Non extraction treatment modalities /certified fixed orthodontic courses by Indian dental academy

NON-EXTRACTION
TREATMENT
MODALITY
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com


Extraction?
OR
Non-extraction?


Non- Extraction:

Extraction:

1900-1930

1930-1970

Dr.Edward Angle

Dr.Tweed,Dr.Beggs

1980’s to Till now.
Cetlin, Jasper, James Hilgers,
Panchetz, Alexander, …….

Traditionally Begg practitioners were
branded as extractionists.

Advances in

mechanotherapy, and changes in treatment
concepts have changed this opinion about
the Begg technique and curtailed the need
for extraction in contemporary treatment.

The prevalence of indiscriminate extractions
in earlier decades can partly be blamed on
over use of

certain cephalometric norms

routinely followed.
Secondly, Camouflaged treatment plan for
the underlying jaw discrepancies, with little
emphasis on growth modulation and still little
on orthognathic surgery.

TWEED : Advocated placing mandibular
incisors upright over basal bone IMPA-90 0 +
Small Variation to maintain FMIA of 65 0
-680
STEINERS
: Positions for max and mand
teeth, determined by lines of NA and NB and
varied according to angle ANB.

RICKETTS
: Supported Tweeds, Related
mandibular incisors to APO line. 1 mm ahead of
APO plane (-1 to +3mm and at an Angle of 22 0 ).
The Maxillary incisors were positioned with a
2-2.5mm over bite and over jet and inter incisal
angle 1300


The Casko study in 1967 which measured 79
cases with ideal occlusion and acceptable
esthetics, found wide range of incisor` positions
and jaw relationships.
Mandibular plane angle
Facial angle
Max incisor to SN
Lower incisor to APO

-


150 to 410
790 to 950
930 to 1200
-4mm to +6mm

“These values are all normal in the pleasant faces
in which they were found”.

Creekmore states these values at current time
would classify many of these patients as
abnormal and classify them as Class I, Class II,
Class III sk pattern’s.

In yet another study by Casko and Walter
Shepherd on same Tweeds sample of 95 cases,
found wide range of incisor positions and Jaw
relationships.
Low
Mean
High
FMA
15
24.6
36
IMPA

76

86.9

99

FMIA

56

68.2

80


The basis for selecting the sample was entirely
from the standpoint of satisfactory facial
esthetics and good facial out line.

Inspite of wide variation in his own sample
of angle IMPA, Tweed Advocated placing the
mandibular incisors upright over basal bone for
optimum esthetics and stability.

Rickets Analysis was also built upon mandibular
incisor position
C.J. Burstone, park AJO 1986
Fallacies of Hard tissue standard in treatment planning.
Studied 30 adolescents who were successfully
treated with end result as mandibular incisors 1.5mm to
A-PO line. Authors have shown even in this
uniformly treated group, there was large variation in lip
protrusion

Thus, when antero-posterior Jaw relationships
differ greatly from average, Measurements of
maxillary and mandibular incisors to the APO
plane misrepresents their positions within jaws
In Steiners analysis the position of mandibular
incisors remains fairly constant, but the position
of maxillary incisors varies a great deal to fit
with mandibular arch, the concept of which has
proved wrong.

In order to achieve these contemporary goals of
placing

upright

lower

incisors,

clinicians

invariably considered extraction of teeth.
This indiscriminate extractions in earlier decades
can also be attributed to the camouflage
treatment for basal jaw discrepancies, with little
emphasis on growth modulation or orthognathic
surgery procedures.

- Now, the concept of diagnosing and treating a
malocclusion depending on the position of lower
incisors, has changed. The upper incisor position
is being given more importance, along with the
soft tissue profile, lip competency, position of
chin, and the type of growth pattern.
- Clinicians today, agree to err on non-extraction
side rather than considering extraction option.

- This swing of the pendulum towards nonextraction was essentially due to the marked
advances in diagnosis and mechanotherapy
between early 1970’s and the late 1990’s, which
has given the clinician lots of options for
rethinking the treatment plan.

“Beauty lies in beholder eyes”
The concept of beautiful smile is now
changing. Toothy broad smile is now more
appreciated.
Orthodontics has kept in pace to this evolving
newer concept of non-extraction with
upgrading of more mechanics

Many of this mechanics have evolved
embracing the preadjusted edgewise appliance.
No doubt present day refined Begg has also
evolved in similar path and boost with
advantage of retaining its simple approach and
yet incorporating all the modern day mechanics
in its non-extraction practice.

• Slenderization technique as proposed by
Sheridon and popularized by Alexander is now
being done based on sound diagnosis.
• The whole array of modalities for distal
driving of the molars.
• The use of expansion devices.

• The early reorganization and correction of
malocclusion during the mixed dentition phase.
•

The

multitude

of

evolving

orthopaedic

appliances.
• Conservation of E-space, Leeway space and
correction of molar rotations.
• Long-term stability.

- One of the paradoxical but pleasant surprises of
Begg non-extraction technique is the Anchorage
potential, which is often enhanced if the anchor
molars have mesial axial Inclination at the
commencement of treatment.

The differential

force system of controlled tipping of Incisors as
against the bodily movement of molars has added
to the beauty of anchorage preservation in nonextraction Begg technique.

Pre treatment profile, Age:15yrs


Prakash, 14yrs; skeletal Cl III, concave profile,
crowding in the upper arch, super Cl I molar relation.


Name: Padmini / 10yrs
Severe Class II Div.1
Convex profile


Anil / 12yrs; Skeletal Class II, Horizontal growth,
severe proclination of upper incisors, Molar relation
- Left Class I, Right Class II, Mild retroclination
of lower incisors, Overjet 13mm, Overbite 5mm


Midline distema,
skeletal class I


Nagprasad/21yrs, Sk. Class II, Convex profile,
retroclined upper incisors, proclined lower
incisors, reduced lower facial height.


Refined Begg has an distinctive advantage of
anchorage preservation.
The Begg technique, with its modern day
concepts and under the guidance of innovative
teachers has definitely evolved to its best.


Thank you
For more details please visit


Non extraction treatment modalities /certified fixed orthodontic courses by Indian dental academy

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