Space Gaining Method Akash Kar,
- 1. Under the guidance of : DR. RAJIB KR SEAL, DR. PINTSO TSH LEPCHA, DR.SUBHASIS SHEET, DR.PARTHA PRATIM CHOWDHARY, DEPT. OF ORTHODONTIAAND DENTOFACIAL ORTHOPEDICS NORTH BENGAL DENTAL COLLEGE AND HOSPITAL BY- AKASH KAR, ROLL NO-26, IVTH YEAR YEAR - 2016-2017
- 2. WHY SPACE IS NEEDED???????????? IN SOME MALOCCLUSIONS AND IN THOSE CASES WHERE TOOTH MATERIAL AND ARCH LENGTH DISCREPANCY IS PRESENT, SPACE IS NEEDED TO CORRECT THOSE MALOCCLUSIONS. SUCH SITUATION WHICH REQUIRE SPACE FOR CORRECTION ARE: 1) CROWDING, 2) ANTERIOR PROCLINATION, 3) IMPACTED CANINE, 4) CURVE OF SPEE LEVELING, 5) CONSTRICTED ARCH,
- 3. VARIOUSMETHODS FOR GAINING SPACE PROXIMAL STIPPING ARCH EXPANSION EXTRACTION DISTALIZATION OF MOLAR UPRIGHTING OF TILTED MOLAR DEROTATION OF POSTERIOR TEETH PROCLINATION/FLARING OF ANTERIORS.
- 4. PROXIMAL STRIPPING PROXIMAL STRIPPING IS A METHOD BY WHICH THE PROXIMAL SURFACES OF THE TEETH ARE SLICED IN ORDER TO REDUCE THE MESIO-DISTAL WIDTH OF THE TEETH. SYNONYMS – REPROXIMATION, SLENDERIZATION,DISKING.
- 5. PROXIMAL STRIPPING INDICATION OF PROXIMAL STRIPPING: 1) IF BOLTON ANALSIS SHOWS MILD TOOTH MATERIAL EXCESS IN EITHER ARCH. 2) IF CAREY’S ANALYSIS SHOWS TOTAL TOOTH MATERIAL EXCESS 0-2.5 mm. 3) IN LOWER ANTERIOR REGION AS AN AID TO RETENTION. 4) IN CASES WHERE INDIVIDUAL TOOTH SIZES PREVENTS A CLASS I MOLAR AND CANINE RELATIONSHIP. 5) TO OBTAIN MORE FAVOURABLE OVERJET AND OVERBITE. CONTRAINDICATION OF PROXIMAL STRIPING: 1) YOUNG PATIENT AS THEY POSSESS LARGE PULP CHAMBER,WHICH INCREASE RISK OF PULP EXPOSURE. 2) CARIES RISK PATIENT. 3) TEETH WITH ENAMEL HYPOPLASIA. 4) PATIENT WITH POOR ORAL HYGINE.
- 6. PROXIMAL STRIPPING ADVANTAGES OF PROXIMAL STRIPPING: 1) POSSIBLE TO AVOID EXTRACTION IN BORDERLINE CASES WHERE SPACE REQUIRMENT IS MINIMUM. 2) MORE FAVOURABLE OVERJET AND OVERBITE CAN BE ESTABLISHED. 3) MINIMIZE THE POTENTIAL CONSEQUENCES OF EXTRACTION: • DIFFICULTY IN COMPLETING SPACE CLOSURE. • DIFFICULTY IN PARALLELING THE ROOT AFTER EXTRACTION. • NEED FOR GREATER ANCHORAGE REINFORCEMENT. • POSSIBILITY OF SPACE RE-OPENING. DISADVANTAGES OF PROXIMAL STRIPPING: 1) CARIES SUSCEPTIBILITY IS INCREASED. 2) PATIENT MAY EXPERIENCES SENSITIVITY. 3) LOSS OF CONTACT BETWEEN TEETH MAY LEAD TO FOOD IMPACTION. 4) IMPROPER PROCEDURE MAY LEAD TO CHANGE IN MORPHOLOGY OF TOOTH. 5) ROUGH PROXIMAL SURFACE ATTRACT PLAQUE.
