Choice of Teeth For Extraction in Orthodontics - OUUSSAMA SANDID - MOHAMAD ABOUALNASER

Choice of teeth for extraction in
orthodontics :Part III

M. ABOULNASER- Orthodontist, BAU, USA.
O. SANDID- Orthodontist, D.C.D., D.U.O, C.E.S.B.B, C.E.S.O.D.F ,
S.Q.O.D.F, Ex charg de cours, Paris. France.
Contact: dr.aboualnaser@hotmail.com
Choice of teeth for extraction in orthodontics -oussama sandid- olivier sandid -o sandid-mohamad aboualnaser-mohamad aboulnaser-m aboualnaser
Time 30 minutes
Extractions Contreversies in
Orthodontics
Part 3: Choice of teeth for
extraction
CHOICE OF TEETH FOR EXTRACTION
1st Upper Premolar Extraction

Extraction of two lower premolars
Extraction of 4 premolars
Lower incisor extraction
First molars extractions
Wisdom teeth extractions
Tooth impaction Extraction
Unfavorable position
Choice of teeth for extraction.
1st Upper Premolar Extraction in Orthodontics- 51%
Camouflage treatment in adult skeletal Class III cases by

extraction of two lower premolars
Extraction of two lower premolars
Crowding- Extractionof4 premolars

www.orthofree.com
Extractionof4 premolars 11%
M.DMCNUTT

www.orthofree.com
Extractionof4 premolars 11%

15-25-34-44
M.DMCNUTT

Extractionof4 premolars
15-25-35-45
M.DMCNUTT
Orthodontic treatment with lower incisor

extraction
.
Overeruption and attachment loss of tooth 31.
KenzaLAHLOUAalloulaELHOUSSAINE
Choice of teeth for extraction in orthodontics -oussama sandid- olivier sandid -o sandid-mohamad aboualnaser-mohamad aboulnaser-m
aboualnaser
First molars extractions
DrLemay-http://www.orthodontisteenligne.com/blogue/extractions/
Second Molar Extraction
Wisdom teeth extractions (7%)
Impacted Maxillary Canine-Extraction
\
Traitements orthodontique sur des vrais jumelles
Twins treated by different orthodontic techniques.
Dr Alan Bagden
Dr Bagden a expriment 2 traitements sur des vrais jumelles avec et sans extractions,
rsultats, profil est concave pour le cas trait avec extractions
Relation entre extractions dentaires et lapne du sommeil ?

Relationship BetweenExtractions andSleep Apnea ?
Extractions en orthodontie et constriction des arcades dentaires, Le

volume destin a loger la langue a t rduit, pas suffisamment dtudes
pour quantifier lincidence sur la permabilit des voies ariennes
suprieures , tout dpendra sil y a msialisation des dents vers le site
dextraction ou recul du bloc incisivo- canin ?
Extractions et dure de traitement

Les extractions en orthodontie
reduisent - Elle la dure du
traitement ou la rallonge ?
http://www.dr-alexandrian-stella.chirurgiens-dentistes.fr/les-conseils-de-lorthodontiste/un-traitement-en-orthodontie-dure-combien-de-temps
Conclusion

Plus japprends moins je sais ?

Je sais que je ne sais rien, mais je le sais!
Socrate
EXTRACTIONS
Compromis
Non Extraction
Extractions Contreversies in
Orthodontics
Indications Part 1
M. ABOUELNASER
Time 30 minutes
Les bnfices du traitement orthodontique

Benefits of Orthodontic Treatment.
Du Sourire,
Le praticien espre obtenir:

Une Amlioration Esthtique
Du Profil rtrusif,
Ou prognathique
Une Amlioration Fonctionnelle

De locclusion,
Du parodonte,
De lATM
Extraction versus Non-Extraction
Edward Angle
Charles Tweed
Le dbat dure depuis plus de 100 ans, et ca continue, cest le sujet le plus de
controvers en
Orthodontie
E. Angle le pre de l'orthodontie croyait fermement dans le traitement nonextraction.
C. Tweed, a observ que certains patients traits par Angle prsentaient une
quantit notable de rcidives, a retrait un certain nombre de ces cas en extrayant
quatre prmolaires, pour plus de stabilit
Choice of teeth for extraction in orthodontics -oussama sandid- olivier sandid
Bousaba
-o sandid-mohamad
S,Delatte
aboualnaser-mohamad
M,De Clerck
aboulnaser-m
H. Rev Belge
aboualnaser
Med
Dent (1984).1995;50(2):53-65.
Extraction versus Non-Extraction
Part 1: Extraction in Orthodontics and its Indications.

