Orthodontics. Part 8: Extractions in orthodontics

Non-compliance treatment in a young adult full-step class II division 2 malocclusion with preadjusted lingual appliance and upper first molars extractions

This case report describes a complex full-step class II case in a young adult patient treated with lingual straight-wire appliance and upper first molar extraction. As the patient refused a surgical treatment, she was offered the best possible camouflage with the double aim of obtaining an ideal occlusal relationship and maintaining the profile; appropriate biomechanical strategies, including extraction choice and anchorage control during space closure, were needed to achieve the planned results. This case report demonstrates the possibility of successfully resolving severe sagittal discrepancies in an adult patient without surgical treatment by means of a completely invisible non-compliance technique, with the extraction of the most compromised teeth. This report also underlines the need for careful planning during both diagnostic and treatment phases, in order to obtain the best results.

Multidisciplinary Treatment: Follow-Up of Dental Autotransplantation for 10 Years

The objective is to present a clinical case of dental autotransplantation managed with surgery, orthodontics, endodontics, periodontics, and aesthetic rehabilitation. A 10-year-old boy sought treatment after avulsion of the maxillary left central incisor, which was not reimplanted. Based on anamnesis, clinical examination, and complementary examinations, agenesis of the maxillary and mandibular second premolars except the mandibular right second premolar was observed. After a multidisciplinary planning, the space in the maxillary left central incisor region was opened to receive the transplanted mandibular right second premolar. The receptor site was created in a single surgical procedure. Pulp necrosis was noted in the transplanted tooth, which was treated endodontically, and the agenesis spaces were closed using fixed orthodontic appliances. After removing the appliance, gingivectomy with osteotomy was performed in the maxillary right central incisor and the transplanted tooth regions to harmonize the height and shape of the gingival contour. Next, aesthetic readjustment was performed with tooth whitening, using office and home techniques, followed by microabrasion of the vestibular surface of the maxillary right central incisor. Direct composite resin restorations were placed in the maxillary incisors, and the teeth were rehabilitated using incisal and palatal guides. A multidisciplinary approach is essential for reestablishing the function and aesthetics of complex cases involving dental autotransplantation.

United Arab Emirates dentists' perceptions about the management of broken down first permanent molars and their enforced extraction in children: a questionnaire survey

PURPOSE

The broken down first permanent molar (BDFPM) is common in children. Enforced extractions of first permanent molars (EExFPMs) guidelines were published in the United Kingdom (UK) in 2014. We aimed to assess the knowledge and practice of dentists in the United Arab Emirates (UAE) of BDFPMs in children in light of the guidelines.

METHODS

A cross-sectional sample of UAE-based dentists treating children completed a self-administered questionnaire covering; knowledge and practice of the principle of EExFPMs; to whom dentists would refer in case of BDFPMs; knowledge of the ideal age for EExFPMs (8-10 years) and finally actual awareness of the EExFPMs guidelines. Chi-square tests (p < 0.05).

RESULTS

A total of 199 questionnaires were completed (total return rate was 66.33%). There was no agreement on how to deal with a scenario of BDFPMs. Over 85% majority believed in saving BDFPMs rather than extracting them but 89% would consult/refer to other specialists. Whilst 51% of the participants had never carried out EExFPMs in children, 69% were aware of the EExFPMs concept and 61% knew the ideal timing of a lower FPM extraction. More than 82% were unaware of the actual UK EExFPMs guidelines. Paediatric dentists would consider EExFPMs more than other groups (p = 0.007).

CONCLUSION

In the UAE dentist sample surveyed, there was a preference for preserving BDFPMs rather than extracting them in children, despite knowing when the ideal time for extraction was. Training background and specialty were influencing factors. There was a lack of awareness of the actual UK 2014 EExFPMs guidelines.