- 7. INSTRUMENTS USED FOR PROXIMAL STRIPPING DIAMOND PROXIMAL STRIPS: THIN STRIPS OF STAINLESS STEEL WITH ELECTROLYTICALLY BONDED DIAMONDS,USED WITH STRIP HOLDER AND AVAILABLE IN EITHER SINGLE OR DOUBLE SIDED COATINGS AND COME IN THREE GRADES OF COARSENESS (FINE, MEDIUM AND COARSE). CARBIDE AND DIAMOND BAR: CROSS CUT CARBIDE FISSURE BURS AND MEDIUM OR FINE GRIT DIAMOND FINISHING BUR CAN BE USED. DIAMOND DISCS: AS LIKE STRIPS THEY COME IN VARYING GRIT AND RECOMMENDED WITH DISC GUARD TO PREVENT LIP INJURY. LEAF GAUGE: LEAVES ALLOW THE ACCURATE MEASUREMENT OF THE AMOUNT OF TOOTH STRUCTURE REDUCED.
- 8. EXPANSION EXPANSION IS A NON-INVASIVE METHODS OF GAINING SPACE WHICH IS DONE IN PATIENT WITH NARROW ARCH. ARCH EXPANSION HAS BEEN ONE OF THE OLDEST MEANS OF CREATING SPACE IN DENTAL ARCHES. INDICATION: CROSSBITE. MILD CROWDING. SKELETAL CLASS III MALOCCLUSION.
- 9. EXPANSION WHEN CAN WE GO FOR ARCH EXPANSION???? ACCORDING TO ASHLEY HOWE’S ANALYSIS: IF PREMOLAR DIAMETER(PMD) IS LESS THAN PREMOLAR BASAL ARCH WIDTH(PMBAW) THEN ONLY ARCH EXPANSION IS INDICATED. ACCORDING TO PONT’S ANALYSIS: IF MEASURED VALUE IS LESS THAN CALCULATED VALUE THEN EXPANSION IS POSSIBLE.
- 10. EXPANSION EXPANSION DEVICES CAN BE CLASSIFIED AS- RAPID MAXILLARY EXPANSION DEVICES SLOW EXPANSION DEVICES FEATURE SLOW EXPANSION RAPID EXPANSION TYPE OF EXPANSION MOSTLY DENTAL SKELETAL RATE OF EXPANSION SLOW RAPID TYPE OF TISSUE REACTION MORE PHYSIOLOGICAL MORE TRAUMATIC FORCE USED MILDER FORCE GREATER FORCE FREQUENCY OF ACTIVATION LESS FREQUENT MORE FREQUENT DURATION OF TREATMENT LONG SHORT TYPE OF APPLIANCE EITHER FIXED OR REMOVAL MOSTLY FIXED AGE ANY AGE BEFORE FUSION OF MID PALATINE SUTURE RETENTION LESSER CHANCE OF MORE CHANCE OF
- 11. EXPANSION RAPID EXPANSION DEVICES: FIXED APPLIANCES- FIXED APPLIANCE CAN BE EITHER TOOTH-BORNE OR TOOTH AND TISSUE BORNE. TOOTH BORNE FIXED APPLIANCES: ISAACSON RME APPLIANCE. HYRAX RME APPLIANCE BANDED HYRAX. BONDED HYRAX. ISAACSON RME APPLIANCE BANDED HYRAX BONDED HYRAX
- 12. EXPANSION TOOTH AND TISSUE FIXED APPLIANCE : DERICHSWEILER TYPE EXPANDER. HASS TYPE. DERICHSWEILER TYPE EXPANDER HASS TYPE EXPANDER
- 13. EXPANSION SLOW EXPANSION DEVICES: REMOVABLE APPLIANCES- Removable appliance mainly consist of split acrylic plate , a screw in midline and retentive clasps in posterior teeth. This appliance is more effective when used in the early mixed dentition phase.
- 14. EXPANSION OTHER SLOW EXPANSION DEVICES: COFFIN SPRING QUAD HELIX Ni-Ti EXPANDER COFFIN SPRING QUAD HELIX Ni-Ti EXPANDER
- 15. EXTRACTION THERE ARE NUMBER OF CIMCUMSTANCES THAT NECESSITATE EXTRACTION OF TEETH AS A PART OF ROUTINE ORTHODONTIC TREATMENT. THEY ARE LISTED AS FOLLOWS: Arch length – Tooth material discrepancy The following signs can be seen in this case -- Absence of physiological space. Ectopic eruption of teeth. Malposition or impacted teeth. Mesial migration of posterior segment. Crowding in upper and lower anteriors.
