MADHA DENTAL COLLEGE AND HOSPITAL

DEPARTMENT OF ORTHODONTICS
 DEPARTMENT OF ORTHODONTICS

TOPIC
METHODS OF GAINING SPACE

GUIDED BY
DONE BY
DR.SATHISH.M.D.S. N.SANDEEP RAJA CRI
METHODS OF GAINING SPACE
CONTENTS:-
INTRODUCTION
METHODS OF GAINING SPACE
REQUIREMENTS
PROXIMAL STRIPPING
EXPANSION
EXTRACTION
DISTALIZATION
UPRIGHTING OF MOLARS
DEROTATION OF MOLARS
PROCLINATION OF ANTERIOR TEETH
CONCLUSION
INTRODUCTION
In orthodontic majority of the treatment,
space is required in order to move the teeth
into more ideal locations.
Orthodontic correction of malocclusion
requires an arithmetical balance between the
space required and available.
Space has to be created within the jaws to
meet the space requirements in order to
resolve the malocclusion.
METHODS OF GAINING SPACE
Non-extraction methods;
 Proximal stripping,
 Arch expansion,
 Distalization of molars,
 Uprighting of tilted teeth,
 Derotation of posterior teeth,
 Proclination of anterior teeth.
Extraction methods.
EXTRACTION METHODS
REQUIREMENTS
Conditions where space is required;
DECROWDING-for every millimeter of decrowding,the
space is required for aligning the teeth
DEROTATION OF ANTERIOR TEETH-for every millimeter
of derotation required, the same amount of space is required
for aligning the teeth
CORRECTION OF MOLAR RELATION-space required for
mesial/distal movement of the molars is as per the actual
movement planned
LEVELING CURVE OF SPEE-for every 1mm of leveling of
spee,approximately 0.5mm of space is required in the arch
OVEREJET REDUCTION-for every 1mm of incisor
retraction,2mm of space is required in the arch
DEROTATION OF POSTERIOR TEETH-space is
created when rotated posterior teeth are aligned. The
space created depends upon the tooth and the amount
of rotation present
PROCLINATION OF ANTERIOR TEETH-for every
1mm of incisor proclination,2mm of space is gained in
the arch
PROXIMAL STRIPPING
It is a method by which the mesio-distal width of
the teeth is reduced to gain the space.
It is also known as slenderization,disking or
proximal slicing.
This procedure is mainly carried out in lower anteriors
but it can be done in buccal segments of the upper and
lower arch.
Acidulated phosphate flouride should be applied after
proximal stripping to reduce the caries susceptibility
PROXIMAL STRIPPING
INDICATIONS:-
Reproximation or proximal stripping is usually
indicated when the space requirement to correct the
malocclusion is below 2.5mm.
It can also be undertaken in the lower anterior
segment as an aid to retention.
It can be undertaken as an adjunctive procedure in
adult orthodontics.
PROXIMAL STRIPPING
CONTRAINDICATIONS:-
Proximal stripping is not generally carried out in
young patients who have large pulp chambers with thin
underlying dentin which may increase the risk of pulpal
involvement.
Patients who have a high caries index and are
susceptible to caries.
PROCEDURE:-
It involves 4 steps;
 Assessing space requirements,
 Selecting the teeth & amount of enamel to be
stripped,
 Enamel stripping and
 Fluoride application
Diagnostic aids for proximal stripping;
 MODEL ANALYSIS-
 Arch perimeter(upper) or Carey’s analysis(lower) and
Bolton’s analysis have to be carried out & the cases showing a
tooth material discrepancy in between 0-2.5mm are to be
selected for proximal stripping.
RADIOGRAPHS-IOPA Radiographs gives a fair idea of
enamel thickness and a rough estimate of proximal enamel
that can be safely removed from the proximal surface, without
pulp exposure. Panoramic view to assess the proximity of roots.
DIAGNOSTIC SET UP-It may be helpful in treatment
planning of alignment problems.
AMOUNT OF PROXIMAL STRIPPING:-
Appox. 0.5mm of enamel may be removed from the mesial
and distal surface of each maxillary anterior tooth, giving a
maximum of 4mm additional space in the anterior part of
the arch
In the mandibular arch, the smaller mesiodistal width of
the incisor teeth reduces the amount of the interproximal
stripping that can be undertaken without producing
unacceptable root proximity
It is also possible to gain space by stripping enamel from
posterior teeth.
An additional 4mm can be obtained in this way
ENAMEL STRIPPING-INSTRUMENTS
Proximal stripping is carried our in one of the
following ways;
 a. Use of metallic abrasive strips
 b. Safe sided carborundum disks
 c. Long thin taperal fissure burs
 A.METALLIC STRIPS:-
 It may have single side abrasive action or may be
double sided.
 They can be used with the frame handle instrument
which this abrasive strip fits in.
 Depending upon the size of the particles coated, the
strips can be coarse, medium or fine.
 Usually fine abrasive strips are used; this avoids the
deep scratching of the enamel.
 B. Safe sided corborundum disks:-
 These were used extensively in earlier days.
 They have the inherent problem of being rigid and
brittle
 They may break during function and may cause
injury to patient and clinician
 They are difficult to use in the posterior region
 C. Thin straight or tapered bur:-
 They can be used for proximal stripping
 They usually leave rough surface on the enamel
surface reduced and hence need to be followed up
with metallic abrasive strips to polish the region
FLUORIDE APPLICATION
This is an important step after slenderisation.
The enamel roughness increases and hence carries
susceptibility after proximal stripping also increases
This can be prevented by fluoride application after the
procedure
 Acidulated phosphate flouride gel is used
DISADVANTAGES
The stripping procedure creates a roughened proximal
surface that attracts plaque and is caries prone
Sensitivity of the tooth may increase
This may cause alteration of the morphology of the
teeth giving an unnatural appearance of the teeth
Loss of contact
ADVANTAGES
Extraction are avoided in border line cases where space
requirement is minimal
A more favorable incisor relation and molar relation
can be established by eliminating excess tooth material
in either of the arches
More stable contact areas can be established instead of
unstable contact points
 Expansion
Expansion is a non-invasive method of gaining space
The expansion of the arch is one of the oldest ways of
creating space in the dental arches.
o Arch expansion can be skeletal or dental
 Skeletal expansion involves splitting of midpalatal
suture
 Indications
Class 2 div 2 cases
Unilateral crossbite
Bilateral crossbite
Cleft palate
Rotated maxillary molars
 Skeletal class 3 malocclusion
 Expansion can be broadly classified into two types
 Rapid expansion
 Slow expansion

