Methods of Space Gaining in Orthodontics

Methods of gaining space
:Introduction
 Every few malocclusion are encountered where

there is excess of space.
 So : to resolution of malocclusion the space is
required.
 In this lecture we well discuss the various ways in
which space can be created.
-: Space is required for
 alignment of crowded teeth.

 Retraction of proclined teeth.
 Correction of molar relationship.
 Derotation of interior teeth.
 Leveling of curve of spee.
 Anchorage requirement
-: The various methods of gaining space include
 proximal stripping.
 Arch expansion.
 Distalization of molar.
 Uprighting of tilted teeth.
 Derotation of posterior teeth.
 Proclination of interior teeth.
 Extraction.
proximal
-:stripping
it is involve the selective reduction of mesiodistal
width of cretins teeth to create space.
Also called :
 Slinderization
 Disking
 Proximal slicing
Usually we stripping from these teeth:
 Mandibular anterior
 Maxillary anterior
 Premolars of both arches
The teeth selected depended
upon:
 Location of excess tooth
material
 Amount of discrepancy
 Thickness of enamel
 The carious or oral hygiene

status of patient
Indication:-
 when space requirement is minimal
( 2.5 – 3mm )
 usually when the excess exists in mand.
Anterior segment, this does not mean that it
can not be perform in other part of dentition.
 When there is exists a Botton's tooth material
excess (less than 2.5 mm).
Contraindication:-
 patients who are susceptible to caries.
 In young individuals.
Procedure:-
The procedure involve three steps:
 assessing space requirement.

 Selecting the teeth and amount of enamel to be
stripped.
 Enamel stripping.
Advantages of P.S :-
 avoid extraction (when space req. are minimal).

 Tooth material excess can be reduce achieving
better interdigitation, over bite and over jet.
 Broad contact may add to stability result.
 Localized malalignment can be corrected without
involved too many teeth.
Disadvantages:-
 sensitivity.
 Increase caries susceptibility.
 Difficult to reproduce exact morphology of the
tooth.
 Loss of proximal contact lead to tooth lodgment.
-: arch expansion
there are two type:

 rapid expansion.
 Slow expansion.
-:rapid expansion
Types of rapid maxillary expansion appliance:
 It is classified as:-
 removable appliances.
 Fixed appliances.
 tooth borne.
 Tooth and tissue borne.

removable appliance:
 basically consist of a escrow in the midline with
retentive clasps on posterior teeth.
 It is more effective when used in young patient
(especially during mixed dentition phase).
fixed appliances:
tooth & tissue borne:
 ISAACSON Rme appliances.
 HYRAX appliances.
 Hass Rme appliances.
-:slow expansion
indications:
 correction unilateral crossbite.

 Correction of V shaped arches (thumb sucker).
 Preparation of bone grafts in cleft cases.
 Elimination of a displacement.
Appliances used:
 screw appliances.
 Coffin spring.
 Quad /Tri / Bi-Helix.

-:Distalization of molars -3
indications:
 sometime difficulty to
convice the patient for
extraction of otherwise
healthy teeth.
Purpose:
 Push the max. & mand. Terminal molars

posteriorly, so this increase the arch length by the
same length as the amount of distalization
achieved.
Note:
 The distalization are usually under taken

before eruption of second permanent molars,
because it is more easier than moved to molars (i.e.
first & second molars).
The appliances used for distalization can be
classified as:
 Extraoral distalization appliance.

 Intraoral distalization appliances.
Extraoral distalization #
-:appliance
the most frequently used
E.O.D. appliances are
a headgear
headgear assembly
consist of:
 force delivering unit
(facebow, J hook).
 Force generating unit.
 Anchor unit – head
cap ,neck strap.
-:intra oral methods #
at time patient compliance

is a major problem with
extraoral appliance,
hence intraoral methods
were devised for the
purpose.
Intraoral appliance generate tooth movement forces
by mainly three methods:
 use of screws.
 Open coil spring.
 Wire spring in corporation helices.
 Magnets : but not very popular.
Various intraoral
distalization appliances
include:
 Schwartz plate.
 Sagittal appliance.
 First class.
 Veltribilateral &
monolateral sagittal screw.
 Open coil spring.
 Lip bumper.
-:Uprighting of tilted posterior teeth -4
tilted post. Teeth occupy

more space
molars tend to tip mesially due to :
 deciduous second molar lost early.

 Decay on distal surface of tooth.
 Delayed eruption of first & second molar.
 Uprighting of molar lead to an arch length gain
1 – 1:5 mm.
Derotation of posterior teeth -5
rotated post. Teeth occupy

more space so, derotation
these teeth will gain
space
derotation can be achieved
by used couple force
system.
extraction -6
it is one of the most common methods of gaining

space in the arch.
Need for extraction:

 We need extraction for the following:
 arch length- tooth material discrepancy.
 Correction of sagittal interarch relationship.
 Extraction for relief the crowding.

