SERIAL EKSTRAKSI

CONTENTSINTRODUCTION
HISTORY
RATIONALE
INDICATIONS
CONTRAINDICATIONS
ADVANTAGES
DISADVANTAGES
DIAGNOSITC PROCEDURE
PROBLEMS IN SERIAL
EXTRACTION

INTRODUCTION:
Serial Extraction merupakan
prosedur interseptif orthodontik
yang biasanya dimulai pada awal
masa gigi bercampur.
Merupakan prosedur yang
termasuk perencanaan ekstraksi gigi
desidui dan permanen tertentu
secara berurutan dan dengan pola
tertentu agar posisi yang baik pada
gigi dapat tercapai

HISTORY:Kjellgren (1929) used the term Serial

extraction to describe a procedure
where some deciduous teeth followed
by permanent teeth were extracted to
guide the rest of the teeth in to normal
occlusion.

Nance during 1940 s popularized

this technique in united states of

America ,term edit planned &
progressive extraction & has been
called the father of Serial
extraction philosophy in united
states.
Hotz in 1970 called such a
procedure active supervision of
teeth by extraction.

RATIONALE
Serial extraction dilakukan
berdasarkan 2 prinsip:Arch Length tooth material
discrepancy:
Kapanpun terdapat kelebihan tooth
material dibanding dengan lengkung
rahang, maka ekstraksi selektif
dilakukan sehingga gigi dapat
diarahkan ke oklusi normal.

Physiologic tooth movementGigi geligi manusia menunjukkan

adanya kecenderungan untuk
bergerak secara fisiologis ke arah
ruang kosong. Sehingga dengan cara
ekstraksi selektif, gigi akan merubah
posisinya lewat tekanan alami.

INDICATIONS FOR SERIAL EXTRACTION1.Maloklusi kelas I dimana terdapat

keserasian antara sistem muskular dan
skeletal.
2.Kekurangan lengkung rahang
dibandingkan tooth material merupakan
hal yang paling penting dalam serial
extraction.

Defisiensi lengkung rahang

diindikasikan dengan adanya satu
atau lebih dari keadaan di bawah ini:Tidak adanya general diastema.
Unilateral or bilateral premature loss
gigi kaninus desidui dengan pergeseran
midline.
Malpositioned or impacted insisivus
lateral.
Irregular or crowded gigi insisivus atas
dan bawah.

Ectopic.
Migrasi mesial dari segmen
bukal.
Pola erupsi dan urutan yang
abnormal.
Lower anterior flaring.
Ankylosis.

3.Dimana pertumbuhan tidak cukup

untuk mengatasi diskrepasi
lengkung rahang terhadap tooth
material.
4.Pasien dengan profil lurus dan
penampilan baik.

Contraindications of Serial
Extraction1.ClassII & III malocclusion skeletal.
2.Gigi yang berjarak.
3.Anodontia /oligodontia.
4.Openbite & deep bite.
5.Midline diastema.

6.ClassI malocclusion dengan sedikit

kekurangan ruang.
7.Unerupted gigi malformasi.
Eg.Dilacerations.
8.Extensive caries atau tambalan
besar pada gigi molar 1 permanen.
9.Disproporsi ringan antara panjang
rahang dan gigi yang dapat diatasi
dengan pengasahan proksimal.

Advantages of Serial ExtractionPerawatan lebih fisiologis karena

menuntun gigi menuju posisi normal.
Psychological trauma akibat maloklusi
dapat dicegah sejak dini.
Tidak dibutuhkannya durasi
pemakaian alat cekat.

OH membaik.
Menjaga kesehatan jaringan.
Periode retensi lebih singkat jika
dibutuhkan.
Hasil lebih stabil.

Disadvantages of Serial Extraction:

Tidak dapat dilakukan pada semua
jenis pasien.
Perawatan jangka panjang yang harus
bertahap dilakukan selama 2-3 tahun.
Membutuhkan kehadiran pasien
sehingga pasien kooperatif sangat
dibutuhkan.

Saat ruang terbentuk, pasien

memiliki kecenderungan tongu
thrust.
Ekstraksi gigi daerah bukal dapat
memperdalam gigitan.

