[Monitored extractions: serial extractions].
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Cement-retained implant-supported prostheses are particularly indicated where access for screw placement is limited or impossible like in posterior locations or where there is limited jaw opening. The patient in this case report suffered from limited jaw opening as a result of a long history of temporomandibular joint ankylosis related to hemophilia. Cement-retained implant-supported prostheses coupled with serial extraction, serial implant installations, and chairside provisional restorations made uneventful treatment possible.
Serial extraction of mandibular second premolars should be considered if they are impacted or in cases with moderate arch length deficiency combined with an absence of dentofacial protrusion. The favorable dental changes associated with this approach greatly minimize future orthodontic treatment complexity and time.
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We examined changes in dentition after serial extraction in subjects who wore no appliances to determine the relationships between changes in dentition and improvement in dental crowding. Mandibular dental casts and lateral cephalograms from 31 subjects who had undergone serial extraction without orthodontic treatment were analyzed at 3 stages: before extraction of the deciduous canines (T1), after extraction of first premolars (T2), and at the end of the observation period (T3). Although movements of the first molar cusp and apex from T2 to T3 were significantly greater than from T1 to T2, movements of the incisor cusp and apex from T1 to T2 were significantly greater than from T2 to T3. The first molar tipped mesially from T1 to T2 but tipped distally from T2 to T3. The distal tipping of the incisor from T1 to T2 was significantly greater than from T2 to T3. These results suggest that the main changes in dentition from T1 to T2 are different from those from T2 to T3. The correlations between the annual change in the canine movement or tipping from T2 to T3 and the annual change in the irregularity index at the same time were significant. These results suggest that the canine movement or tipping contributed to the correction of the anterior crowding from T2 to T3.
In this study, we examined the effect of serial extraction alone on crowding. We also investigated the relationships between tooth width, arch length, and irregularity index. Maxillary dental casts from 32 subjects who had undergone only serial extraction were analyzed at 3 stages: before deciduous canines extraction, after first premolars extraction, and at the end of the observation period. The mean of the irregularity index decreased significantly as serial extraction proceeded and further decreased during the observation period. In cases where the width of the incisor was more than 2 standard deviations above the means for the control subjects, there was a significant correlation between tooth width of the lateral incisors and irregularity index before extraction as well as a significant correlation between the summation of tooth widths of the central and lateral incisors and irregularity index at that time. There was a significant negative correlation between arch length discrepancy and irregularity index before extraction and also a significant correlation between arch length discrepancy and correction of the irregularity index from before deciduous canines extraction to after first premolars extraction. These results suggest that tooth width and arch length discrepancy might preferentially affect the degree of anterior crowding in cases of severe crowding. There was no aggravation of the average crowding level during the observation period in the present study. The present study quantitatively suggested that serial extraction was useful for the purpose of correcting crowding in most cases.
The purpose of this study was to evaluate the mandibular incisor alignment in serial extraction cases, using the longitudinal dental cast records of the Burlington Growth Center as a control sample. Various parameters were investigated and the statistical differences determined between the treated and untreated groups. The results were also compared with data from serial extraction groups that subsequently had orthodontic treatment. Untreated subjects and subjects treated only with serial extractions showed similar longitudinal changes. However, the extraction group that also received orthodontic treatment appeared to show more lower incisor crowding long-term. No predictors for stability of clinical significance could be determined. Mechanotherapy influences the craniofacial and dentoalveolar dimensions, which appear to cause more long-term lower incisor crowding.
To assess soft tissue profile changes through time, a comparison was made of patients treated by serial extraction without subsequent orthodontic treatment (n=28), patients treated with serial extraction and orthodontic treatment (n=30), and patients treated orthodontically with late extraction (n=30). Cephalometric radiographs were traced and digitized; linear and angular measurements were made with a custom computer program that allowed digitization of specific soft tissue points. Maxillary, mandibular, and overall cephalometric superimpositions and linear measurements of change from the superimpositions were done by hand. Statistical analyses were made to determine if significant differences existed within each group at each time period and between groups at each time period, as well as between males and females at each time period. Data were also analyzed to determine if significant correlations existed between any hard tissue variable and any soft tissue variable, or between any soft tissue variable and any other soft tissue variable. It was found that in those patients treated with late premolar extraction, the most labial point of the mandibular incisor was more posterior from pretreatment to posttreatment than in the serial extraction group. While a great number of associations existed between variables, no significant differences were found between the soft tissue profiles of these three groups of patients. The gender differences that were found to exist were most likely due to normal maturational changes, not the treatment itself.
Serial Extraction is a useful means of improving the shape and function of the developing dento-alveolar system in selected cases. However, it requires an ability to recognise departures from normal development and to predict growth changes. This may be beyond the skill of the average practitioner. Much depends upon careful monitoring with the aid of study casts and radiographs. It is often necessary to carry out simple interceptive measures such as grinding of deciduous teeth or simple tooth movements at carefully selected ages. The selection of suitable cases and the procedures for managing them are illustrated by examples of treated cases.
Treatment outcome and duration of 2 different treatment approaches in 2 groups of comparable extraction cases were analyzed: Group I: serial extraction performed in the early mixed dentition followed by orthodontic treatment in the permanent dentition; group II: extractions as well as orthodontic treatment in the permanent dentition. The following conclusions were reached: 1. The treatment period with fixed appliances was highly significantly shorter in group I; however, the number of appointments was significantly higher and the total duration of treatment/observation time significantly longer. 2. In both groups the reduction in PAR score was either improved or greatly improved in all cases.
Crowding of teeth is the result of arch length discrepancy (ALD). Minimal crowding can be solved with slice-technique, more severe crowding (ALD > or = 5 mm) can be intercepted with a serial extraction procedure. In this paper a sequence of serial extraction will be explained and illustrated with case reports.
Case records were evaluated for 30 patients who had undergone serial extraction of deciduous teeth plus first premolars followed by comprehensive orthodontic treatment and retention. Diagnostic records were available for the following stages: pre-extraction, start of active treatment, end of active treatment, and a minimum of 10 years postretention. All cases were treated with standard edgewise mechanics and were judged clinically satisfactory by the end of active treatment. Twenty-two of the 30 cases (73%) demonstrated clinically unsatisfactory mandibular anterior alignment postretention. Intercanine width and arch length decreased in 29 of the 30 cases by the postretention stage. There was no difference between the serial extraction sample and a matched sample extracted and treated after full eruption.
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Mandibular dentitions from 33 subjects who had undergone serial extraction without appliances were analyzed at three stages: before extraction of deciduous canines (T1), after extraction of first premolars (T2), and at the end of the observation (T3). It was suggest that the mesial movement or tipping of the second premolars was associated with most of the space closure from T2 to T3, although the distal movement or tipping of canines might also contribute space closure.
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