Abstract

Space Discrepancy: Expansion Versus Extraction

by Giuliante Luca

Space discrepancy: expansion versus extractions? Anterior crowding in growing patient is one of the most frequent occurrences in orthodontics, but it is an expression of different typology of malocclusion. Differential diagnosis, therefore, proves to be crucial in setting up a proper treatment plan. Space analysis continues to be a valuable diagnostic tool for quantifying the deficit in the lower arch, but it must be coupled with all other diagnostic evaluations (clinical and cephalometric), as well as in-depth knowledge of craniofacial growth, to arrive at a correct diagnosis of actual crowding, or as a consequence of other malocclusions or transverse growth deficits. Timing, consequently, will also differ depending on the type of crowding to be treated.

Learning Objectives

After this lecture, you will be able to to recognize different typology of dental crowding
After this lecture, you will be able to to realize a correct differential diagnosis
After this lecture, you will be able to to define a correct timing

Space Discrepancy: Expansion Versus Extraction

by Ursini Roberto

Crowding is one of the most frequent malocclusion in the growing patient in mixed dentition. In particular, mandibular crowding, in the anterior area, is often found in the early stages of mixed dentition and expresses the discrepancy between the mesio-distal dimensions of the four permanent incisors and the space available at the level of the alveolar processes. The Clinician therefore, is often confronted with the therapeutic decisions to be made to intercept the future manifestation of potential tooth crowding. These considerations have led to the development of a variety of interceptive choices to avoid or limit lower anterior crowding and/or more impactful orthodontic therapies at later ages. Early dental intervention performs the function of so-called interceptive therapy in preventing the full expression of a malocclusion by ruling out the interference of factors that prevent normal arch development. The disadvantages associated with early initiation of therapy are: the lengthening of therapy time with a risk of impaired cooperation. The fundamental question for orthodontists is whether the most appropriate treatment plan is to modify the morphology of the bone bases and/or the size of the dental arches using expansive mechanics, in distalization of the dentition, proinclining the anterior sectors, or formulating a choice of serial extractions. Space analysis continues to be a valuable diagnostic tool for quantifying the deficit in the lower arch, but it must be coupled with all other diagnostic evaluations (clinical and cephalometric), as well as in-depth knowledge d craniofacial growth, to arrive at a correct diagnosis of actual crowding, or as a consequence of other malocclusions or transverse growth deficits. The timing, consequently, will also differ depending on the type of crowding to be treated.

Learning Objectives

After this lecture, you will be able to differentially diagnose the various types of crowding.
After this lecture, you will be able to integrate diagnostic information to plan an individualized treatment plan
After this lecture, you will be able to define the prescription areas of serial extractions.