Ada resiko pengurangan panjang

rahang akibat mesial drifting gigi
posterior.
Ditching or space can exist b/w the
canine & 2nd premolar.
Inklinasi aksial pada akhir perawatan
dapat membutuhkan koreksi.

Selection Of Suitable Extraction

Procedure
Extracting the primary canines
only it produces rapid selfimprovement in incisor crowding
and alignment intercepting the
development of lingual cross bite
of the lateral incisors.

Extracting the first primary molars

only this approach produces the earlier
eruption of first premolars but reduces
the rapidity and amount of incisor
alignment. This is the result of retention
of primary canines
Enucleation of first premolar buds it is
advocated when first premolar eruption
is behind that of canines and second
premolars. This allows maximal distal
translation of the erupting canines. It is
rarely indicated in the maxillary arch

Growth and development

analysisPeriodic growth assessment
records should be made in all
patients where growth is still going
on i.e. made until 14 to 16 year old
in girls and 18 to 19 year old in
boys

Morphologic assessmentIt includes assessment of tooth mass, arch

form, arch length, skeletal pattern, skeletal
growth potential, orofacial musculature,
facial aesthetics, oral habits and hereditary
assessment of parents and siblings. The
most favorable morphologic factors for
serial extraction include class 1
malocclusion, a favorable morphogenetic
pattern one that does not change, a flush
terminal plane or a mesial step relationship
of the primary second molars, minimum
overjet and minimum overbite

DIAGNOSTIC PROCEDURE
The 1st step is to assess that a
malocclusion exist in a clinical
examination and the need for
investigation and collection of
diagnostic records . Comprehensive
assessment of the dental , skeletal
and soft tissue is required.
The investigation required are as
follows;
-study model
-radiograph

STUDY MODEL
Assess the dental anatomy of the
teeth
Assess the intercuspation of
teeth
Assess the arch form and curve
of occlusion
Evaluate the occlusion
Undertake model analysis i.e.
arch perimeter analysis , Carrey's
analysis , mixed dentition analysis

RADIOGRAPHS
Intra oral x-rays e.g. periapicals ,
occlusal views.
Extra oral x-rays e.g. cephalometric ,
panoramic views e.t.c.
The above provide the following
information;
1. Detection of congenitally missing
teeth , supernumerary e.t.c.
2. Detection of any bony pathosis.
3. To assess the stages of root
development and the possible

To assess the different relationship between

craniofacial structures using
cephalometric analysis.
6. To assess facial patterns
7. To assess soft tissue matrix
8. To assess changes in mid and post tx
relationship cephalometrically to monitor
treatment progress

According to most
authors, an arch length
deficiency of not <5-7mm
should exist for serial
extraction.

Procedure
There are mainly three methods:Dewels Method
Tweeds Method
Nance method

DEWELS METHOD
Dewel has proposed a 3 step serial
extraction procedure.
In the 1st Step , the deciduous canines
are extracted to create a space for
alignment of the incisors.
This step is carried out at 8-9 years of
age.

After 1 years , the deciduous 1st molars

are extracted so that the eruption of 1st
premolars is accelerated.

This is followed by the extraction of

the erupting 1st premolar to permit the
permanent canines to erupt in their
place.

In some cases ,a Modified Dewels

Technique is followed where in the 1st
premolar are enucleated at the time of
extraction of the 1st deciduous molars.
This is frequently necessary in the
mandibular arch where the canines of
ten erupt before the 1st PM.

TWEEDSMETHOD:
This method involves the extraction of
the deciduous 1st molars around 8 years
of age.
This is followed by the extraction of
the 1st premolar & the deciduous
canines

TWEED METHOD
EXTRACTION OF DECIDUOUS
FIRST MOLAR

EXTRACTION OF DECIDUOUS
CANINE AND PREMOLAR

Nance Method:
This is similar to the Tweeds
technique & involves the
extraction of the deciduous 1st
molars followed by the extraction
of the 1st Premolars & the
deciduous canines.

Problems in the serial

extractionAnterior cross bites
Anterior Cross bite in which 1 or
more maxillary teeth are in lingual
relation to the mandibular anterior is
termed as Dentoalveolar anterior
Cross bites.
This is manifested as single tooth
cross bite & usually occurs due to

References:
Text book of
orthodontics:
GRABER
Text book of
orthodontics:
S.I.BHALAJHI