METHODS OF SPACE GAINING

Dr sasikumar M.D.S.,

Calculate the amount of space required

Model analysis Method depends on outcome of space analysis

SPACE REQUIRED FOR

ALIGNMENT OF CROWDED TEETH RETRACTION OF PROCLINED TEETH CORRECTION OF MOLAR RELATIONSHIP DEROTATION OF ANTERIOR TEETH LEVELING OF CURVE OF SPEE INTRUSION

METHODS OF GAINING SPACE

PROXIMAL STRIPPING ARCH EXPANSION DISTALIZATION OF MOLARS UPRIGHTING OF TILTED TEETH DEROTATION OF POSTERIOR TEETH PROCLINATION OF ANTERIOR TEETH EXTRACTION

PROXIMAL STRIPPING
Reproximation,slenderization,disking,proxi mal Slicing, Teeth For Striping Depends Upon

Location of excess tooth material Amount of discrepancy Thickness of enamel present

INDICATION OF PROXIMAL STRIPPING

Space requirement is less than 3mm Boltan tooth excess is less thsn 2.5mm

CONTRAINDICATION OF PROXIMAL STRIPPING

Susceptible to caries Young individual bigger pulp chamber

Amount of enamel to be stripped

Iopa x ray

Methods of stripping
Metal abrasive strips Diamond disks Corborundum disks Thin fissure burs

Advantages
Tooth extraction can be avoided Broad contacts Localized malalignments can be corrected

disadvantages
Sensitivity Caries susceptibility Food impaction Difficult to reproduce exact morphology

ARCH EXPANSION

Classification

Rapid palatel expansion Slow expansion

PHILOSOPHY OF RME
Dentofacial orthopedic appliance Teeth are used to apply force on suture Splitting of mid palatine suture Bone growth in split gap

Anatomy of suture Effects of RME

Max teeth and alveolar bone Maxillary skeletal effects Mandible Nasal cavity and adjacent bone

MAXILLARY TEETH AND ALVEOLAR BONE

Post teeth are used to transmit force on maxilla Teeth tip buccaly Compression of bone- bending of alveolar bone Midline diastema

MAXILLARY SKELETAL EFFECTS

Palatine process separate in a triangular fashion 2 dimension

Occlusal vertical

EFFECTS ON MANDIBLE

Rotates downward and backward

NASAL CAVITY

Increase in inter nasal space The effect is sufficient sometimes to correct the deviated nasal septum

INDICATIONS FOR RME

Posterior crossbite with maxillary deficiency Cleft palate patients Class III case with mild maxillary deficiency As part of interceptive orthodontics

TYPES OF RME

Tooth borne

Isaacson rme appliance Hyrax rme appliance Derichsweiler rme appliance Hass rme appliance

Tooth and tissue borne

Activation Retention

SLOW EXPANSION DEVICES

Coffin spring Quadhelix Niti expanders Schwarz appliance

DISTALIZATION OF MOLARS
Pushing molar distally created space Before eruption of second molar Classification

Extra oral

Cervical head gear

Intra oral

Intra oral distalizers

Schwartz plate First class appliance Open coil spring Jones jig Distel jet appliance Pendulum appliance K-loop appliance Lip bumper

UPRIGHTING
Tilted teeth occupy more space Extracted space /missing teeth Space regainers lipbumpers

DEROTATION OF POSTERIOR TEETH

Rotated posterior teeth occupy more space Anterior teeth less space Derotate using couple forces Fixed appliance

PROCLINATION OF ANTERIOR TEETH

When teeth are retroclined Class II div 2 cases Fixed appliance

Reverse curve Z- spring screws

Removable appliance

Extraction
Common method of gaining space Need for extraction

Arch length tooth material discrepancy

crowding Class I-ext in both arches classII ext in upper arch Class III-ext in lower arch

Correction of sagittal inter arch relationship

DIFFERENT EXTRACTION PROCEDURES

Balancing extraction Compensating extraction Phased extraction Enforced extraction Wilkinson extraction therapeutic extraction

THERAPEUTIC EXTRACTIONS
Maxillary incisors Mandibular incisors Canines 1st premolars 2nd premolars Ist molars 2nd molars 3rd molars