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    Extraction of Primary Teeth

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    mirfanulhaq
    This document discusses guidelines for deciding whether to extract contralateral or opposing primary teeth when extracting an unsaveable primary tooth. It may be appropriate to extract a balancing tooth to minimize centerline shift, especially in crowded arches, but compensation is generally not recommended. Space maintenance is important after primary molar extractions to prevent mesial drift of permanent teeth.

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    Extraction of Primary Teeth

    Uploaded by

    mirfanulhaq
    185 views6 pages
    This document discusses guidelines for deciding whether to extract contralateral or opposing primary teeth when extracting an unsaveable primary tooth. It may be appropriate to extract a balancing tooth to minimize centerline shift, especially in crowded arches, but compensation is generally not recommended. Space maintenance is important after primary molar extractions to prevent mesial drift of permanent teeth.

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    pediatric dentistry

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    This document discusses guidelines for deciding whether to extract contralateral or opposing primary teeth when extracting an unsaveable primary tooth. It may be appropriate to extract a balancing tooth to minimize centerline shift, especially in crowded arches, but compensation is generally not recommended. Space maintenance is important after primary molar extractions to prevent mesial drift of permanent teeth.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    185 views6 pages

    Extraction of Primary Teeth

    Uploaded by

    mirfanulhaq
    This document discusses guidelines for deciding whether to extract contralateral or opposing primary teeth when extracting an unsaveable primary tooth. It may be appropriate to extract a balancing tooth to minimize centerline shift, especially in crowded arches, but compensation is generally not recommended. Space maintenance is important after primary molar extractions to prevent mesial drift of permanent teeth.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 6

    EXTRACTION OF PRIMARY TEETH - BALANCE AND COMPENSATION

    Introduction
    When a practitioner is faced with enforced extraction of a primary tooth it is often a
    dilemma whether to merely remove the unsaveable tooth , to extract a contralateral tooth
    from the same arch (balance), or to extract a tooth from the opposing arch
    (compensation). The following guidelines are intended to assist in making such a
    decision and to minimise the effect of space loss on the developing dentition. There have
    been no properly controlled prospective randomised studies into the consequences of
    early loss of primary teeth, probably due to the difficulty of recruiting subjects for such
    studies and the need to follow them for up to 10 years. The recommendations given are
    therefore based partly upon current clinical opinion, although this is supported where
    possible by the best available research data. There is a need for more research in the
    area.
    Consideration must always be given to the overall dental health and history of the child,
    which may over-ride purely orthodontic advice.

    C>

    B>

    1.

    Definitions

    1.1

    Balance enforced extractions


    A balancing extraction is a tooth from the opposite side of the same arch,
    designed to minimise centreline shift.

    1.2

    Compensate enforced extractions


    Compensation means extraction of a tooth from the opposing quadrant to the
    enforced extraction. It is designed to minimise occlusal interferance by allowing
    teeth to maintain occlusal relationships as they drift. It is more difficult to justify
    compensation than balance, especially when it would involve removal of a tooth
    from an intact arch.

    2.

    Recommendations

    2.1

    Radiographic screening is highly desirable before extracting primary molars to


    check for the presence, position and correct formation of the crowns and roots of
    successional teeth. Potential problems indicate the need to seek an orthodontic
    opinion before teeth are removed.

    2.2

    Loss of primary incisors Early loss of primary incisors has little effect upon the
    permanent dentition although it does detract from appearance. It is not necessary
    to balance or compensate the loss of a primary incisor.

    2.3

    Loss of primary canines and first molars Early loss of a primary canine in all
    but spaced dentitions is likely to have most effect on centre lines. The more
    crowded the dentition, the more the need for balance.
    With regard to a primary first molar, a balancing extraction may be needed in a
    crowded arch1. Compensation is not needed. In the event that unbalanced
    extraction of a primary canine or first molar has already occurred, one of three
    situations will apply.

    No centreline shift. Do not balance.


    Centreline shift with complete space closure. Delay balancing until a full
    orthodontic assessment is made.
    Centreline shift with spacing remaining mesial to the extraction site. Monitor to
    determine whether tooth movement is continuing: if so seek orthodontic advice.

    B>

    2.4

    Loss of primary second molars There is no need to balance the loss of a


    primary second molar because this will have no appreciable effect on centreline
    coincidence3. However this extraction may allow serious forward movement and
    tilting of the adjacent first permanent molar. Therefore when a primary
    second molar has to be extracted consideration should be given to fitting
    a space maintainer.

    2.5

    Space maintainer - A tooth is the ideal space maintainer and every effort should
    be made to retain primary molars until the proper time for their natural loss. The
    decision to fit a space maintainer after enforced extraction must be arrived at by
    balancing the occlusal disturbance that may result if one is not used against the
    plaque accumulation and caries that the appliance may cause and poor oral
    hygiene is a contraindication . Space maintenance is most valuable in two
    situations.

    Loss of a primary first molar where crowding is severe, i.e. more than 3.5mm
    (half a unit) per quadrant. In this situation space loss due to drift may be so
    severe that the extraction of one premolar may be insufficient to relieve resultant
    crowding so that subsequent orthodontic treatment is more difficult.

    Loss of a primary second molar, except in spaced arches.