Rapid maxillary expansion

• Skeletal type of expansion
• Involves separation of midpalatal suture and
movement of maxillary shelves away from each other
• Should be initiated prior to the ossification of
midpalatal suture
Indications of R.M.E
Posterior crossbite
 Class 3 malocclusion
Cleft palate patients
Facemask therapy
 Medical indications include nasal stenosis,septal
deformities,recurrent ear and nasal infection,allergic
rhinitis,etc.
Skeletal arch length problems
Types of appliance used
1. Removable appliance
2. Fixed appliance
• Tooth borne
• Tooth and tissue borne
 A removable appliance consists of a split acrylic plate
with a midline screw
 The appliance is retained using clasps on posterior
teeth
Fixed appliances are more reliable and found to
produce consistent skeletal effects
Tooth and tissue borne appliances are
Derichsweiler type
Hass type
Tooth borne appliances are
Isaacson type
 Hyrax type
 Derichweiler type
 The first premolars and molars are bonded
 Wire tags are soldered onto the palatal aspect of bands
 Wire tags get inserted into the split palatal acrylic plate
incorporting a screw at its centre
 Hass type
 The first premolar and molar of either side are banded
 1.2mm diameter stainless steel wire is soldered on the buccal and
lingual aspects connecting premolar and molar bands
 Lingual wire is kept longer to extend past the bands
 These extensions are bent palatally to get embedded in palatal
acrylic
Isaacson type
 Tooth borne appliace without any acrylic
palatal covering
 The first premolars and molars are

banded
 Metal flanges are soldered onto the

bands on both buccal and lingual sides

 The expander consists of a coil spring

having anut that can compress the

spring
 The expander is activated by closing the

nut so that the spring gets compressed

Hyrax type
 A special type of screw called HYRAX
is used
 The screw have heavy gauge wire

