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
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
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 reopening
 Difficulty in paralleling
roots next to extraction
sites
Disadvantages
Drawbacks include:
 Roughened proximal
surfaces that atrract
plaque
 Increased caries
susceptibility
 Sensitivity of teeth
 Non-invasive method of space gaining
 Undertaken in patients having constricted arch
Indications:
 Crossbite
 Crowding
 Skeletal class III malocclusion
 surgical orthodontics
Indications:
1. Posterior cross bite
2. Class II malocclusion
3. Class III malocclusion
4. Constricted arch
5. SARPE
6. Cleft palate
7. TS-ALD
Contraindications
1. Existing openbite
2. Single tooth cross bite
3. Skeletal assymmetry
4. Patent mid palatal
suture
5. 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
 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
Extra oral: (Using headgears)
 Components:
Force delivering unit : face bow/ J hook
2. Force generating unit :elastic strap
3. Anchoring unit: head cap/ neck strap
1.
 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:
1.
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
I.
Heliger’s pendex
II. Heliger’s PhD appliance
III. 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
4.
Skeletal jaw mal-relations
• 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