Stability of extraction space closure

Treatment of severe anterior open bite by using tongue crib and teeth extraction: a case report

BACKGROUND

Anterior open bite is a kind of malocclusion that can affect the oral function, aesthetics and even mental health of adolescents. Breaking harmful habits plays an important role in the orthodontic treatment of patients during the growth and development period.

CASE PRESENTATION

This case focuses on a 13-year-old adolescent male with anterior open bite of 6 mm, Class II malocclusion, and finger sucking, tongue thrusting habits, and abnormal swallowing pattern. Based on the etiology and the patient's condition, a treatment plan involving extraction of second premolars and use of an adhesive tongue crib was implemented. After 35 months of active treatment and 12 months of retention, results showed improved occlusion, normal overbite and overjet, proper molar relationships, and enhanced facial aesthetics. The study highlights addressing etiological factors and using appropriate treatments. A modified Hawley retainer and a retainer with a welded tongue crib at night helped maintain results due to the patient's history and potential for recurrence.

CONCLUSIONS

For adolescent patients with anterior open bite, clear diagnosis and elimination of causative factors are key to favorable treatment results. Combining multiple mechanisms can effectively restore and establish a good occlusal relationship. Throughout the treatment, it is also necessary to pay attention to patients' growth and development.

CLINICAL TRIAL NUMBER

Not applicable.

Non-extraction camouflage on a fully cooperative full-step class II division 2 adult patient treated with en-masse distalization, class II elastics and preadjusted lingual appliance: A case report

This article describes one adult bilateral full-step class II case with severe initial upper incisors retroclination successfully treated by a completely invisible lingual appliance. A non-extraction treatment to compensate for the severe sagittal discrepancy was made possible following the excellent patient cooperation with intermaxillary elastics, combined with upper arch en-masse effective distalization with miniscrews. The application of an auxiliary torque spring was essential to increase upper incisors torque during class II mechanics. This case report shows the possibility of obtaining a full-step class II correction in an hypodivergent adult patient with a completely invisible appliance, taking advantage for the patient cooperation, for a more straightforward and faster non-extraction case resolution. It also underlines on the other hand the importance of successfully controlling incisors torque with auxiliaries in cases of severe retroclination in an adult class II malocclusion, in combination with the simultaneous distalization mechanics for monolateral full-step class II correction, by means of a completely invisible appliance.

The effectiveness of the total-maxillary-arch-distalization approach in treating class II division 1 malocclusion: A systematic review

OBJECTIVE

The objective of this review is to assess the effect of total maxillary arch distalization (TMAD) treatment on the dental, skeletal, soft tissues, and airways during non-extraction camouflage treatment of class II division 1 patients.

METHODS

We performed a systematic review of the published data in four electronic databases up to April 2023. We considered studies for inclusion if they were examining the effects of TMAD during treatment of class II division 1 malocclusion in the permanent dentition. Study selection, data extraction, risk of bias assessment, and assessment of the strength of the evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool were performed in duplicate.

RESULTS

Out of the 27 articles that met the initial eligibility criteria, 19 studies were finally selected. Fair to relatively good quality evidence was identified after the risk of bias assessment of the included studies. Out of the 19 selected studies, 5 studies used inter-radicular TADs, 10 studies used modified C- palatal plate (MCPP), 3 studies used infra zygomatic crest (IZC) TADs, 1 study compared buccal TADs versus MCPP, and 1 study compared between cervical headgear and MCPP. The maximum amount of maxillary arch distalization using buccal TADs, MCPP, IZC TADs, and headgear was 4.2mm, 5.4mm, 5mm, and 2.5mm respectively. Different results regarding the amount of dental, skeletal, and soft tissue changes were observed.

CONCLUSIONS

The current low to very low certainty level of evidence suggests that TMAD is effective in camouflaging class II division 1 malocclusion. Future well-conducted and clearly reported randomized controlled trials that include a control group are needed to make robust recommendations regarding the effect of TMAD with different appliances on dental, skeletal, and soft tissue structures.

