Serial Extraction

Question 0

How do laterals ormally erupt if crowding is present?

Answer 0

Lingual to centrals, however, can sometimes self resolve.

Question 1

What are some signs of mixed dentition crowding?

Answer 1

Incisor crowding

Prediction of 3-4 mm per quadran using moyers

Question 2

When checking dental midlines, what aspects should be observd?

Answer 2

Coincidence
Asymmetry
Early loss of teeth

Question 3

What should be checked before carrying out sial extractions?

Answer 3

Eruption times and sequence

Midlines

Question 4

Whats the first thing to do with a midline issue?

Answer 4

Centre the midlines ( study models or manipulate mandible intraorally) and check the transverse relationships as well as for premature contacts.

Question 5

How should mandibular displacement be managed?

Answer 5

Use burs and take care of premature contact. Try to calibrate so that mandible goes into a more centric occlusion

Question 6

What are the checks involved in planned extraction?

Answer 6

Harmonioius soft tissue pattern
Look to space regain if premature loss of teeth and arch length
Educate patient and parents - further treatment normally still required
Ensure all teeth present - BEFORE STARTING EXOS

Question 7

What are the steps in serial extractiion?

Answer 7

After moyers,

1) take lower d’s out when premolar roots are one third formed
2) consider space maintainence
3) when lower 4s emerge, remove upper d’s
4) evaluate and consider extraction of lower 4’s
5) when upper 4’s emerge, evaluate and extract.
6) if space still requuired, extract lower e’s
7) monitor interocclusal relationshp
8) lower c’s should have exfoliated and upper c’s should be extracted if eruption of upper 3’s abnormal.

Question 8

What are some variations of serial extractn?

Answer 8

Tp changes at each appt.
Variation 1
Start with removing c’s prior to d’s. Then 4’s and then e’s
Always do a moyers to see how much space there is.
Variatioin 2
If lower premolar impacts, extract second deciduous molar and space maintain
Variatioin 3
Extraction of lateral incisors if crowding is severe and patient very young. However, do notng is probably a better option in this case unless obvus asymmetry
Variatioin 4
With severe crowding, enucleation of first premolars for maximum movement of canines. Severe alveolar bone loss (surgical scar left however). Not in australia.

Question 9

What are some of the problems with serial extratcions?

Answer 9

1) diagnosis is vital
- growht
- arch prediction
- timing of extractions
2) untill first premolars taken out, crowding is merely being moved posteriiorly
- poor axial inclincation of 3’s and 5’s.
3) increase in overbite and overjet
4) crowding in about 50% cases hence the need for mechanotherapy and adeequate patient cooperation.