Professional Documents
Culture Documents
C SR T H O D O N T I C S
Tooth requiring Acceptable overjet Acceptable overjet and Unacceptable overjet and/or Reverse overjet
extraction and dental alignment crowding in buccal space required for labial
segments only segment crowding
6| and/or |6 Compensate to aid Compensation and balancing Seek specialist orthodontic opinion. Refer for a specialist
mandibular space closure. required, assuming the crowding Options regarding maxillary FPM opinion regarding
Balancing unnecessary as is symmetrical. include: necessity to
centreline shift is unlikely Retain FPM until second molars compensate.
in an uncrowded arch. erupt. A maxillary holding appliance Balance if
can be used to prevent overeruption crowding exists.
of the maxillary FPM.
Compensate. Later distalization
therapy can be used to regain space, or
two premolar units can be extracted if
the third molars are developing.
Balance to prevent centreline shift.
6| and/or |6 Compensation and Balance only. Retain FPMs until second molars erupt. Refer to specialist.
balancing unnecessary. Balance to prevent centreline shift.
for space maintenance until the second In class III cases it is wise to seek a dental midline. Balancing and
molar erupts. If crowding exists only in specialist orthodontic opinion before compensating extractions should be
the buccal segments, loss of the first extraction. considered during the mixed-dentition
molar at the ideal dental age may result in stage if no active appliance treatment is
spontaneous resolution of crowding and to be undertaken. In the permanent
good space closure. Presence and Condition of the dentition, balancing extractions are not
In class II division 1 malocclusion Other Teeth appropriate although removal of an upper
cases, an increased overjet (>3 mm) A clinical and radiographic examination molar should be considered if the lower
increases the risk of trauma to the upper should be carried out to check the molar is not being replaced.
central incisors and can confer a poor presence and condition of the remaining The following scenarios aim to illustrate
dental appearance. For each millimetre of teeth. In some cases it may be more when balancing and compensating
overjet reduction required, approximately appropriate to balance the loss of a FPM should be considered. These are
2 mm of space is required from the dental with the extraction of a poor prognosis summarized in Table 1.
arch.8 To meet these space requirements contralateral tooth other than the FPM.
for overjet reduction, poor-prognosis For example, radiographic examination
maxillary FPMs may be retained until the may show that a contralateral developing Acceptable Overjet and Dental
second permanent molar erupts – premolar has a hypoplastic crown. It may Alignment
although this may prejudice the mesial be more appropriate to balance loss of a Removal of a lower FPM should be
movement of the lower second molar. FPM with this tooth. compensated by removal of the maxillary
Once these teeth have been removed, The absence of third molars does not FPM to prevent overeruption. There is no
mesial migration of the second molar can generally contraindicate the extraction of need to compensate for extraction of a
be restricted using a palatal arch (Figure FPMs. However, the presence of mesially maxillary FPM. It is unlikely that a
4) or J-hook headgear to the upper arch directed forces from developing third significant centreline shift will result from
wire. Functional appliances can be used molars may aid space closure. removal of a FPM in an uncrowded
to reduce the overjet and substantially dentition, and balancing extractions are
reduce anchorage requirements in later unnecessary.
fixed appliance therapy where FPMs are BALANCING AND
electively removed. COMPENSATING
In class II division II malocclusion EXTRACTIONS Acceptable Overjet and
cases, overbite control may present a Compensating involves extraction of an Crowding in Buccal Segments
difficult problem during orthodontic antagonistic molar to prevent its Removal of a mandibular FPM should be
treatment. Lower arch extractions make it overeruption. As discussed earlier, balanced at the ideal age to provide
more difficult to control the position of overeruption of the upper FPM can spontaneous improvement of premolar
the lower labial segment and can make prevent mesial migration of the crowding and maintenance of the dental
overbite control problematical. For this mandibular second permanent molar. midline. Extraction of a mandibular FPM
reason, extractions in the lower arch Balancing involves removal of a should be compensated by removal of
should be avoided if at all possible in contralateral tooth, which needn’t the opposing FPM.
deep bite cases. necessarily be a FPM, to preserve the Extraction of one maxillary FPM should
be balanced by extraction of the create space for alignment and reduction crowding and reduce overjet.
contralateral tooth if crowding exists. of overjet. A maxillary holding appliance Most patients will not accept the
Compensating extractions are not may be used to prevent overeruption of extraction of several FPMs under local
beneficial. the maxillary FPM until the mandibular anaesthesia. For patients referred for
second permanent molar is in a good extraction under general anaesthesia it is
position. important, for ethical reasons, that both
Unacceptable Overjet and/or In uncrowded arches it may still be referring and receiving dentists ensure
Space Required for Labial better to balance molar extractions to that a specialist orthodontic opinion has
Segment Alignment allow symmetrical orthodontic arch been gained to be sure that the
mechanics. The opinion of an treatment plan is appropriate for the
Upper Molars orthodontic specialist should be sought patient in question.