CLINICAL RELEVANCE

TMAD should be given priority with caution in class II patients who refuse the extraction of premolars. TMAD may be considered an adjunctive approach to solve cases associated with high anchorage need or anchorage loss.

Longitudinal behavior of orthodontic extraction spaces: A retrospective dental cast analysis

INTRODUCTION

This retrospective study aimed to qualitatively and quantitatively evaluate orthodontic extraction space behavior and size at the end of treatment and the short- and long-term stages in Class I, II, and III malocclusions.

METHODS

The sample comprised records of 1283 orthodontic patients treated with extractions (cross-sectional group). From these patients, 1- and 5-year posttreatment records of 214 patients were additionally evaluated (longitudinal group). Orthodontic extraction sites of immediate (end of treatment), short-term (1-year posttreatment), and long-term (5-year posttreatment) stage dental casts were measured with a digital caliper. Extraction spaces were classified according to their qualitative behavior in the open, closed, reopened, and recently closed spaces. Space qualitative longitudinal behavior was compared among the malocclusion types with chi-square tests. Kolmogorov-Smirnov normality tests were performed to check the variable's distribution. All variables showed normal distribution, except the malocclusion group ages. Therefore, parametric tests were used for all comparisons between the malocclusion groups, except for age comparisons in each stage, which were compared with the Kruskal-Wallis tests. Thus, space size and its reduction were compared among the 3 stages, in general, and between the maxillary and mandibular arches, with analysis of variance followed by Tukey tests and t tests, respectively.

RESULTS

Classes I, II, and III malocclusion patients presented similar ages at each stage. At the end of treatment, 71.4% and 65.1% of the quadrants were closed in the cross-sectional and longitudinal groups, respectively, and 43.6% and 38.2% of patients presented all quadrants closed at this same stage in both groups. The reopening and late closure tendencies were 2.9 and 2.3 times greater in the short term than in the long term. Reopening tendency in the short-term was greater in Class II than in Class I malocclusion. Of the quadrants closed at the end of treatment, 87% were stable in the long term. From the quadrants with residual spaces at the end of treatment, 28.4% persisted openly in the long term. Residual space size reduced significantly in the short and long term, primarily in the mandibular arch.

CONCLUSIONS

The percentage of patients with residual spaces at the end of treatment was 56.4%. Space reopening and late closure occur mainly in the first year after treatment. There was long-term stability in 87% of the quadrants closed at the end of treatment. There was a significant reduction in orthodontic extraction space size in the short and long term, especially in the mandibular arch.

Orthodontic management of a horizontally impacted maxillary incisor in an adolescent patient

Horizontal maxillary incisor impaction is not common, but it affects facial esthetics, phonetics, and the patient's self-esteem. Therefore, it is necessary to manage this problem as early as possible. This case report presents a patient with an unerupted maxillary left central incisor combined with anterior and left posterior crossbite, edge-to-edge overbite on the right and left anterior open bite, low smile line, and mild skeletal Class III discrepancy. The treatment consisted of 3 stages: (1) maxillary expansion and sufficient space creation for the impacted tooth; (2) surgical exposure by closed-eruption technique; and (3) induced eruption of impaction. The treatment outcome was highly favorable. Maxillary impaction erupted in the proper position with a normal clinical crown height and consonant gingival line with the adjacent teeth. Maxillary and mandibular teeth had normal and stable occlusion. The 3-year follow-up demonstrated an esthetically functional outcome after orthodontically induced tooth eruption. This treatment required a good treatment plan by the orthodontist to obtain satisfactory results.

Oropharynx and hyoid bone changes in female extraction patients with distinct sagittal and vertical skeletal patterns: a retrospective study

Background

Previous studies have reported inconsistent effects of premolar extraction on the oropharynx and hyoid bones. Currently, no strong evidence is available regarding the effect of extraction on upper airway size. Hence, the aim of this study was to analyse the effects of first premolar extraction on the oropharynx and hyoid bone positions in female adult patients, and further explored differences in oropharynx and hyoid bone changes among skeletal patterns.

