METHODS OF GAINING SPACE

Submitted by:- Aamir faiz (02) (B.D.S. Final year)

METHODS OF GAINING SPACE

The correction of many malocclusions requires space

in order to move teeth in to more ideal locations. Space is required for correction of crowding, retraction of proclined teeth, leveling a steep curve of spee, derotation of anterior teeth and for correction of unstable molar relation.

 SOME OF THE METHODS OF GAINING SPACE

INCLUDES :
PROXIMAL STRIPPING
EXPANSION EXTRACTION DISTALISATION UPRIGHTING OF MOLARS DEROTATION OF POSTERIOR TEETH PROCLINATION OF ANTERIOR TEETH

PROXIMAL STRIPPING
It is a method by which the proximal surface of the

teeth are sliced in order to reduced the mesiodistal width of the teeth. Synonyms- reproximation, slenderization, disking, proximal slicing. Although this procedure is routinely carried out on the lower anterior it can also be done on the upper anterior and buccal segments of the upper and lower arches.

INDICATIONS OF PRXIMAL STRIPPING

When the space required is minimal that is 0- 2.5 mm.
To avoid extractions. If the boltons analysis show mild tooth material excess

in either of the arches. it can be undertaken in the lower anterior region as an aid to retention.

CONTRAINDICATION
It is not carried out in younger

patients as they possess large pulp chamber which increase the risk of pulp exposure Patients who are susceptible to caries or who have high caries index.

ADVANTAGES
To avoid extraction in border line cases A more favorable overbite and overjet relation can be

established by eliminating tooth material excess in either of the arches. More stable results can be established by broadening the contact area there by eliminating small contact points which can slip and cause rotation of teeth.

DIAGNOSTIC AIDS
Arch perimeter analysis- arch perimeter or careys analysis

showing tooth material excess of 0-2.5mm over the arch length is a diagnostic criteria favoring reproximation. Boltons analysis- it revealing an excess of tooth material in either of the arches in the indication of tooth material in that arch. Minimal inter arch tooth material. discrepancies can also be corrected by proximal stripping Intra oral periapical radiographs- this would give an idea of the enamel thickness and a rough estimate of the amount of enamel that can be removed from the proximal surface without exposure to pulp chamber.

AMOUNT OF PROXIMAL STRIPPING

Not more than 50% of enamel thickness should be reduced by

proximal stripping whenever reproximation is under taken in a segment of an arch it is advisable to equally distribute them over all the teeth.

DISADVANTAGES
This procedure creates roughened proximal surface

that attracts plaque. Caries susceptibility is increased. Sensitivity of teeth. Improper procedure can result in alteration of morphology of tooth and creating an unnatural appearance of tooth. Loss of contact between adjacent teeth may result in food impaction.

PROCEDURE
Three proceduresUse of metallic abrasive strips Safe sided carborundum discs Long thin tapered fissure burs

FLOURIDE APPLICATION

The increased caries

susceptibility after slenderization is managed by a comprehensive flouride programme following the procedure.

EXPANSION
It is usually undertaken in patient having constricted maxillary arch or in patients with unilateral or bilateral cross bite. Expansion can be skeletal or dento-alveolar. Skeletal expansion involves splitting of mid palatal suture while dento-alveolar expansion produces a dental expansion with no skeletal change. Expansion is brought about by various appliances that incorporate jack screw or by use of springs.

EXTRACTIONS
Extraction that is undertaken as a part of orthodontic

treatment is called therapeutic extraction. Premolars are the most extracted teeth as a part of ortho treatment. Extraction of premolars from each quadrant of the jaw provide sufficient space to correct the confronting problem without unduly hampering function and esthetics. In addition the location of premolars in the arch is such that the space gained by their extraction can be utilized for correction in both anterior and posterior segment. It is not uncommon to extract molars or lower incisors, extraction of canines and upper incisors is avoided. The answer of the question of which teeth to extract for a patient should be based on sound diagnosis.

DISTALIZATION
It is the most popular technique in recent timedistalization of molars. These procedures are aimed at moving the molars in distal direction so as to gain space. The popularity because of that extraction can be avoided. The ideal timing for distalization is during the mixed dentition prior to eruption of the second permanent molar. Two methods- * extra oral * intra oral

EXTRA ORAL
Head gears deriving anchorage from the cervical or cranial region can be used to distalize the molars. The head gear assembly consist of a face bow. Disadvantages patients cooperation is essential for timely wear of appliance. The appliances are usually not worn continually thus they are intermittent in action this results in prolonged treatment time.

INTRAdrawback of extra oral ORAL In order to over come the

appliance, intra oral appliances are introduced. They are fixed on the teeth and therefore produce continuous effect on the teeth. Some intra oral devices Sagittal appliance-molar distalization can be brought about by removable appliances incorporating jack screws. The appliance consist of spilt acrylic plate joined together by a jack screw. These appliances are retained using adams clasp on the molars and pre molars. .

 The jack screws are positioned in such a way that their long

axis is parallel to occlusal plane as well as the buccal surface of molar. These type of appliances can be used for distalization of only one tooth at a time to avoid undue strain on the anchorage. Distalization using intra oral magnets-used to distalize the molars. This consist of repelling magnets placed on the molars to be distalized and the tooth anterior to it. The anterior anchorage can be reinforced using a nance holding arch. pendulum appliance-this is the appliance that incorporates a modified nance button for purpose of anchorage. In addition it consist of stainless steel wire with helix, the distal end of which is inserted into a sleeve on the palatal aspect of the molars to be distalized . Distalization is produced by opening the helix and forcefully engaging the distal ends into the sleeves

UPRIGHTING OF MOLARS
Premature loss of second deciduous molar or extraction of a second premolar can cause mesial tipping of the first permanent molar.
A mesially tipped molar occupies more space than upright molar thus by uprighting these molars certain amount of space can be recovered. Molars can be uprighted using molar uprighting springs or some form space regainers.

DEROTATION OF POSTERIOR TEETH

Rotated posterior teeth occupies space than normally

placed posterior teeth. Derotation of these teeth hence provides some amount of arch length. Derotation is best achieved with fixed appliances incorporating springs or elastics using a force couple.

PROCLINATION OF ANTERIOR TEETH

Proclination of retruded anterior tooth results in gain

of arch length. This is usually indicated in cases where the teeth retroclined or in those cases where protecting the anteriors will not affect the soft tissue profile of the patient.

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