Maxillary FPMs with poor prognosis can in such cases.
be stabilized until the second permanent
molars have erupted. Space obtained by REFERENCES
removing an FPM can be used for Reverse Overjet
1. Todd JE, Dodd T. Children’s Dental Health in the
reduction of overjet and dental alignment. Orthodontic advice should be sought United Kingdom. London: Office of Population
Compensating extractions are not before carrying out any extractions. Censuses and Surveys, 1983.
2. Sandler PJ, Atkinson R, Murray AM. For four sixes.
necessary. Am J Orthod Dentofacial Orthop 2000; 117: 418–
435.
Lower Molars CONCLUSION 3. Thunold K. Early loss of the first molars 25 years
If there is no significant crowding in the When planning extraction of FPMs with later. Trans Eur Orthod Soc 1970; 349–365.
4. Richardson A. Spontaneous changes in the incisor
lower arch, the FPM should be extracted poor prognosis it is important to relationship following extraction of lower first
at the ideal time for spontaneous space consider whether future active appliance permanent molars. Br J Orthod 1979; 6: 85–90.
closure. If a maxillary FPM also has a treatment will be necessary. If such 5. Williams R, Hosila L. The effects of different
poor prognosis it may be retained until therapy is not needed, consideration extraction sites upon incisor retraction. Am J Orthod
1976; 69: 388–410.
the second permanent molar erupts. In a should be given to extraction at the ideal 6. Plint DA. The effect on the occlusion of the loss of
class II molar relationship the maxillary developmental age to achieve one or more first permanent molar. Trans Eur
FPM may not overerupt as its mesial spontaneous space closure. Each case Orthod Soc 1970; 329–336.
7. Hallett GEM, Burke PH. Symmetrical extraction of
surface occludes with the distal surface should be assessed for the need of
first permanent molars. Factors controlling results in
of the mandibular second deciduous balancing or compensating extractions the lower arch. Trans Eur Orthod Soc 1961; 238–255.
molar. If it is likely that the maxillary FPM to preserve the dental midline and 8. O’Higgins EA, Lee RT. How much space is created
may overerupt and prevent the prevent overuption, respectively. If from expansion or premolar extraction. Br J
Orthod 2000; 27: 11–13.
mandibular second molar from moving future appliance treatment is likely to be
mesially, extraction of the maxillary FPM necessary, it is important to seek
should be considered: space can be specialist advice, and it may be more
regained later by molar distalization. If the appropriate to stabilize the FPMs until FURTHER READING
maxillary FPM is disease free it may be the second molars erupt so that Richardson A. Interceptive Orthodontics, 4th ed. London:
possible to remove premolar units later to extraction space can be used to relieve British Dental Association, 1999.
these pastes has been triclosan, which compared to the controls. The more
ABSTRACT
is thought to contribute antibacterial concentrated 8% test group showed
TOOTHPASTE FORMULATION and antiplaque effects. significantly less reduction in both
IMPROVED AGAIN? This study examined a new scores. The authors suggest reasons
A Study to Assess the Plaque formulation containing bromo- for the beneficial effects, and also why
Inhibitory Action of a New Zinc chlorophene and triglyceride oil, in the more concentrated material may
Citrate Toothpaste Formulation. J. either a 1% or 8% concentration. not have been so effective.
Moran, M. Addy, D. Corry, R.G. Volunteers avoided all oral hygiene Since the vast majority of the
Newcombe and J. Haywood. Journal aids except for a toothpaste slurry population suffer from plaque-related
of Clinical Periodontology 2001; 28: rinse for varying periods in a double- gingivitis and other dental problems,
157–161. blind trial. Although after 24 and 48 further investigation is required into
hours there was no significant the potential value of the zinc citrate/
It has previously been suggested that difference, after 96 hours the 1% bromochlorophene/triglyceride
toothpastes containing zinc citrate concentration test group had a formulation.
may inhibit plaque and gingival significant reduction in both plaque Peter Carrotte
inflammation. One agent contained in score (10.6%) and plaque area (24.2%), Glasgow Dental School