Methods

The study population included 40 female adult patients who did not undergo extraction and 120 female adult patients who underwent extraction of four premolars; the including patients had four distinct sagittal and vertical skeletal patterns. Cone-beam computed tomography was performed before (T0) and after (T1) orthodontic treatment. Eight oropharynx variables and five hyoid bone variables were measured using Dolphin 3D Imaging software. Paired and independent t-tests were used to analyse measurements between timepoints and groups, respectively.

Results

The oropharynx volume increased significantly in the extraction group; changes did not differ significantly between extraction and non-extraction groups. Oropharynx variables did not differ significantly at T0 among the four skeletal pattern groups. After orthodontic extraction treatment, the oropharynx volume increased significantly in the class I-norm and class I-hyper subgroups, but not in the class II-norm and class II-hyper subgroups. Significant increases were observed in the oropharynx volume and most constricted axial area from T0 to T1 in the moderate retraction group, but not in the maximum retraction group. Extraction patients exhibited significant posterior movement of the hyoid, particularly among maximum retraction patients.

Conclusions

In female adult patients, first premolar extraction tends to increase the oropharynx size and cause posterior movement of the hyoid bone, particularly in skeletal class I patients. For skeletal class II and hyperdivergent patients with a narrow oropharynx, first premolar extraction does not negatively influence oropharynx size or hyoid bone position. The differences of oropharyngeal changes between moderate retraction patients and maximum retraction patients were not significant.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13005-022-00334-1.

The absence of proximal contact point on periodontal parameters of teeth moved into extraction sites

The aim of study was to evaluate periodontal conditions of upper canines and second premolars with and without proximal contact of individuals undergoing orthodontic treatment associated to extractions of the upper first premolars. The study selected upper canines and premolars of individuals undergoing orthodontic treatment without extractions (30 hemiarches - control group), or with extraction of the upper first premolars and whose canines and second premolars had interproximal contact (16 hemiarches - group 1) or diastema (17 hemiarches - group 2). Clinical (plaque index, probing depth, gingival bleeding index, height of the gingival margin, clinical attachment loss and gingival clefts) and radiographic (crest height, bone height and bone-crest discrepancy) parameters of the distal surfaces of canines and mesial surfaces of premolars were evaluated. Group 1 had worse results when compared to the control group for the levels of plaque in canines and premolars and for probing depth in canines (distal and mean) and in premolars (lingual and mean), as well as increasing tendency of clinical attachment loss (lingual and mean) in premolars. Plaque level in canines in group 1 was also significantly higher than in group 2. There was no difference between group 2 and the control group. The lack of proximal contact between canines and second premolars did not significantly affect their periodontal characteristics.

Comparison of treatment effects from total arch distalization using modified C-palatal plates versus maxillary premolar extraction in Class II patients with severe overjet

INTRODUCTION

This study aimed to compare the skeletodental and soft tissue changes with total arch distalization using a modified C-palatal plate (MCPP) and maxillary first premolar extraction treatment in Class II malocclusion patients with severe overjet.

SETTING AND SAMPLE POPULATION

The sample consisted of 46 adult patients who had Class II Division 1 malocclusion with severe overjet; 25 of them received non-extraction treatment with MCPPs (age, 22.5 ± 7.2 years), and 21 received maxillary first premolar extraction treatment (age 23.4 ± 6.5 years).

METHOD

A total of 26 variables were measured on pre- and post-treatment lateral cephalograms. To evaluate the differences between pretreatment and post-treatment in each group, t tests and Wilcoxon rank-sum tests were used. To compare the amount of change between the two groups, MANOVA test was used.

RESULTS

The overjet was significantly reduced in the MCPP and extraction groups by 4.8 mm and 5.4 mm, respectively. However, the two groups had no significant difference in the sagittal, vertical and angular changes of the maxillary incisors. In addition, regarding soft tissue changes, the MCPP and extraction groups showed an increased nasolabial angle of 7.5° and 9.4°, decreased upper lip to the true vertical line of 1.8 mm and 2.2 mm, respectively (P < .001).