Factors affecting treatment decisions for Class I malocclusions

INTRODUCTION

Orthodontic treatment planning requires skill and expertise with considerable practice variations. The aims of this study were to review retrospectively the pretreatment records of patients with Class I malocclusion and to identify variables that could play a role in the treatment decision.

METHODS

From the available records of 1500 orthdontic patients, the pretreatment records of 202 patients were selected at random. Inclusion and exclusion criteria were applied, and the surviving records were divided into extraction (n = 92) and nonextraction (n = 92) treatment groups. Skeletal, dental, and soft tissue measurements were obtained from pretreatment lateral cephalograms and dental casts of subjects with bilateral Class I molar relationships. Data were statistically analyzed by binary logistic regression tests.

RESULTS

The results showed that the variables of lower anterior facial height, E-plane to upper lip, and maxillary and mandibular incisor inclinations were significantly increased in the extraction group (P <0.05), whereas spacing in the mandibular arch and increased overbite were statistically significant in the nonextraction treatment group (P <0.05). According to the model, the odds of nonextraction treatment are 1.29 and 1.24 times that of extraction treatment for every 1-mm increase in overbite and spacing in the mandibular arch, respectively.

CONCLUSIONS

Vertical facial pattern, overbite, mandibular tooth size-arch length discrepancy, lip position, and maxillary and mandibular incisor inclinations are a few of the important variables that should not be overlooked when planning orthodontic treatment. The findings of this study could facilitate the treatment planning process for patients with Class I malocclusion.

Effectiveness of en masse versus two-step retraction: a systematic review and meta-analysis

Background

This review aims to compare the effectiveness of en masse and two-step retraction methods during orthodontic space closure regarding anchorage preservation and anterior segment retraction and to assess their effect on the duration of treatment and root resorption.

Methods

An electronic search for potentially eligible randomized controlled trials and prospective controlled trials was performed in five electronic databases up to July 2017. The process of study selection, data extraction, and quality assessment was performed by two reviewers independently. A narrative review is presented in addition to a quantitative synthesis of the pooled results where possible. The Cochrane risk of bias tool and the Newcastle-Ottawa Scale were used for the methodological quality assessment of the included studies.

Results

Eight studies were included in the qualitative synthesis in this review. Four studies were included in the quantitative synthesis. En masse/miniscrew combination showed a statistically significant standard mean difference regarding anchorage preservation − 2.55 mm (95% CI − 2.99 to − 2.11) and the amount of upper incisor retraction − 0.38 mm (95% CI − 0.70 to − 0.06) when compared to a two-step/conventional anchorage combination. Qualitative synthesis suggested that en masse retraction requires less time than two-step retraction with no difference in the amount of root resorption.

Conclusions

Both en masse and two-step retraction methods are effective during the space closure phase. The en masse/miniscrew combination is superior to the two-step/conventional anchorage combination with regard to anchorage preservation and amount of retraction. Limited evidence suggests that anchorage reinforcement with a headgear produces similar results with both retraction methods. Limited evidence also suggests that en masse retraction may require less time and that no significant differences exist in the amount of root resorption between the two methods.

Electronic supplementary material

The online version of this article (10.1186/s40510-017-0196-7) contains supplementary material, which is available to authorized users.

Incidence of Risk and Complications Associated with Orthodontic Therapeutic Extraction

Background:

Extraction in orthodontics are carried out in the cases where there is space deficiency to align the teeth. The elective extraction of first or second premolars has been discussed in the literature for more than 50 years. In the 1940s and 1950s Nance, Dewel and Carey reviewed this as a useful option, and in the 1970s Logan and other leading orthodontists favoured the extraction as choice. It is not always the elective extraction of premolar is a smooth drive for the surgeon as well as to patient. Sometimes the elective extraction of premolar result in complications, which might be due to both anatomical and surgical factors.

