Management of crowding in children with serial extraction

What is serial extraction?
Serial extraction or the guidance of eruption is an age-old procedure to correct crowded jaw
arch. It involves the correctly timed, planned removal of certain deciduous and permanent teeth
in mixed dentition stage with dentoalveolar disproportion in order to

  • Alleviate crowding of incisor teeth
  • Allow unerupted teeth to guide themselves into proper positions
  • Lessen (or eliminate) the period orthodontic appliance therapy.
  • Reduce the complexity of further orthodontic therapy treatment, if required.

Why serial extraction is needed?
Crowding is encountered at various stages of teeth development and in varying degrees of
severity. In the early dentition stage, crowding takes place due to the difference in the size of
the permanent tooth to their deciduous or primary tooth.
Management of crowding in the mixed dentition phase of a child can be done earliest with serial
extraction. Early management of improper alignment of teeth is also known as interceptive
orthodontics, where the fault is corrected before it becomes more complex.

How many teeth need to be removed in serial extraction treatment?
Depending upon the severity pedodontist will decide the sequence, the most followed sequence
is the removal of deciduous canines and first deciduous molars followed by timely

Can the crowding of teeth in a growing child resolve on its own?
The answer to this question depends on several factors, considering them we can choose to
observe or intervene at the right time to make space available for the eruption of permanent

  • Spacing between the primary teeth, which will help in accommodating the bigger
    erupting permanent teeth properly.
  • The inclination of front teeth/ incisors which may help in increasing jaw arch
  • The ratio of the size between the permanent and primary teeth will give an indication as
    to whether adequate space will be available for an uneventful eruption of permanent

Before                                    After


  • Reducing or eliminating the need for further complex treatment

    Crowding causes individual tooth position problems of rotation, tipping and overlapping. These
    problems are solvable with fixed appliance therapy, but the treated positions may be more
    difficult to stabilize even with long term retention. It is much better to have the teeth erupt into
    relatively correct positions on their own, which planned serial extraction can do, thereby
    reducing later treatment time in braces.

  •  Less tissue damage, better stability

    Teeth erupting into very crowded positions can suffer gingival tissue damage such as recession
    or can be damaged by unusual angles of wear. Serial extraction not only enhances the stability
    of the final product, but it may also prevent irreversible tissue damage to teeth.

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