CONCLUSIONS

There was no significant difference in the skeletal changes between the MCPP and extraction groups, and the reduction in overjet was similar in the groups. These results suggest that MCPP might be a viable treatment option for total arch distalization in Class II malocclusion patients with severe overjet.

Factors affecting the stability of maxillary extraction site closure

Introduction:

A side effect observed in cases treated with extractions is the instability of orthodontic space closure.

Objective:

The aim of this study was to investigate the influence of gingival invagination, presence of third molars and facial pattern, on the stability of orthodontic space-closure in the maxillary arch.

Methods:

Ninety-nine subjects (41 male and 58 female) with Class I malocclusion treated with four premolars extraction were evaluated. Extraction sites reopening and gingival invaginations were evaluated in scanned dental models in the posttreatment and 1-year posttreatment stages (mean age 16.1 years). Third molars presence was evaluated at 1-year posttreatment panoramic radiographs, and the facial pattern (SN.GoGn) was evaluated in the initial lateral headfilms. Multiple logistic regression analysis was used to estimate the influence of the aforementioned independent variables on the frequency of extraction space reopening.

Results:

Space reopening was observed in 20.20% of the subjects 1-year post-debonding. Gingival invaginations were present in 25.73% of quadrants after debonding and in 22.80% 1-year posttreatment. The mean pre-treatment SN.GoGn was 35.64 degrees (SD=5.26). No significant influence was observed of the three independent variables on the instability of extraction site closure.

Conclusions:

The presence of gingival invaginations, third molars and facial growth pattern do not seem to influence maxillary extraction sites reopening.

Stability of maxillary interincisor diastema closure after extraction orthodontic treatment

OBJECTIVES

To evaluate the stability of maxillary interincisor diastema closure and the relationship between space relapse and interincisor diastema width, overjet, overbite, angulations between adjacent maxillary anterior teeth and presence of intermaxillary osseous cleft after orthodontic treatment with extractions.

MATERIALS AND METHODS

Twenty-four individuals with a maxillary interincisor diastema pretreatment, treated with maxillary first premolar extractions were evaluated. Dental casts and panoramic radiographs taken at pretreatment (T1), posttreatment (T2), and posttreatment follow-up (T3) were assessed. Periapical radiographs at T1 and T2 were also evaluated. Diastema relapse was assumed when T3-T2 interincisor space change was greater than zero. Diastema relapse was considered clinically significant when it was at least 0.50 mm. Data were analyzed using repeated-measures analysis of variance followed by post hoc Tukey tests or Friedman followed by Wilcoxon tests. T-test or Mann-Whitney U-test, Pearson correlation coefficient, and multiple linear regression analyses were also performed.

RESULTS

No statistically significant relapse of maxillary interincisor diastemas was found. The percentage of clinically significant relapse of the maxillary interincisor diastemas was 27.78%. Specifically, for the interincisor midline diastema, it was 8.33%.

CONCLUSIONS

Maxillary interincisor diastema closure showed no statistically significant relapse after orthodontic treatment with premolar extractions. Clinically significant stability for maxillary interincisor diastema closure was 72.22% and, specifically, for interincisor midline diastema closure, it was 91.67%.

Pretreatment dentoskeletal comparison between individuals treated with extractions in the 1970s and in the new millennium

OBJECTIVE

This retrospective study aimed to compare the occlusal and dentoskeletal initial features of patients treated with four first premolar extractions in the 1970s and after 2000.

MATERIALS AND METHODS

Group 70' was composed by 30 subjects with Class I malocclusion (mean age of 12.8 years, 10 male, 20 female) treated in the 1970s with four first premolar extractions and comprehensive orthodontic treatment. Group NM comprised 30 subjects with Class I malocclusion (mean age of 13.4 years, 13 male, 17 female) treated in the new millennium, similarly to Group 70'. Initial dental models and lateral cephalograms were digitized and measured using OrthoAnalyzerTM 3D software and Dolphin Imaging 11.0 software, respectively. Initial occlusal and dentoskeletal features were analyzed and compared. Intergroup comparison was performed using t tests (p < 0.05). Holm-Bonferroni correction for multiple comparison was applied.

