space gainig

• METHODS OF SPACE GAINING by Dr.Zaid AL-Dewachi

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 :
Crowding
Proclination
Rotated anteriors
Deep bite
Constricted arches

INTRODUCTION:

Methods to gain space include:

Proximal stripping
Expansion
Extraction
Distalisation
Uprighting of molars
Derotation of posterior teeth
Proclination of anteriors


Methods to gain space include:

Proximal stripping

Expansion
Extraction
Distalisation
Uprighting of molars
Derotation of posterior teeth
Proclination 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 0-2.5mm
Bolton’s analysis showing mild tooth material excess
For correction of minimal interarch tooth material discrepancy
In lower anteriors to aid retention
In cases where individual tooth size prevents class I molar relation
To obtain favourable overjet or overbite


Contraindications:
Young patients
Patients with high caries index
Patients 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

EXPANSION

Non-invasive method of space gaining
Undertaken in patients having constricted arch

Indications:

Crossbite
Crowding
Skeletal class III malocclusion
surgical orthodontics

RAPID MAXILLARY EXPANSION

Indications:
• Posterior cross bite
• Class II malocclusion
• Class III malocclusion
• Constricted arch
• SARPE
• Cleft palate
• TS-ALD


Contraindications
• Existing openbite
• Single tooth cross bite
• Skeletal assymmetry
• Patent mid palatal suture
• Periodontally weak molars

SLOW EXPANSION DEVICES

Coffin spring:

Designed by Walter Coffin

Removable appliance
Dento-alveolar expansion
Made up of 1.25mm thick omega shaped wire placed in mid palatal region
Free ends of omega embedded in acrylic
Activated 1 to 2 mm per week

Quad helix:

Described by Ricketts
Constructed using a 0.038 inch wire
Incorporates 4 helices, therefore flexibility and range of application is more

Ni-Ti expanders:

Developed by Arndt
Fixed-removable tandem loop maxillary expanders
Has the capacity to rotate,upright,distalize and expand the anterior and posterior arch
Dual temp sensitive components
Anteriorly, finger spring of 0.032 inch diameter wire
0.5mm per week tooth movement

Advantages:

Self activated
Automatically expands to pre-determined shape
Requires little manipulation by clinician
Light continuous forces
Easy adaptability in inactive state

First tried by Kingsley using headgear

Aimed at moving the molars distally to gain spoace
Ideal timimg mixed denition period prior to eruption of second permanent molars

Indications:

Straight profile
Functional :
Normal, healthy T.M.J
Correct Maxillo-Mandibular relationship

Distalization:

Skeletal
class I skeletal relationship
skeletal closed bite
brachycephalic growth pattern

Dental

Class II or end on relationship
Discrepancy of (2 - 3 mm)

Contraindications :

Class I or III malocclusion
Open bite
Posterior crowding

Types:

Extra oral: (Using headgears)


Components:
• Force delivering unit : face bow/ J hook
• Force generating unit :elastic strap
• 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:

• 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 molars
Used 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
• Heliger’s pendex
• Heliger’s PhD appliance
• T-rex appliance

Jasper jumper

Fixed appliance for correction of class II skeletal malocclusion
Delivers light continuous forces
Takes anchorage from lower canine region to distalise maxillary molars
Used for single tooth or entire arch

Distal jet appliance:

Lingual distalization appliance
Active components are placed palatally which provide more bodily movements
Consists of bilateral piston and tube arrangement
Tube is embedded in modified acrylic
Anchorage by Nance palatal button that are bonded to bands attached to 1 or 2 premolars
A Ni-Ti spring and activation collar are placed near each tube
Activation collar is retracted distally, causing compression and thereby activation
Advg: less distal tipping

• Skeletal jaw mal-relations

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