1. SPACING AND
CROWDING
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By: MAHDI MOHAMMED

2. SPACE RELATED PROBLEMS
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Irregular and malaligned teeth in the early mixed dentition arise from two majorcauses
o Lack of adequate space causing the permanent teeth to erupt an abnormalposition
o Interferences with eruption ( drifted and tipped teeth causing space loss and over retained
primary teeth, ankylosed primary teeth, supernumerary teeth, transposed teeth, and
ectopically erupting teeth), which prevent a permanent teeth from eruptingon a normal
schedule and in the proper position.

26. SPACE CLOSURE
It is carried out by:
1- Molar protraction: early extraction of any deciduous teeth allows forward movement of the first
permanent molars, but fixed appliances are required to complete alignment and correct the axial
inclinations. Temporary anchorage screws may be helpful where large spaces need to be closed.
2- Incisor retraction where there is an increased overjet
3- Conservative closure of the space: If any masking procedures (for example contouring a canine
incisally, palatally, and interproximally to resemble a lateral incisor) or acid-etch composite additions
are required, these should be carried out prior to the placement of appliances to facilitate final tooth
alignment (although definitive restorations e.g. crowns or veneers, are best delayed until treatment is
completed).
Placement of a bonded retainer post-treatment is advisable

29. MAXILLARY DENTAL PROTRUSION AND SPACING
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o It is often a sequel to a prolonged finger sucking habit.( eliminating finger habit prior to tooth movement is necessary).
o The more common cause for maxillary incisor protrusion is a class II malocclusion that often has a skeletal larger component,
and in that case, treatment must address the largerproblem.
o If there is adequate vertical clearance (not a deep bite) maxillary incisors that are proclined facially can be tipped linguallywith
with a removable appliance.(HAWLEYAPPLIANCE)
o If overbite is deep, it will bring the upper and lower incisors into vertical contact before the upper incisors can be retracted
enough. This presents a much more complex treatment problem requires skeletal change and comprehensive orthodontic
treatment

30. MISSING PERMANENT TEETH
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o The most commonly missing permanent teeth are second premolars (specially mandibular) and maxillary lateral incisors.
MISSING SECOND PREMOLARS
o Maintaining the primary second molar as long as possible.
o If the space, profile, and jaw relationship are good, or somewhat protrusive, it is possible to extract primary second molar that
have no successor at age 7 to 9 and allow the first molar to drift mesialy. This can produce partial or even complete space
closure. It may be necessary to extract teeth in opposing arch to reach a near ideal class Iocclusion.
MISSING MAXILLARY LATERALINCISOR
o Treatment is substitution of the canine for lateral incisors or opening the space for prosthetic lateral replacement.

31. MAXILLARY MIDLINE DIASTEMA
o The unreacted permanent canine often lies superior and distal to lateral incisor root, which forces lateral and centralincisors
roots towards the midline while their crown diverge lateraldistally.
o In its extreme form, this condition of flared and spaced incisors called ugly duckling stage of development.
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UGLYDUCKLING PHASE

32. A small but unaesthetic diastema (2mm or less ) can be closed by removable appliance with clasp, finger spring, anterior bow
with tipping of central incisorstogether.
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33. o Diastema( greater than 2mm) supernumerary tooth or intra bony lesion must besuspected
o comprehensive orthodontic treatment is required (2x4 appliance)
o Presence of large or inferiorly attached labial frenum require frenectomy after space closure and retention may benecessary
.therefore frenectomy before treatment is contraindicated.
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34. PREMATURE LOSS WITH ADEQUATE SPACE
o Early loss of primary tooth presents a potential alignment problem because drift of permanent or other primary teeth is likely
unless it is prevented.
o If permanent successor will erupt within 6 months a space maintainer willunnecessary.
Band and loop space maintainer
o It is unilateral fixed appliance.
o Indicated for space maintenance in posteriorsegments.
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35. PARTIAL DENTURE SPACE MAINTAINERS
o Indicated for bilateral posterior space maintenance when more than one
tooth has been lost per segment and permanent incisors have not yeterupted
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36. DISTAL SHOE SPACE MAINTANER
o Appliance of choice when a primary second molar is lost before eruption of permanent first molar. This appliance
consists of metal or plastic guide planes along which thepermanent
molar erupts.
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37. LINGUAL ARCH SPACE MAINTANER
o A lingual arch is indicated for space maintenance when multiple primary
posterior teeth are missing and permanent incisors haveerupted.
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38. LOCALIZED LOSS (3mm or LESS)
SPACE SPACEREGAINING
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Maxillary space regaining
Mandibular space regaining

39. MAXILLARY SPACE REGAINING
o A removable appliance retained with Adams clasp and a helical finger spring can be used to regain space by distally tipping
permanent first molar. One posterior tooth can be moved up to 3mm distally during 3to 4 month of full time appliance wear.
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40. MAXILLARY SPACE REGAINING
o Afixed appliance can be used to regain space in maxillary posterior region, with a coil spring generating the distalizing force
o Palatal anchorage was gained using a Nance arch and the eruptedteeth
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41. MANDIBULAR SPACE REGAINING
o Lingual arch is used for unilateral space regaining
o Lip bumper is used for bilateral spaceregaining
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43. When there is too little space for all the teeth to
fit into the mouth properly, crowding occurs.

44. METHODS OF SPACE CREATION
1- Derotation

45. 2- Uprightening

46. 3- Distal movement of molars

47. DISTAL MOLAR MOVEMENT
Several options to distalize molar
o Helical spring (pendulum)
o Magnates
o TADS
o Steel and super elastic coil spring
o Temporary anchorage device for molar distalization
not indicated for patient younger than 12 years due
to bone density and TADSinstability.
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48. 4- Expansion

49. Maxillary expansion can be done with the help of jackscrew by opening the mid palatalsuture.
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50. Moderate arch length increase can be accomplished using a multiple bonded and banded appliance and mechanism of expansion.A)this
patient has moderate lower arch crowding and space shortage B) in this coil spring served to generate tooth moving force, lingual arch
control the transverse molar dimension C)the lingual arch is adjusted by opening the loops and advancing the arch so it can serve as
retainer following removal of arch wire and bondedbracket.
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51. 5- Proclination of incisors

52. 6- Enamel stripping

53. 7- Extractions

54. EARLY SERIAL EXTRACTION
In many children with severe crowding, a decision can be made during the early mixed dentition that expansion is not advisable and
some permanent teeth have to be extracted to make room for others.
The sequence often termed as serial extraction simply involves the timed extraction of primary, and ultimately permanent teeth to
relieve severe crowding.
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55. INDICATIIONS
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o Space discrepancy greater than 10mm perarch
o No any skeletal problem
o Normal overjet and overbite
o Class 1 molar relation
o Straight profile

56. A)Severe space deficiency and marked incisors crowding.
B)Primary canines are extracted to align the incisors.
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57. C)Primary first molar are extracted when half to two third of roots of premolar isformed
to speed up its eruption.
D)Extraction of first premolars after their eruption and canine erupt into the extraction
space.
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58. THANK YOU
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