Part 2: Non-extractionPhilosophy, Space regaining.
Part 3: Choice of teeth for extraction.
Extractions in Orthodontics
Indications
1-Indications: Severe dental crowding > 7mm-Tooth-arch discrepancy

2-Indications: Anteroposterior relationships discrepancy.
3-Indications: unfavorable position of Tooth impaction, Dental ankylosis.
4- Indications: unaesthetic facial profile, Protrusion.
5- Indications: Adult crowding with gingival recession.
6- Indications: Dental Caries.
7-Indications: Supernumerary teeth
8- Indications: Patients not motivated and we need to shorten duration of
treatment.
9-Indications: Hyperdivergent facial type vertical growth pattern.
1-Arch length- Severe Dental Crowding > 7mm
Tooth-arch discrepancy: Size of the jaw is smaller than the size of the
teeth
Dental crowding can be simply defined as the overlap of teeth caused
by insufficient space within the dental arch.
If the dentition is too large (Macrodontia) to fit in the dental arch
without irregularity, it may be necessary to reduce the dentition size by
the extraction of teeth.
2-Indications: SevereSkeletalClass II
Correction of Occlusion Reduce overjet
Anteroposterior relationships ( Problem in patient cooperation, elastics, functional

appliances, headgear )
Overjet is also known as protrusion of teeth, the lower teeth are too far behind
the upper front teeth.
In most Class II cases with abnormal upper proclination, it is advisable to extract
teeth (14-24) only in the upper arch and to retract the maxillary incisors and
canines. In case of the lower arch crowding it is advisable to extract in both the
arches (34-44).
2-Indications: Severe skeletal Class III

malocclusion Reduce Reverse Overjet
www.orthofree.com
REVERSE OVERJET IMPORTANT Class III cases are

usually treated by extracting teeth only in the lower arch to
discourage the forward growth of mandibe (34-44)
Or surgery (15-25-34-44)
2-Dcalage des bases osseuses- Classe III squelettique- Overjet invers

Skeletal Class III malocclusion- Reduce Reverse Overjet
www.orthofree.com
Dans le cas de Classe III squelettique, les extractions sont

envisageables pour Rduire le surplomb invers, Extractions
de ( 34-44) ou ( 34-44 et 15 et 25 ).
Diego Rey Mora, Giovanni Oberti,PROGRESSinORTHODONTICS
2-Indications: Severe Openbite, hyperdivrgent

Reduce Openbite- Reduce lower facial height
Before Trt
After Trt
2- Svre Bance, hyperdivergence

Severe Openbite, hyperdivrgent
Cas De Svre Bance, Hyperdivergence, Les Extractions Entrane Une
Rduction De La Bance Et une Diminution De Ltage Inferieur De La Face
Avant Trt
Apres Trt
www.orthofree.com
2-Indications: Midline correction, Dental asymmetry
Correction of Occlusion, Dental asymmetry,

Midline correction
2-Correction des asymtries et de la ligne mdiane

Midline correction, Dental asymmetry
Guilherme JANSON, Jos Eduardo Prado de SOUZA, J Appl Oral Sci. 2009;17(4):354-63
3-Impacted teeth - unfavorable position

Impacted Canine, Root Proximity, Root resorption
3-Impacted teeth - Unfavorable position

Impactedmolars, Root Proximity, Root resorption
3-Indications: Dental ankylosis
Tipping of teeth toward the ankylosed tooth and we need surgical intervention.
4-Biprotrusion - Convex Profile
Before Trt
After Trt
LIP POSITION: Incisor inclination
Biprotrusion
Reduce Biprotrusion, Gingival recession
Before Trt
After Trt
J Canon orthofree.com
4-Protrusive profile and gingival recession, lower

incisor inclination on mandibular plane.
4-Position de l'incisive infrieure par rapport au plan

mandibulaire, soutien osseux
Lower incisor inclination on mandibular plane 90.
90
Quand on ne peut pas vestibuler incisive infrieure, tissu de soutien faible

Nous envisageons un traitement par extractions ,
La Position de l'incisive infrieure par rapport au plan mandibulaire nous donne des indications sur la
ncessite ou non dextraire , on compare cela une personne qui avance sur un balcon au au-del
decertaines limites la personne risque de tomber
www.orthofree.com
Agenesis compensation
6-UNHEALTHY TOOTH
6- Indications: Caries, Decay
6-Delabrement dentaire-Caries
Unhealthy tooth
Extraction des dents caries et prferable est indique
dans le plan de traitement orthodontique
7-Supernumerary teeth
8-Patients motivation
Indications: Patients not motivated- shortening duration
treatment, headgear wear, missing appointments
8-Manque de coopration et de motivation du patient