    2.5.1

    Types of space maintainer


    A tooth - even badly decayed primary molars can often be restored for a
    few years2.
    Band and loop - the design of choice for a single tooth space.
    Lingual or palatal arch - best for bilateral spaces. Studies have shown a lingual
    arch to be very effective for maintaining arch perimeter 4,5 .
    Upper removable appliance - avoid unless the appliance can be used also for
    active orthodontic treatment.

    B>

    B>

    Explanatory Notes
    1.

    Normal Occlusal Development

    1.1

    The teeth of the first dentition are sometimes described as temporary or deciduous
    teeth, to be shed like the leaves of a tree and therefore of only passing importance.
    This is incorrect and short-sighted since the primary teeth, have a vital role to
    play in maintaining the dimensions and form of the dental arches during eruption
    of the permanent dentition.

    1.2

    The primary dentition


    There is much natural variation in occlusal development. However three features
    indicative of good development are incisor spacing 6 , anthropoid spaces mesial
    to the maxillary primary canines and distal to the mandibular canines7 and
    straight or mesial step primary second molar occlusion8,9 .

    1.3
    A>

    First permanent molar eruption


    Class I molar relationship is the basis upon which a fully intercuspated Class I
    occlusion is built 10,11. Development of Class 1 occlusion depends on the primary
    molars remaining in position until the correct time so that unwanted movements
    of permanent teeth are prevented.

    2.

    Effects of Premature Tooth Loss


    Early loss of a primary incisor has little effect upon the permanent dentition
    although it does detract from appearance.

    A>

    Early loss of primary canines or molars is more serious, since space loss may
    follow. In each quadrant the primary canine and molars together are larger than
    the succeeding permanent canine and premolars, the difference in tooth sizes
    between the two dentitions being the Leeway space 11. This can be assessed
    with reasonable accuracy by the size difference between first and second primary
    molars, since the primary first molar is equal in size to the premolar that will
    replace it, while the primary second molar is much larger than the second
    premolar. For this reason the Leeway space is also known as the E space.
    Extraction of a primary canine or molar may cause mesial drift of teeth behind the
    space and distal drift of anterior teeth, with resultant displacement of permanent
    teeth and centreline disturbance.

    2.1

    Factors affecting space loss

    Three factors are important.

    Degree of crowding is directly related to the rate and extent of space loss after
    primary tooth extractions.

    Type of tooth lost. Loss of one primary canine may cause centreline shift. Loss
    of a primary molar, especially the second may allow mesial drift of the first
    permanent molar.

    Age of child. The earlier a tooth is lost, the greater the opportunity for drift.

    3.

    Space Analysis
    British dentists have a rather casual attitude to the possible consequences of the
    extraction of primary molars. In the United States the approach to space
    management is more careful and standard American textbooks stress the
    importance of space analysis when planning treatment in the mixed dentition 6,12 .
    Methods include:

    Observation of erupting permanent incisors. By the time that the permanent


    incisors reach full eruption the space available to accommodate them is at its
    greatest. In particular intercanine width is fixed so that incisor crowding can only
    worsen 13 .

    Exfoliation of a primary canine during eruption of the permanent lateral incisor


    is a sign of severe crowding.

    Mixed dentition analysis (MDA). This is quick and easy to do and gives an
    accurate assessment of future crowding by using the sizes of the erupted lower
    permanent incisors to predict those of the unerupted permanent canines and
    premolars 8.

    References
    1.

    Proffit WR (1993) Contemporary orthodontics 2nd edn. Mosby Year Book Inc,
    p197-204

    2.

    Roberts JF (1996) Treatment of vital and non-vital primary molar teeth by one
    stage formocresol pulpotomy: clinical success and effect upon age of exfoliation.
    International Journal of Paediatric Dentistry 6: 111-116.

    3.

    Avramaki E and Stephens CD (1988) The effect of balanced and unbalanced


    extraction of primary molars on the relationship of incisor centre lines- A pilot
    study. Journal of Paediatric Dentistry 4: 9-12.

    4.

    Foster TD and Hamilton MC (1969) Occlusion in the primary dentition. British


    Dental Journal 126: 76-79

    5.

    Baume LJ (1950) Physiological tooth migration and its significance to the


    development of occlusion. Journal of Dental Research 29:132-133, 331-348, 440447.

    6.

    Ravn JJ (1975) Occlusion in the primary dentition in three year old children.
    Journal of the American Dental Association 89: 599-606.

    7.

    Andrews LF (1972) The six keys of normal occlusion. American Journal of


    Orthodontics 62: 296-309

    8.

    Andlaw RJ and Rock WP (1996) A manual of paediatric dentistry 4th edn.


    Churchill Livingstone, Edinburgh (a) pp 130-131, (b) 163-164, (c) 166-167.

    9.

    Moyers RE (1980) Handbook of orthodontics, 4th edn. Year Book Medical


    Publishers, Inc. Chicago p 361-383.

    10.

    Ballard ML and Wylie WL (1947) Mixed dentition case analysis - estimating size
    of unerupted permanent teeth. American Journal of Orthodontics and Oral
    Surgery 33:754-759.

    11.

    Foster TD (1980) A textbook of orthodontics, 3rd edn. Blackwell, Oxford, p138

    12.

    Graber TM and Vanardsdall (1994) Orthodontics: current principles and


    techniques, 2nd edn, Mosby, St Louis, p 349-372.

    13.

    Teplitsky PED and Grieman R(1984) History of formocresol pulpotomy. Journal


    of the Canadian Dental Association 50: 629-634.

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