Methodology:

The study sample consisted of 100 patients referred for one or more orthodontic extractions to the department of oral and maxillofacial surgery were included in this retrospective study at the vivekanandha dental college for women tiruchengode between November 2014 and May 2016. All referrals were from the department of orthodontics. A survey was carried out to record the intraoperative risks and correlated with its morbidity as when occured. All intraoperative morbities were managed appropriately as required.

Result and Conclusion:

Between November 2014 and May 2016, 100 patients had one or more premolar teeth removed by the oral surgeons. The sample size was 100 patients who had a total of 334 premolars removed. The sample's mean age was 11.4+\- 8.4 years, and 57.0% were male. The average number of teeth extracted per patient was 2.34 +\- 1.46, and 73.8% had complete root development. More than 93.4% of subjects had normal root and bone morphology, whereas 35.65% had variations in root forms and bone texture. The intra-operative and post operative complication rates were 7.4% and 1.9%, respectively. Complications were generally minor (91.9%) and were managed nonoperatively on an outpatient basis. There were no case of oral antral communication.

A retrospective study comparing the loss of anchorage following the extraction of maxillary first or second premolars during orthodontic treatment with fixed appliances in adolescent patients

INTRODUCTION

This retrospective study assessed the difference in anchorage loss using 3D superimposition of study models between cases treated with extraction of maxillary first premolars and maxillary second premolars carried out in orthodontic specialist practice.

METHOD

Sixty subjects who have undergone extractions of either maxillary first or second premolars as part of their orthodontic treatment were selected. Eligibility criteria included patients with a Class I, mild Class II or III malocclusions, mild-to-moderate crowding with no anchorage reinforcement. Pre- and post-treatment maxillary dental study cases were scanned using a surface laser scanner to produced 3D digital images which were superimposed using areas of stability on the anterior hard palate. Anchorage loss was measured by the mesial movement of the maxillary first permanent molar.

RESULTS

The mean mesial movement for the maxillary first molars, when adjusted for confounding factors was 4.7 mm (SD 1.6) in the maxillary first premolar extraction group and 4.6 mm (SD 1.6) in the maxillary second premolar extraction group.

CONCLUSIONS

There is no difference in anchorage loss when comparing the extraction of the maxillary first premolars to the extraction maxillary second premolars.

There is Insufficient Evidence that Upper Airway Dimension Changes after Four Premolar Extraction Orthodontic Treatment

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

The effect of teeth extraction for orthodontic treatment on the upper airway: a systematic review. Hu Z, Yin X, Liao J, Zhou C, Yang Z, Zou S. Sleep Breath 2015;19(2):441-51.

SOURCE OF FUNDING

The review was supported by the National Nature Science Foundation of China and the Research Fund for the Doctoral Program of Higher Education in China.

TYPE OF STUDY/DESIGN

Systematic review.

Stability of Palatal Rugae as a Forensic Marker in Orthodontically Treated Cases

The palatal rugae have been used as a reference landmark and identification marker by orthodontists and forensic analysts. However, the reliability of palatal rugae as a forensic marker remains questionable once an individual is subjected to orthodontic treatment. This study aimed at evaluating the changes in the rugae pattern after nonextraction, extraction, and maxillary expansion orthodontic treatment. The lengths and shapes of palatal rugae were evaluated on the pretreatment and post-treatment dental casts of 168 subjects using the Thomas and Kotze classification. Extraction treatment significantly reduced the second and third rugae lengths (p < 0.05), whereas the third rugae length was significantly increased after palatal expansion (p < 0.05). The shape of rugae remained consistent in all the study groups which may be used as a reliable forensic marker in subjects undergoing orthodontic treatment. However, the use of the lengths of palatal rugae in forensic odontology must be made with caution.

Agenesis of Maxillary Lateral Incisors: Treatment Involves Much More Than Just Canine Guidance

Objective:

In this study, we aimed highlight some clinical features present in patients whose maxillary lateral incisors are missing, and proposed more logical, rational and predictable solutions to inform decision making in rehabilitation procedures.

Methods:

Literature review and discussion.