RESULTS

Group NM showed significantly greater maxillary and mandibular effective lengths and greater maxillary and mandibular incisor protrusion in comparison with Group 70'. Group NM presented a significantly greater lower anterior facial height. Group NM also showed significantly smaller nasolabial angle and protruded inferior lip.

CONCLUSION

Patients with Class I malocclusion treated with four first premolar extractions in the new millennium present a greater degree of dental and labial protrusion, increased lower anterior facial height, and more acute nasolabial angle compared with patients treated similarly in the 1970s. Greater dental and labial protrusion determines first premolar extractions in the new millennium.

CLINICAL RELEVANCE

Despite the decrease of tooth extraction frequency, four first premolar extractions may be justified in cases with severe dental and skeletal protrusions.

Comparison of treatment effects between four premolar extraction and total arch distalization using the modified C-palatal plate

Objective

The purpose of this study was to compare the skeletal, dental, and soft-tissue treatment effects of nonextraction therapy using the modified C-palatal plate (MCPP) to those of premolar extraction (PE) treatment in adult patients with Class II malocclusion.

Methods

Pretreatment and posttreatment lateral cephalographs of 40 adult patients with Class II malocclusion were retrospectively analyzed. The MCPP group comprised 20 patients treated with total arch distalization of the maxillary arch while the PE group comprised 20 patients treated with four PE. Fifty-eight linear and angular measurements were analyzed to assess the changes before and after treatment. Descriptive statistics, paired t-test, and multivariate analysis of variance were performed to evaluate the treatment effects within and between the two groups.

Results

The MCPP group presented 3.4 mm of retraction, 1.0 mm of extrusion, and 7.3° lingual inclination of the maxillary central incisor. In comparison, the PE group displayed greater amount of maxillary central incisor retraction and retroclination, mandibular incisor retraction, and upper lip retraction (5.3 mm, 14.8°, 5.1 mm, and 2.0 mm, respectively; p < 0.001 for all). In addition, the MCPP group showed 4.0 mm of distalization and 1.3 mm of intrusion with 2.9° distal tipping of the maxillary first molars.

Conclusions

These findings suggest the MCPP is an effective distalization appliance in the maxillary arch. The amount of incisor retraction, however, was significantly higher in the PE group. Therefore, four PE may be recommended when greater improvement of incisor position and soft-tissue profile is required.

Orthodontic treatment stability predictors: A retrospective longitudinal study

OBJECTIVE

To examine medium- to long-term orthodontic treatment stability and its possible association with certain variables.

MATERIALS AND METHODS

In a retrospective longitudinal study of 70 postretention patients, the Peer Assessment Rating (PAR) index was measured at the start (T1) and end (T2) of treatment and between 4 and 10 years afterwards (T3). The stability was considered absolute when the T2 and T3 values were identical and relative when the difference was within the ±5 range.

RESULTS

Among the 70 patients, 65.8% were female and 34.2% were male. Their mean age was 14.5 years. The mean treatment length was 2.4 years. The mean retention phase was 3.3 years. The mean pre- and posttreatment PAR scores were 29.8 (T1) and 6.3 (T2). The mean T1-T2 difference was 23.6. The mean T2-T3 difference was -0.39.

CONCLUSIONS

Within the study, 7.1% presented absolute stability and 68.6% presented relative stability. Lower anterior segment alignment and overbite were the most unstable occlusal features and tended to worsen. Fixed retainer (odds ratio [OR] 0.31; 95% confidence interval [CI] 0.10-0.98) as a protective factor and years without retention (OR 1.32; 95% CI 1.03-1.68) as a risk factor are predictor variables of instability in the case of lower anterior segment alignment. The PAR value at the end of treatment (OR 1.29; 95% CI 1.08-1.54) and extractions (OR 4.76; 95% CI 1.05-21.6) before treatment are predictors for midline instability.