Patients not motivated
Le manque de motivation du patient: Non port des
lastiques, des forces extra-orales , des appareillages
fonctionnels etc
Serial extraction
Guidance of Eruption
Traitements interceptifs -Guidage de lruption

Early Treatment - Guidance of Eruption
Le Guidage de lruption: Lextraction prcoce des canines lactales et dans certains
cas des premires molaires lactales, permet dviter linclusion des canines,
Do lintrt des traitements prcoces interceptifs .
Retard d ruption des dents dfinitives

Delayed eruption of permanent teeth
Extraction de dents lactales quand il y a Retard d ruption des
dents dfinitives
Retard d ruption des dents dfinitives

Delayed eruption of permanent teeth
Une patient sest prsent a lge de 8 ans, retard druption, la panoramique
Montre lexistence de dents surnumraires , do lindication des extractions afin de
Guider l ruption des dents dfinitives
Non Extraction
Extraction
Profil Concave
Convexe
Avant de dcider le traitement par extractions il faut tenir compte

du profil et de la typologie de croissance du patient
Typologie faciale
Hypodivergent
hyperdivergent
Non Extraction
Extraction
Position de lincisive
infrieure
Etat parodontal
Avant de dcider le traitement par extractions il faut tenir compte de la position

de lincisive infrieure, l tat parodontal, et la prdisposition a lapne du
sommeil
Apne du sommeil
Permabilit des
voiesariennes
suprieures
Non Extraction
Extraction
Stabilit
traitement
orthodontique,
Rcidive
Penser la stabilit du traitement et au facteurs de rcidives ainsi que de la

possibilit denvisager une rduction amlaire proximale
ou stripping, en fonction de la forme coronaire
Rduction amlaire
proximale,
Stripping, Formes
des couronnes
Non-extraction Orthodontictherapy
Part 2
Dr M. ABOUELNASER
1-Transverse Control, Expansion
2-Sagittal Control, Reduction of overjet.
3- Levelling of the curve of Spee on the proclination of
mandibular incisors and expansion of dental arches
4-Molar distalization
5-Stripping: Reduction of proximal enamel.
6-Vertical Control: Unblocking of mandibular growth.
Transverse Control
ExpansionGingival recession-Stabilty ?
Dr. Greenfeld orthofree.com
Transverse Control
Expansion
Quadhelix
Rapid Palatal Expander(RPE)
2-Sagittal Control- Overjet reduction

Functional appliance
Early treatment , Bone Growth Stimulation, stop growing

Benefits of early treatment stimulate mandibular growth and blockageof maxilla, reduce
overjet and treatment without extraction.
O.SANDID

IntermaxillaryClass II elastics
O.SANDID
Frankel functional regulator
IntermaxillaryClass II elastics- Cooperation
IntermaxillaryClass II elastics
O.SANDID
Impacted Maxillary Canine

Open space
Maxillary canine impaction
Molars distalization
O.SANDID
Facial Mask- Cooperation
O.SANDID
Vertical Control
Unlocking growth of mandible
O.SANDID
Levelling of the curve of Spee on the proclination

of mandibular incisors
Levelling of the curve of Spee on the proclination of mandibular incisors
Respect angulation of lower incisors on mand plane (Tweed triangle)
Levelling of the curve of Spee by the proclination of

mandibular incisors and expansion of dental arches
http://simpliclearpro.com
Molar distalization- Cooperation
Headgear
Pendulum
Mini-implant
Lip Bumper
Tooth Stripping" - Interproximal enamel reduction
Le dblocage de la croissance mandibulaire