Conclusion:

Choosing the best possible treatment for congenital absence of maxillary lateral incisors depends on the multidisciplinary diagnosis of facial, occlusal, functional and periodontal features. It also depends on the individual long-term stability, and it does not only rely on canine-guided disocclusion.

Mandibular incisor extraction: a systematic review of an uncommon extraction choice in orthodontic treatment

OBJECTIVES

To review the published literature in order to address clinical questions regarding the indications, effects and outcomes of mandibular incisor extraction in orthodontics.

DATA SOURCES

Three electronic databases were searched: PubMed (1950-January 2011), Ovid Embase+Ovid Embase Classic (1947-January 2011) and Cochrane library (6 Cochrane databases, 1996-January 2011). The following journals were additionally searched: American Journal of Orthodontics and Dentofacial Orthopedics (1960-January 2011), Angle Orthodontist (1960-January 2011), European Journal of Orthodontics (1970-January 2011) and Journal of Orthodontics (1974-January 2011). Grey literature was searched using Google Scholar and System for Information on Grey Literature in Europe. Secondary search of the references cited in the relevant articles was also conducted.

DATA SELECTION

Articles in vivo, in Humans, in English, concerning treatment of malocclusion with mandibular incisor extractions or missing mandibular incisors. Fifty-four publications met these inclusion criteria and were reviewed.

DATA EXTRACTION

Data were extracted independently by two reviewers with regard to: (1) indications; (2) contraindications; (3) effects; (4) outcomes; and (5) factors associated with successful outcomes.

DATA SYNTHESIS

Considering the descriptive nature of the studies found, a narrative synthesis was undertaken.

CONCLUSIONS

The descriptive nature of published articles precludes making strong evidence-based recommendations regarding this extraction choice, but it is clear that mandibular incisor extraction can be effectively used in the resolution of crowding, as well as intermaxillary malocclusion in carefully selected cases. Several factors that could lead to good outcomes of orthodontic treatment following mandibular incisor extraction were identified. Mild-to-moderate class III malocclusion, an edge-to-edge anterior occlusion or anterior crossbite, with mild anterior mandibular tooth size excess, and minimal open bite tendencies were the clinical situations most frequently treated with this unique extraction choice. On the other hand, clinicians should be careful to avoid poor outcomes such as gingival recession, open interproximal gingival embrasures, increased overjet and overbite.

Computational Formulation of Orthodontic Tooth-Extraction Decisions

Objective: To develop a mathematical model that simulates optimum site(s) for tooth extraction and to examine what kinds of dentoskeletal traits, in the model, influence optimizing decisions for extraction site(s).

Materials and Methods: Conventional orthodontic records were obtained for 193 women who had received orthodontic tooth-extraction treatments judged as excellent treatment outcomes. The feature vector-elements that represented dentoskeletal traits, and weights of their contributions to achieving optimum simulation in the model, were determined.

Results: The rate of coincidence between recommendations made by the optimized model and the actual judgments was found to be 86.0%. The elements that were sensitive to increasing the rate of coincidence and corresponding weights in judging the site(s) of tooth extraction were: protrusiveness of the upper and lower incisors (2.0), overjet and overbite (1.5), the membership grade for the skeletal Class II jaw relationship, molar relationship in the sagittal direction, the mandibular plane angle, and the severity of tooth crowding in the lower dentition (1.0). The remaining 10 feature vector-elements were also found to be indispensable for the model.

Conclusions: A mathematical model that simulates optimum site(s) for orthodontic tooth extraction, with a high agreement rate (86.0%) between the system's recommendations and the actual judgments given by orthodontists, was developed. The dentoskeletal structural traits that affected optimizing decisions for orthodontic tooth-extraction site(s) were formulated and subdivided into five major categories, ie, the sagittal dentoskeletal and soft tissue relationship, the vertical dentoskeletal relationship, the transverse dental relationship, the intra-arch conditions, and the pathological conditions.