Choice of teeth for extraction:
* Choice of teeth to be extracted depended on
local conditions which include:
 direction & amount of jaw growth.
 Discrepancy between size of dental arches & basal
arches.
 State of soundness, position & eruption of teeth.
 Facial profile.
 Age patient.
 State of dentition as a whole.
Incisors
Indication for maxillary incisors extraction:

 unfavorably impacted max. incisors.
 Bucally or lingually lateral incisor with good
contact between central & canine.
 Grossly carious incisor that can not be restored.
 Trauma/ irreparable damage to incisors by
fracture.
Indication for mand. Incisors extraction:
 when one incisors completely excluded from arch

& there are satisfactory approximal contact
between other incisors.
 Boor prognosis as in case : trauma, caries,
bone lose, ect.
 Severely malpositioned incisor.
 Lower canine as severely inclined distally &
lower incisor are farred.
 In mild class III incisors relation with an
acceptable upper arch & lower incisors
crowding.
Contraindication for mand. Incisors
extraction:
 deep bite with horizontal growth pattern.

 All cases which require upper first PM extraction
while canine are in a class I relationship.
 Bimax. Crowding cases with no tooth size
discrepancy in the incisors area.
 Cases having interior discrepancy due to ether
small lower incisors or large upper incisors
:Canines
Indications:
 mand. Canine maybe extracted when it is likely to

be very difficult to align.
 Max. canines develop far away from their final
location & have along bath of eruption from their
development site to their final position in oral
cavity.
 When max. canine is completely excluded from the
arch & approximal contact between first premolar
& lateral incisor is good.
:First premolar
It is the most tooth commonly extracted as part of

orthodontic therapy because:
 it is positioned near the center of each quadrant of
the arch & is there for near the site of crowding.
 Is the least at to upset molar occlusion & is the best
alternative to maintain vertical dimension.
 The contact between the canine & second PM is
satisfactory.
 First PM extraction leaves behind posterior segment
that offer adequate anchorage for retraction of the 6
interior teeth.
Indication for exo. :
 to relief moderate to sever anterior crowding in

both the arches.
 Correction of moderate to sever anterior
proclination as in class II div. I or class I bimax.
Protrusion.
 In high anchorage cases, first PM takes
precedence over second PM as the teeth to be
extracted.
 As a part of serial extraction.
:Second premolar
Indication:
 when second PM is completely excluded from the

arch
 preferred in mild anterior crowding cases as space
closer & vertical control is easier after anterior
alignment.
 When one wishes to maintain soft tissue profile &
esthetic.
 Unfavorably impacted second PM.
 Crossly carious.
 In open bite.
:First molar
Avoid extraction because:
 it dose not give adequate space to relieve anterior

crowding.
 Deepening of bite.
 Poor approximal contact between second PM &
second molar.
 Second PM & second molar may tip in to extraction
space.
 Mastication is affected.
Indications:
 minimal space requirement for correction of

anterior crowding or mild proclination.
 Crossly decayed with poor prognosis.
 Impacted molar – rarely seen.
:Second molar
Indication:
 to relief impaction of second PM.

 To relief impaction of mand. Third molar.
 When mand. Third molar Uprighting or it is long axis
is not tilted mesially more than 300 to the long axis of
the second molar.
 To relief lower incisors crowding.
 To correct mild to moderate arch length deficiencies

Methods of Space Gaining in Orthodontics

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What are some methods for gaining space discussed in the document?

What are some methods for gaining space discussed in the document?

What are the indications for proximal stripping?

What are the indications for proximal stripping?

Methods of gaining space

 Every few malocclusion are encountered where

 alignment of crowded teeth.

 The carious or oral hygiene

 assessing space requirement.

 avoid extraction (when space req. are minimal).

there are two type:

Types of rapid maxillary expansion appliance:

 Tooth and tissue borne.

 correction unilateral crossbite.

 Preparation of bone grafts in cleft cases.

 Quad /Tri / Bi-Helix.

 Push the max. & mand. Terminal molars

 The distalization are usually under taken

 Extraoral distalization appliance.

at time patient compliance

tilted post. Teeth occupy

 deciduous second molar lost early.

 Delayed eruption of first & second molar.

 Uprighting of molar lead to an arch length gain

rotated post. Teeth occupy

it is one of the most common methods of gaining

Need for extraction:

 arch length- tooth material discrepancy.

 Correction of sagittal interarch relationship.

 Extraction for relief the crowding.

Indication for maxillary incisors extraction:

 when one incisors completely excluded from arch

 deep bite with horizontal growth pattern.

 mand. Canine maybe extracted when it is likely to

It is the most tooth commonly extracted as part of

 to relief moderate to sever anterior crowding in

 when second PM is completely excluded from the

Avoid extraction because:

 it dose not give adequate space to relieve anterior

 minimal space requirement for correction of

 to relief impaction of second PM.

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