Premolar

extractio
n
treatment
Leny Aggitya
Extraction consideration

crowding protrusion Profile

Dental
improvemen
camouflage
t
In recent years, the evolution of clear aligner technology has
allowed the clinician to treat an increasing range of complex
malocclusions, including premolar extraction cases,
successfully with clear aligners.
 ANCHORAGE

RECIPROCAL
The posterior teeth act as an anchorage segment for the anterior teeth, and the
anterior teeth act as an anchorage segment for the posterior teeth (67%:33%)

maximum
in a deemed maximum anchorage situation, the extraction space is anticipated
to close in a 75%:25% ratio

absolute
TAD needed. posterior segment may be made immovable, and the entire
extraction space can be closed by retraction of the anterior segment
Biomechanics of
extraction space
closure
 Bodily vs
tipping
Perform bodily movement in fixed appliance: using recta archwire

CLEAR ALIGNER: root control attachments on teeth adjacent to the extraction site
Loss of torque as teeth retrocline rather than retract
bodily
In fixed appliances, a rectangular stainless steel archwire will help express the torque

CLEAR ALIGNER: In clear aligner therapy, power ridges may be placed to maintain incisor
torque during retraction

power ridges may be placed to maintain

incisor torque
Loss of anchorage during space closure resulting in
incomplete correction of the buccal relationship
In clear aligner therapy, precision cuts for Class II elastics may be
prescribed for interarch anchorage even in Class I extraction cases
 CASE
SELECTION

Critical to successfully treating premolar

extraction cases with clear aligners.
 ■ Class I or mild Class II
maxillomandibular protrusion
■ Proclined maxillary and
mandibular incisors
Ideal case ■ Mesially tipped canines with
favorable root inclinations
adjacent to the extraction
site
■ Minor crowding
Staging patterns

Reciprocal The G6 Maximum

retraction Anchorage Protocol.
 Reciprocal
retraction
Very effective staging pattern; anterior and posterior act as anchorage to
close extraction site. Space closure of the extraction site starts
immediately from the first aligner
G6 Maximum Anchorage
Protocol
 Cases of premolar extraction treatment where maximum anchorage is
desirable, maximum retraction needed.

 Applies to first premolar extraction treatments where the

posterior loss in anchorage must be 2 mm or less to finish in a
cusp-to-fossa relationship.
 Staggered staging
technique
To minimize tipping of the canines and control
incisor torque with strict anchorage control for
maximum retraction of the incisors

PATTERN
Canine Retraction&some posterior mezialisation
Anterior retraction  Canine retraction 
Anterior retraction
Case
report
A 24-year-old woman
presented with a
severe dolichofacial
skeletal Class II
malocclusion with
increased overjet and
anterior open bite
Treatment Protocols

Maxillary First
Premolars
Extraction

Lower IPR to 10 months: the Settling elastics

prevent extraction sites were in posterior
proclination closed segments
Post treatment
Thank
s