extensions that are adapted to follow

the palatal contour and are soldered to
bands on premolars and molars
Contraindications of R.M.E.
Single tooth crossbite
Vertical growers with steep mandibular plane angle
Skeletal asymmetry of maxilla amd mandible
 Periodontally weak patients
Uncooperative patients
Patients with anterior open bite
 R.M.E. is not carried out after ossification of the mid
palatal suture
Appliances used for slow expansion
 Removable appliance incorporating jack screw
 Coffin spring
 Quad helix
 Removable appliance with Jack screw
 Various jack screw used for RME can be used for slow
expansion but with a more spread out activation schedule
 Expansion is produced predominantly by tipping the molar
teeth buccally
 To produce bilateral symmetrical expansion,the baseplate of
the appliance is sectioned in the middle
 Retention can be had by placing Adams clasp
 Coffin spring
 Appliance consists of an omega shaped wire of 1.25mm
thickness placed in the mid palatal region
 The free ends are embedded in acrylic covering the slopes of the
palate
 The spring is activated by pulling the two sides apart or by using
three prong pliers
 Quad helix
 Used to expand a narrow maxilla
 Consists of a pair of anterior helices and a pair of posterior
helices
 The free wire ends adjacent to the posterior helices are called
outer arms and soldered to the lingual aspect of molar bands
 Extraction
The most frequently resorted to methods to gain space
for orthodontic purposes is extraction of teeth
Such extraction are called as therapeutic extractions
Premolars are the most frequently extracted teeth
as part of orthodontic treatment
Extraction of one premolar from each quadrant of the
jaw provides sufficient space to correct the
malocclusions
EXTRACTION
For mild anterior crowding ,second premolars can be
extracted
Second premolars are usually extracted when 4-5mm of
anchorage loss is deliberately desired
For open bite cases ,second premolar extratction
encourages deepening of the bite
Removal of a tooth from one side of a dental arch results
in tendency for the rest of the teeth to move towards the
extraction space
To avoid such unesthetic shifts of the dental arch
,balancing extractions are advocated
• Compensating extractions refers to extraction of teeth
in opposite jaw to preserve buccal occlusal relationship
Sometimes other teeth like molar or lower incisors are
extracted during orthodontic therapy
However, extraction of canines and upper incisors is
rarely carried out
 DISTALIZATION
In recent years the percentage of patients having
extraction as a part of orthodontic treatment has
decreased considerably
Molar distalization in recent years has evolved as an
alternative method of gaining space to conventional
methods
Various appliances used for Molar Distalization:
 Head gears
 Pendulum appliance
 Coil springs Niti and S.Steel
 Distal jet
 K Loop
 Jones Jig
 Magnet
 Wilson’s Bimetric loop
 Use of super elastic NiTi
 Franzulum appliance
HEADGEAR PENDULUM APPLIANCE
COIL SPRING
 UPRIGHTING OF MOLARS
Premature loss of a second deciduous molar or extraction of second
premolar can cause mesial tipping of the first permanent molar
Tilted posterior teeth always occupy more space than an upright
molar
Thus,uprighting of molars can lead to a gain in arch length of 1-
1.5mm.
Molars can be uprighted using molar uprighting springs
incorporated into the removable or fixed appliance or some form of
space regainer
Space regainer or the various screw appliance are frequently used
The lip bumper and its modifications can also bring the same effect
 DEROTATION OF POSTERIOR TEETH
Rotated posterior teeth occupy more space than
normally posterior teeth
Derotation of these malposed teeth gives some
amount of arch length
Derotation can be best achieved using a couple on the
lingual and buccal surface of the tooth
This is done with fixed appliances incorporating
springs or elastics
The rotated anterior tooth occupies less space in the
arch and requires space for its derotation or correction
DEROTATION OF POSTERIOR TEETH
 Proclination of anterior teeth
Proclination of a retruded anterior tooth results in
gain of arch length
The proper overjet and overbite have to be maintained
for the stability of results when the anterior teeth are
proclined
Any of the proclining spring (Z-SPRING) or screws
(medium-,mini-, or micro-screws) or fixed appliance
can be used for the purpose
 CONCLUSION
Orthodontic space closure should be individually
tailored based on the diagnosis, and treatment plan.
The section of any treatment, whether a technique,
stage, spring, or appliance design should be based on
the desired tooth movement.
So, having a wide wisdom on these concepts helps
orthodontist to successfully achieve the treatment
objectives.
S