- 16. EXTRACTION WHEN CAN WE GO FOR EXTRACTION?????? According to carey’s analysis (applicable for lower arch): If Arch length and tooth material discrepancy— 2.5mm-5mm ---- Extraction of second premolar . > 5 mm ------ Extraction of first premolar. According to howe’s analysis: If premolar basal arch width % (PMBAW%) is 37% or less it is indicated for extraction. PMBAW % =PMBAW 100/TTM
- 17. EXTRACTION Why 1st premolar is the choice of tooth for extraction in most cases (for upper arch): 1) Their location in the arch is such that the space gained by their extraction can be utilized for correction of both anterior and posterior segment. 2) The extraction of 1st premolar leaves behind a posterior segment that offers adequate anchorage for the retraction of six anterior teeth. 3) Contact that result between canine and second premolar is very good. 4) 1st premolar is less esthetically important. 5) 1st premolar is not so much useful in chewing.
- 19. DISTALIZATION OF MOLARS Distalization procedures are aimed at moving the molars in a distal direction so as to gain space. This approach became popular due to the fact that extraction can be avoided. The ideal timing for distalization is during the mixed dentition period prior to eruption of second permanent molar. Objectives: 1) To distalize(normalized) mesially migrated maxillary molars due to their premature mesial shift. such a situation may exist unilaterally or bilaterally. 2) To correct mild maxillary dentoalveolar protrusion. 3) The profile of such patient is normal or slightly protrusive at the upper lip due to dental protrusion. 4) In class I occlusion patient ,distalization may be indicated to gain space to resolve minor anterior crowding.
- 20. DISTALIZATION OF MOLARS Distalization can be done by following methods: 1) Extra oral approach. 2) Intra oral approach. EXTRA ORAL APPROACH: Head gear deriving anchorage from the cervical and cranial region can be used to distalize molars. Disadvantage of extra oral method: Patient co operation is necessary for timely wearing the appliance. The appliance are not usually worn for a long time. Thus they are intermittent in their action resulting in prolonged treatment time.
- 21. DISTALIZATION OF MOLARS INTRA ORAL APPROACH: This appliance were introduce to overcome the various drawbacks of extra oral methods.This appliances are fixed with tooth and therefore produce a continuous effect. The devices are following: 1) Sagittal appliance- This appliance consist of a split acrylic plate joined with jack screw,the acrylic plate is sectioned in such a way that the tooth that to be distalized is isolated, and the rest of the arch is used for the purpose of anchorage. 2) Pendulum appliance- Introduced by HILGERS. It incorporate a modified Nance button for the purpose of anchorage.In addition it consist of a stainless steel wire with helix,the distal end of which is inserted on the palatal aspect of the molar to be distalized. Distalization is produced by opening the helix and forcefully engaging the the distal end.
- 22. DISTALIZATION OF MOLARS 3) Jones jig appliance- Jones jig is a maxillary molar distalizing appliance that utilizes a modified nance palatalbutton and a superelastic nickle titanium coil spring to bring about the distal force on the molar. It produce low and continuous force. Jones jig is placed on the buccal aspect of the maxillary molars. 4) Trans palatal arch for distalization of molars – They can also be used to bring about unilateral distalization of molars. Other appliances used for distalization of molars are: Distal Jet appliance Fast Back appliance
- 23. UPRIGHTING OF TILTED MOLAR Premature loss of deciduous second molar or extraction of second premolar can cause mesial tipping of first permanent molar. Mesially tipped molar occupy more space than an upright molar. Thus by uprighting these tipped molars certain amount of space can be recovered. UPRIGHTING OF TILTED MOLAR CAN BE DONE BY : 1) Uprighting Spring. 2) Space Regainer.
- 24. DEROTATION OF POSTERIOR TEETH Rotated posterior teeth occupy more space than normally placed posterior teeth. Derotation of of these teeth hence provide some amount of space. Derotation is best achieved with fixed appliance incorporating spring or elastic using a force couple.
- 25. PROCLINATION/FLARING OF ANTERIORS PROCLINATION OF RETRUDED ANTERIOR TOOTH RESULTS IN GAIN OF ARCH LENGTH. THIS IS USUALLY INDICATED IN : Cases where the teeth are retroclined or In those cases where protracting the anteriors will not affect the profile of patient. PROCLINATION DONE BY: Z-SPRING,T-SPRING.
- 26. REFERENCE: CONTEMPORARY ORTHODONTICS-WILLIAM R.PROFFIT (4TH EDITION) TEXTBOOK OF ORTHODONTICS- GURKEERAT SINGH ORTHODONTICS ,THE ART AND SCIENCE-S.I.BHALAJHI (6TH EDITION)
- 27. THANK YOU VERY MUCH….