Serial extraction (S.E.

): is a procedure involving a series of

teeth extraction in certain areas at certain “definite” time in
order to overcome a suspected malocclusion and
particularly crowding.
SE as an interceptive orthodontic method was developed at
the beginning of the twentieth century by many
orthodontists in USA and Europe and one of the leaders
that establish this method was Nance, he was using this
method routinely in his private profession. However, most of
his cases were of Cl I malocclusion with crowding.

How serial extraction develope????

By the age of 7-8 years all the permanent incisors erupt,
that age previously was the proper age for every individual
to have his or her first visit to an orthodontist !!! “Nowadays
the age is less”.
If the upper and the lower incisors erupt in a crowded
situation at that age and one can hope that growth in the
arch or in the alveolar process can compensate for this
crowding, he’s wrong, nevertheless there is some cases that
the amount of the crowding not exceeding 2mm can be
solved spontaneously by the incisal liability or the force
generation coming from the active protruding tongue but
not all.
Many authors studied the arch perimeter or arch lengths,
by a cross-sectional or longitudinal growth study and they
discover that the intercanine distance sustain the same or
increase very minimal after the eruption of the permanent
incisors, so a spontaneous or self correction of these
crowded teeth is faraway if we depend on growth factor.

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 In fact some authors point to a fact that the growth
anteriorly in the dental arch ceased “stopped” when
permanent incisors erupt.
Such crowding ring the bell for many parents to bring their
children to an orthodontist.

Indications for S.E.:

1- Mild-moderate Cl I crowding.
2- Severe Cl I crowding “but with modifications”

The crowding could be manifested by :

a- palatally malposed 2 and lingually positioned 2
b- Labially proclined 2 2 with rotation.

c- Early exfoliation of C C
C C
d- Lack of space for 6s.
3- Slight dentoalveolar protrusion.

Procedure:
S.E. is done in 3 stages:-
1- Extraction of Cs as soon as the permanent incisors
complete their eruption, such extraction will allow
spontaneous relief of crowding and in a lot of case the
spaces of Cs are completely engulfed by the lateral
incisors.
2- Extraction of Ds & this is done after an accepted
alignment of the incisors take place 6-10 months later.
The aim of these extractions is to accelerate the eruption of
the permanent 1st premolar.
3- Extraction of permanent first premolar as soon as they
emerge from the oral mucosa, thus allowing the space for
the canines & 2nd premolars to occupy the space mesial
to 6s & distal to 2s.

Before committing a crime a complete diagnostic aids

should be taken before starting the S.E. procedure and
patient should have at least beside clinical examination an
OPG that can demonstrate the existence of the complete
dentition at the beginning of the treatment even the tooth
germs of wisdom teeth are cleared by this x-rays at that age
8yrs.

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 All the local factors that cause malocclusion and
particularly those who worsen the crowding should be
avoided during the treatment such as presence of S.N.T., as
early loss of primary Es or bad conservative work for the
rest of remaining teeth.

 SE should be done at both arches at the same time.

 SE is very good applied in the upper arch rather in the
lower arch because of favorable sequence of eruption, i.e.
4 erupt earlier than 3, while in the lower arch 3 erupt
earlier than 4.
 The opinion of starting a serial extraction with a
patient is not a simple one for all “orthodontist, parents
and patient “. It lies in the chamber of early treatment
versus late treatment, because many authors prefer to
wait until full eruption of the whole permanent teeth and
then they perform their orthodontic treatment.

Advantages:
As follow:
1- Immediate relief of crowding or the malocclusion.
2- Less time consuming and low cost especially if at the
end, the teeth arranged with good alignment.
3- Simple procedure.
4- Less duration of wearing orthodontic appliances.

Disadvantages:
As follow:
1- Subject the child to multiple extraction visits, which
may leave a bad impression toward a dentist particularly
if the extraction were done improperly.
2- Painful.

In a lot of cases the final outcome of teeth alignment are

accepted by the parent, patient and even the buzy
orthodontist!!!!!. However, an upper and lower fixed
appliance are needed to give the final touches to each tooth
position or closing residual spaces ….etc. i.e. approaching
toward typical occlusion. These appliances are worn for 6-8
months only rather than 2-2.5 years.