages of proximal stripping To avoid extractions in borderline cases where space requirements are minimal. To achieve better interdigitation, overbite and overjet To broaden the contacts to add the stability of results Localized malalignments can be corrected without involving too many teeth, especially in adult patients. Disadvantages of proximal stripping ≠ Sensitivity ≠ Increases caries susceptibility ≠ Difficult to reproduce exact morphology of the tooth. ≠ The shape created may not be as esthetic ≠ Food lodgement
- 11. Arch expansion Rapid maxillary Removable Fixed Slow expansion
- 12. RAPID MAXILLARY EXPANSION (RME) DEVICES First reported at 1860 by Emerson C. Angell These are the kind of Dentofacial Orthpedic appliance Mid palatine suture is mainly used to separate to gain the space 15- 19 years of age is more Sweetable time post. teeth are used to transmit force to the maxilla Midline diastema seen primarily Open bite is possible
- 13. Growing individuals with severely constricted maxillary arches, Involving airway impairment or mouth breathing tendencies. Posterior cross bites with real or relative maxillary deficiency Cleft patients Along with facemask therapy Class Ill cases with minor maxillary deficiency As part of interceptive orthodontics Indications for RME use
- 14. Removable RME appliance The appliance basically consists of a screw in the midline with retentive clasps on posterior Teeth. More effective when used in the early mixed dentition phase. But its efficiency is doubtful.
- 15. Fixed RME Appliances I. Tooth Born appliance II. Tooth-tissue born appliance Tooth Born appliance are - 1. HYRAX APPLIANCES
- 16. 2. ISAACSON RME APPLIANCES
- 17. 1. DERICHSWEILER RME APPLIANCES 2. HASS RME APPLIANCE Tooth-tissue born appliances are -
- 18. SLOW EXPANSION DEVICES Indications of slow expansion Correction of unilateral cross bites Correction of 'V' shaped arches Preparation for bone grafts in cleft cases Minimal crowding in the upper arch (1-2 mm) Elimination of a displacement
- 19. 1. Screw Appliances (upper & lower) 2. Coffin Spring Some of them are removable, some are fixed type -
- 20. 3. Quad/Tri/Bi -Helix 4. Ni-Ti Expanders
- 21. 5. The Schwarz Appliance
- 22. DISTALIZATION OF MOLARS The main purpose of Distalization is to push the maxillary and/or mandibular terminal molars posteriorly. Usually undertaken before the eruption of the second permanent molars. There are 2 types – I. Extraoral distalizing appliances II. Intraoral distalizing appliances
- 23. Extraoral distalizing appliances The most frequently used extraoral distalizing appliances are the headgears. Bilateral as well as unilateral distalization is possible using headgears. Distal tipping of molars helps in - Opening the bite - Incrising the lower facial heigt 18 to 20 hours of wearing is recomanded for orthodontic effect.
- 24. Headgear
- 25. INTRAORAL METHODS OF DISTALlZING MOLARS Tooth moving force generators are mainly of – - Screws - Open coil springs - Wire springs with helices
- 26. Intra oral distalizing appliances are – • Schwartz plate • Sagitta1 appliance • First class • Veltribilateral and monolateral sagittal screws • Open coil springs • Jones jig • Oistal jet appliance • Fast back appliance • Pendulum appliance • Intraoral magnets • Jasper jumper • Lip bumper
- 27. UPRIGHTING OF TILTED POSTERIOR TEETH Uprighting of molars can lead to an arch length gain of 1-1.5 mm. Fixed appliances are idealIy used.
- 28. DEROTATION OF POSTERIOR TEETH Derotation can be best achieved using a couple force on the lingual and buccal surfaces of the tooth. Forces should be equal in magnitude but opposite in direction. Fixed appliance system with a two point contact is useful.
- 29. PROCLlNATION OF ANTERIOR TEETH Proclination of anteriors is indicated if only – - They are retroclined - Soft tissue profile will not be disturbed - Stability will be achived
- 30. Thanks for Today