By:Karishma Ashok

IV/I B.D.SRoll No: 33

METHODS OF SPACE

GAINING

Why space gaining??The correcction of many malocclusions require space in order to move the teeth into more ideal locations.Such as for correction of :CrowdingProclinationRotated anteriorsDeep biteConstricted arches

INTRODUCTION:

Methods to gain space include:

Proximal strippingExpansionExtractionDistalisationUprighting of molarsDerotation of posterior teethProclination of anteriors

Also known as SLENDERIZATION / REPROXIMATION / DISKING

Method by which proximal surfaces of teeth are sliced to reduce mesio-distal width of teeth.

This procedure provides a maximum of 2.5 mm space

PROXIMAL STRIPPING:

Indications:Carey’s analysis showing a TTM excess of 0-2.5mmBolton’s analysis showing mild tooth material excess For correction of minimal interarch tooth material

discrepancyIn lower anteriors to aid retentionIn cases where individual tooth size prevents class I

molar relationTo obtain favourable overjet or overbite

Contraindications:Young patientsPatients with high caries indexPatients with enamel hypoplasia

Advantages

Minimizes potential consequences of extraction such as:Difficulty in

completing space closure

Need for greater anchorage

Possibility of space re-opening

Difficulty in paralleling roots next to extraction sites

Disadvantages

Drawbacks include:Roughened proximal

surfaces that atrract plaque

Increased caries susceptibility

Sensitivity of teeth

EXPANSIONNon-invasive method of space gainingUndertaken in patients having constricted

arch

Indications:CrossbiteCrowdingSkeletal class III malocclusionsurgical orthodontics

SLOW EXPANSION DEVICESCoffin spring:

Designed by Walter CoffinRemovable applianceDento-alveolar expansion Made up of 1.25mm thick omega shaped wire

placed in mid palatal regionFree ends of omega embedded in acrylicActivated 1 to 2 mm per week

Quad helix:

Described by RickettsConstructed using a 0.038 inch wire Incorporates 4 helices, therefore flexibility

and range of application is more

Ni-Ti expanders:

Developed by ArndtFixed-removable tandem loop maxillary

expandersHas the capacity to rotate,upright,distalize

and expand the anterior and posterior archDual temp sensitive componentsAnteriorly, finger spring of 0.032 inch

diameter wire0.5mm per week tooth movement

Advantages:Self activatedAutomatically expands to pre-determined

shapeRequires little manipulation by clinicianLight continuous forcesEasy adaptability in inactive state

RAPID MAXILLARY EXPANSION

Indications:1. Posterior cross bite2. Class II

malocclusion3. Class III

malocclusion4. Constricted arch5. SARPE6. Cleft palate7. TS-ALD

Contraindications1. Existing openbite2. Single tooth cross

bite3. Skeletal

assymmetry4. Patent mid palatal

suture5. Periodontally weak

molars

First tried by Kingsley using headgearAimed at moving the molars distally to gain spoaceIdeal timimg mixed denition period prior to

eruption of second permanent molars

Indications:Straight profileFunctional :

Normal, healthy tmj Correct maxillo-mandibular relationship

Distalization:

Skeletal class I skeletal relationship skeletal closed bite brachycephalic growth pattern

DentalClass II or end on relationshipDiscrepancy of 2 to 3 mm

Contraindications :Class I or III malocclusionOpen bitePosterior crowding

Types:

Extra oral: (Using headgears)

Components:1. Force delivering unit : face bow/ J hook2. Force generating unit :elastic strap3. Anchoring unit: head cap/ neck strap

It brings about bodily movement or distal tipping of the molars in a posterior direction

Tipping movement is recommended in case of horizontal growth pattern and deep bites. In such cases it helps in opening the bite and also increases lower anterior facial height.

Headgears allow bilateral as well as unilateral distalization. Also, amount of distalization can be controlled individually

Intra oral:

1. Sagittal appliance

Removable appliance incorporating jackscrews

Consists of a split acrylic plate joined by jackscres

Acrylic plate is sectioned in such a way that the tooth to be distalised is isolated and the rest of the arch is used for anchorage

Retained using adams clasps Jackscrews are parallel to surface of molarsUsed for individual tooth distalization

Pendulum appliance:

Intra-oral distalization appliance introduced by Hilgers

Incorporates a modified Nance button for anchorage and a stainless steel wire

The wire has a helix the distal end of which is inserted into a sleeve at the palatal aspect of the molar to be distalised

Activated by opening the helices and engaging the distal ends into the sleeves

Types I. Heliger’s pendexII. Heliger’s PhD applianceIII. T-rex appliance

Jasper jumper

Fixed appliance for correction of class II skeletal malocclusion

Delivers light continuous forcesTakes anchorage from lower canine region to

distalise maxillary molarsUsed for single tooth or entire arch

Jones jigOpen coil springPlaced on buccal aspect; generates required force when compressedAnchorage by Nance’s palatal button and Ni-Ti wire to bring about distal movementThe assembly is ligated onto d first molar to prevent rolling

Distal jet appliance:Lingual distalization applianceActive components are placed palatally which

provide more bodily movementsConsists of bilateral piston and tube

arrangementTube is embedded in modified acrylicAnchorage by Nance palatal button that are

bonded to bands attached to 1 or 2 premolarsA Ni-Ti spring and activation collar are placed

near each tubeActivation collar is retracted distally, causing

compression and thereby activationAdvg: less distal tipping

Lip bumpersUsed in lower arch; counter part used in

upper arch is Denholtz applianceUses :1. Mixed dendition to bring about minor

distallization2. Regain space for unerupted teeth3. Uprighting mesially tipped mandibular

molars4. Inactive lip bumper used as retentive

appliance

Extraction Painless removal of tooth from its socket

Need for extraction:1. Arch length to TTM discrepancy

2. Correction of inter arch relationship

3. Abnormal size and shape of teeth eg: peg shaped laterals, mesio dens , macrodontia

4. Skeletal jaw mal-relations

Different extraction procedures

› Wilkinson’s extraction› Balancing extraction› Compensating extraction› Serial extraction› Phased extraction› Enforced extraction› Atypical extraction

wilkinson’s extraction

All four permanent molars b/w the age of 8-9 years Due to high caries riskAdvg: Additional space for third molars..thus prevents

impaction Overcrowding minimzedDisadvg: Limited space Rotation of 1 and 2 premolars Subsequent treatment may be detrimental because

of lack of anchorage Improper contact leads to food accumulation

Balancing extraction• Intentional extraction of tooth from the

opposite side of same arch• To prevent midline shift

Compensating extractions• Intentional extraction of tooth from the same

side of opposite arch• To preserve molar relationship

Serial extractions Correctly timed and planned extraction of deciduous

and permanent teeth in mixed dentition Purpose : Alleviate crowding Allow unerupted teeth to guide themselves into

position Lessen period of mechanical appliance therapy

Enforced extractionsCarried out on teeth which are decayed ,periodontally weak , impacted, in line of fracture….

Phased extractions At different times in different quadrants To bring about a change in molar relationship

Uprighting of molars• Premature loss of teeth may result in tipping

of the adjacent teeth• A tipped teeth occupies more space • Therefore uprighting of teeth allows for

recovery of some space• It can be achieved by space regainers

• Rotated teeth occupy more space• De-rotation provides some amount of space • Can be brought about by space regainers and

springs

De-rotation of teeth