Unblockingofmandibular growth
Le dblocage de la croissance mandibulaire permet a la mandibule de s
panouir en vitant lencombrement dentaire, et linstallation de la
rtrognathie mandibulaire, do lintrt des traitements interceptifs
O.SANDID
Correction Oral Habits
Swallowing Pattern
swallowing pattern
Finger Sucking
Mouth breathing
Prsentation en anglais
sur
www.orthofree.com
www.slideshare.net
Bibibliographie
1. Aras A. Class II correction with the modified sagittal appliance and maxillary second
molar extraction. Angle Orthod. 2000 Aug;70(4):332-8.
2. Basdra EK, Komposch G. Maxillary second molar extraction treatment. J Clin Orthod.
1994 Aug;28(8):476-81.
3. Basdra EK, Stellzig A, Komposch G. Extraction of maxillary second molars in the
treatment of Class II malocclusion. Angle Orthod. 1996;66(4):287-91.
4. Bishara SE, Burkey PS. Second molar extractions: a review. Am J
Orthod. 1986 May;89(5):415-24.
5. Cavanaugh JJ. Third molar changes following second molar
extractions. Angle Orthod. 1985 Jan;55(1):70-6.
6. Chapin WC. The extraction of maxillary second molars to reduce
growth stimulation. Am J Orthod Oral Surg. 1939;11:1072-8.
7. Chipman MR. Second and third molars: their role in orthodontic
therapy. Am J Orthod. 1961 Jul;47(7):498-520.
8. Graber TM. The role of upper second molar extraction in
orthodontic treatment. Am J Orthod. 1955;41:354-61.
9. Graber TM. Maxillary second molar extraction in Class II
malocclusion. Am J Orthod. 1969 Oct; 56(4):331-53.
Extractions in Orthodontics
www.orthofree.com
Bibibliographie
10. Haas AJ. Lets take a rational look at permanent second molar
extraction. Am J Orthod Dentofacial Orthop. 1986 Nov;90(5):361-3.
11. Harnick DJ. Case report: Class II correction using a modified
Wilson bimetric distalizing arch and maxillary second molar
extraction. Angle Orthod. 1998 Jun; 68(3):275-80.
12. Henriques JFC, Janson G, Hayasaki SM. Parmetros para a
extrao de molares no tratamento ortodntico: consideraes
gerais e apresentao de um caso clnico. Rev Dental Press Ortod
Ortop Facial. 2002 jan-fev;7(1):57-64.
13. Jger A, El- Kabarity A, Singelmann C. Evaluation of orthodontic
treatment with early extraction of four second molars. J Orofac
Orthop. 1997 Feb; 58(1):30-43.
14. Jones H. Second molar extraction therapy - two case reports.
Funct Orthod. 2000 Winter;17(1):17-20.

Choice of Teeth For Extraction in Orthodontics - OUUSSAMA SANDID - MOHAMAD ABOUALNASER

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Choice of teeth for extraction in

orthodontics :Part III

CHOICE OF TEETH FOR EXTRACTION

1st Upper Premolar Extraction

Choice of teeth for extraction.

1st Upper Premolar Extraction in Orthodontics- 51%

Camouflage treatment in adult skeletal Class III cases by

Crowding- Extractionof4 premolars

Extractionof4 premolars 11%

Crowding- Extractionof4 premolars

Extractionof4 premolars 11%

Crowding- Extractionof4 premolars

Orthodontic treatment with lower incisor

Overeruption and attachment loss of tooth 31.

First molars extractions

Second Molar Extraction

Wisdom teeth extractions (7%)

Impacted Maxillary Canine-Extraction

Relation entre extractions dentaires et lapne du sommeil ?

Extractions en orthodontie et constriction des arcades dentaires, Le

Extractions et dure de traitement

Plus japprends moins je sais ?

Les bnfices du traitement orthodontique

Le praticien espre obtenir:

Une Amlioration Fonctionnelle

Extraction versus Non-Extraction

Extraction versus Non-Extraction

Part 1: Extraction in Orthodontics and its Indications.

1-Indications: Severe dental crowding > 7mm-Tooth-arch discrepancy

1-Arch length- Severe Dental Crowding > 7mm

Anteroposterior relationships ( Problem in patient cooperation, elastics, functional

2-Indications: Severe skeletal Class III

REVERSE OVERJET IMPORTANT Class III cases are

2-Dcalage des bases osseuses- Classe III squelettique- Overjet invers

Dans le cas de Classe III squelettique, les extractions sont

2-Indications: Severe Openbite, hyperdivrgent

2- Svre Bance, hyperdivergence

2-Indications: Midline correction, Dental asymmetry

Correction of Occlusion, Dental asymmetry,

2-Correction des asymtries et de la ligne mdiane

3-Impacted teeth - unfavorable position

3-Impacted teeth - Unfavorable position

3-Indications: Dental ankylosis

4-Biprotrusion - Convex Profile

LIP POSITION: Incisor inclination

4-Protrusive profile and gingival recession, lower

4-Position de l'incisive infrieure par rapport au plan

Quand on ne peut pas vestibuler incisive infrieure, tissu de soutien faible

8-Manque de coopration et de motivation du patient

Traitements interceptifs -Guidage de lruption

Retard d ruption des dents dfinitives

Retard d ruption des dents dfinitives

Avant de dcider le traitement par extractions il faut tenir compte

Avant de dcider le traitement par extractions il faut tenir compte de la position

Penser la stabilit du traitement et au facteurs de rcidives ainsi que de la

Dr. Greenfeld orthofree.com

Rapid Palatal Expander(RPE)

2-Sagittal Control- Overjet reduction

Early treatment , Bone Growth Stimulation, stop growing

2-Sagittal Control- Overjet reduction

Frankel functional regulator

2-Sagittal Control- Overjet reduction

IntermaxillaryClass II elastics- Cooperation