SERIAL

EXTRACTION
PRESENTED BY: PRIYANKA SINGH
BDS 2014 BATCH
 CONTENTS

 INTRODUCTION
 HISTORY
 PRINCIPLES
 INDICATION AND CONTRAINDICATION
 ADVANTAGE AND DISADVANTAGE
 DIAGNOSTIC PROCEDURE
 TREATMENT PLANNING AND EXTRACTION SEQUENCE
 TECHNIQUE
 CONCLUSION
 INTRODUCTION
Serial extraction is an interceptive orthodontic procedure
undertaken in the mixed dentition period that involves
planned removal of certain primary and permanent teeth in a
programmed sequence, so as to relieve crowding and guide
the remaining erupting permanent teeth into a more
favourable position.
Definitions
 PROFFIT: Planned and sequential removal of the primary and
permanent teeth to intercept and reduce dental crowding
problems.
 DEWEL: An orthodontic treatment procedure that involves the
orderly removal of selected deciduous and permanent teeth in a
predetermined sequence.
HISTORY
The names that stand out particularly for the modern development of the
serial extraction concept are

 Robert Bunon

 Kjellgren of Sweden

 Hotz of Switzerland

 Nance, Hoyd, Dewel and Mayne

 Nance presented clinics on his technique of “progressive extraction” in

1940 and has been called as the father of “serial extraction” philosophy
in the United States.
PRINCIPLES

Serial extraction is based on two basic principles

 ARCH LENGTH – TOOTH MATERIAL DISCREPENCY

 PHYSIOLOGIC TOOTH MOVEMENT

 INDICATION
 In class I malocclusion with ideal orthognathic profile and showing harmony
between skeletal and muscular system with normal overbite & good skeletal
profile.

 Severe crowding with arch deficiency of 8-10 mm or more which can be

indicated by the following features:

 Absence of physiologic spacing

 Abnormal exfoliation sequence of primary teeth

 Ankylosis of primary teeth

 Lingual eruption of permanent lateral incisor

 Unilateral deciduous canine loss and shift to the same side

 Labial stripping, or gingival recession, usually of lower incisor.

 Mesial eruption of canines over lateral incisors. Abnormal eruption

direction and eruption sequence

 Proclination of permanent upper and lower incisors , associated with

crowding.
 CONTRAINDICATIONS
 Congenital absence of teeth providing space
 Mild to moderate crowding
 Deep or open bites
 Severe Class II, III of dental/Skeletal origin
 Spaced dentition
 Anodontia/oligodontia
 Midline diastema
 Dilacerations
 Extensive caries
ADVANTAGES
 Treatment is more physiologic as it involves guidance of teeth into normal position.
 Physiological trauma associated with malocclusion can be avoided by treatment at
an early age.
 It reduces or eliminates the duration of multibanded fixed treatment.
 Better oral hygiene.
 Health of investing tissue is preserved.
 Lesser retention period.
 More stable results.
 DISADVANTAGES
 Requires clinical judgement. No single approach can be universally applied.
 Prolonged treatment time as it is carried out in stages spread over 2-3 years.
 Requires regular dentist visits.
 Extraction spaces close gradually developing a tendency of tongue thrust.
 Extraction of buccal teeth can lead to deepening of bite.
 If not carried out properly , there is a risk of arch length reduction by mesial migration
of the buccal segment.
 Axial inclination of the teeth at the termination of serial extraction necessitates short
term fixed appliance therapy.
 DIAGNOSTIC PROCEDURES
 I.EXAMINATION
 II. DIAGNOSTIC RECORDS
 Photographs
 Radiographs
 Study models
 TREATMENT PLANNING AND
EXTRACTION SEQUENCING

4 different methods…
 Dewel (CD4) 1978
 Tweed (DC4) 1966
 Nance technique(D4C)
 Grews’s method
DEWELS METHOD (CD4)

FIRST PREMOLAR
EXTRACTION OF EXTRACTION OF PERMANENT
EXTRACTED
DECIDUOUS DECIDUOUS FIRST CANINE ERUPT
CANINE (8-9YR) MOLAR(AFTER 1
YEAR)

FINAL POSITION
TWEED ( DC4)

All deciduous 1 Premolars along with

molars are extracted (8 yrs) deciduous canine is
Extracted(AFTER 4-10
MONTHS)

Canines alligned Incisors alligned

NANCE TECHNIQUE D4C

All deciduous molars

are erupted First premolar erupted Extracted 1st premolar

Deciduous canine
extracted Permanent Final position
canine erupts
 GREWE’S METHOD
 CLASS I MALOCCLUSION WITH PREMATURE LOSS OF MANDIBULAR
CANINE
 Results in midline shift , when arch length discrepancy is 5-10mm/arch.
 Extraction of remaining deciduous canine followed by deciduous first molars.
 First premolar extracted as it emerges.

 CLASS I MALOCCLUSION WITH SEVERE MANDIBULAR ANTERIOR

CROWDING
 Extraction of deciduous canine when there is arch length discrepancy of more
than 5mm per quadrant.
 First deciduous molars are extracted followed by first premolars .
 CLASS I MALOCCLUSION WHERE MINIMAL MANDIBULAR ANTERIOR
CROWDING IS 6-10 mm ARCH DEFICIENCY

 The first premolars are extracted.

 Deciduous molars are extracted depending on the formation of the roots of
premolar.
 Extraction of deciduous canine .
CONCLUSION
 Has its advantages and disadvantages.

 Diagnostic skill, knowledge and experience are critical.

THANK YOU