Frequency evaluation of different extraction protocols in orthodontic treatment during 35 years

Therapeutic extraction of second molars in orthodontics: a scoping review

OBJECTIVE

To review the literature to identify the present evidence on the extraction of second molars in orthodontics.

MATERIALS & METHOD

A search of the MEDLINE/PubMed®, Scopus, Web of Science™, and ProQuest® databases for full-text articles was done on March 5, 2024. The search went back till the 1st of January 1991 and was limited to articles in English. The results of the first search went through a preliminary check to remove duplicates and then the titles and abstracts of the articles were read to exclude the irrelevant studies, case studies, or reviews. The abstracts of the selected studies were read carefully to verify if the inclusion criteria were met. Finally, the full texts of the potentially eligible studies were read to apply the eligibility criteria and decide whether to include them in the review or not. The eligibility criteria were set following the PICO (population, intervention, comparison, and outcome) standard. The included studies were thoroughly summarized by extracting the most important information.

RESULTS

The electronic search located a total of 103 articles distributed among the databases. Removing duplicates left 48 Studies. After careful assessment of the titles and abstracts, 32 studies were excluded leaving 16 studies. Applying the inclusion/exclusion criteria resulted in the exclusion of 2 studies and including 14 studies in the scoping review.

CONCLUSIONS

There is quite low level of evidence to support second molar extraction in orthodontics. Conducting a systematic review would not add much to the evidence as well-conducted RCTs are needed first.

Analysis of predicted and achieved root angulation changes in teeth adjacent to maxillary premolar extraction sites in patients treated with the Invisalign appliance

INTRODUCTION

This study aimed to investigate the expression of root angulation in canine, premolar, and first molar teeth adjacent to first and second premolar extraction sites in the maxilla after treatment with an initial series of Invisalign aligners (Align Technology, Santa Clara, Calif).

METHODS

Adult patients (aged ≥18 years) with at least 1 first and/or second premolar extraction in the maxilla and satisfying strict selection criteria were evaluated. Digital models representing pretreatment, predicted, and posttreatment were obtained from Align Technology's digital interface, ClinCheck. The Geomagic Control X (version 2017.0.3; 3D systems, Rock Hill, NC) software facility was used to determine and compare the root angulation of adjacent canine, premolar, and first molar teeth at different time points.

RESULTS

The predicted angulation of teeth was significantly different (P <0.02) than that achieved in most patients. When adjacent teeth roots were planned to tip away from the extraction site, there was an overexpression of the movement. When teeth roots were planned to tip into the extraction site, underexpression occurred, and movement was in the opposite direction in some instances. There was no difference in root angulation outcomes according to the prescribed number of aligners, 1- or 2-week wear protocols, and sex (P >0.05). Attachments were influential in controlling angulation in first-premolar extractions (P = 0.05), but optimized attachments were not any more effective than conventional attachments (P >0.05).

CONCLUSIONS

The achieved root angulation in teeth adjacent to premolar extraction sites in the maxilla after treatment with an initial series of Invisalign aligners differed significantly from that predicted. Attachments play a minor role in the predictability of root angulation outcomes.

Extraction vs nonextraction orthodontic treatment: a systematic review and meta-analysis

OBJECTIVES

To compare four first premolar extraction and nonextraction treatment effects on intra-arch width, profile, treatment duration, occlusal outcomes, smile aesthetics and stability.

MATERIALS AND METHODS

An electronic search of the literature to June 2, 2023 was conducted using health science databases, with additional search of gray literature, unpublished material, and hand searching, for studies reporting nonsurgical patients with fixed appliances regarding sixteen sub-outcomes. Data extraction used customized forms, quality assessed with ROBINS-I (Risk Of Bias In Non-randomized Studies-of Interventions) and Cochrane RoB 2 (risk-of-bias) tool. GRADE (Grading of Recommendations Assessment, Development and Evaluation) assessed certainty of evidence.

RESULTS

Thirty (29 retrospective studies, 1 randomized controlled trial) studies were included. Random-effect meta-analysis (95% CI) demonstrated maxillary (MD: -2.03 mm; [-2.97, -1.09]; P < .0001) and mandibular inter-first molar width decrease (MD: -2.00 mm; [-2.71, -1.30]; P < .00001) with four first premolar extraction; mandibular intercanine width increase (MD: 0.68 mm; [0.36, 0.99]; P < .0001) and shorter treatment duration (MD: 0.36 years; [0.10, 0.62]; P = .007) in the nonextraction group. Narrative synthesis included three and five studies for upper and lower lip-E plane, respectively. For American Board of Orthodontics Objective Grading System and maxillary/mandibular anterior alignment (Little's irregularity index), each included two studies with inconclusive evidence. There were no eligible studies for UK Peer Assessment Rating (PAR) score. Class I subgroup/sensitivity analyses favored the same results. Prediction interval indicated no significant difference for all outcomes.

CONCLUSIONS

Four first premolar extraction results in maxillary and mandibular inter-first molar width decrease and retraction of upper/lower lips. Nonextraction treatment results in mandibular intercanine width increase and shorter treatment duration. There was no significant difference between the two groups regarding maxillary intercanine width, US PAR score, and posttreatment smile esthetics. Further high-quality focused research is recommended.

Assessment of Arabic Web-Based Knowledge About Clear Aligners: An Infodemiologic Study

BACKGROUND

Orthodontic treatments aim to enhance dental aesthetics, functionality, and long-term oral health. Clear aligners have gained popularity as an aesthetic and convenient option for patients seeking orthodontic correction. However, the quality and readability of online Arabic patient-centered information regarding clear aligners has not been studied yet. The aim of our study is to investigate the quality and readability of Arabic patient-centered information about clear aligners.

METHODS

We conducted an extensive evaluation of Arabic web-based content pertaining to clear aligners using three prominent search engines. Eligible websites were categorized based on specialization, organizational affiliation, material type, and presentation style. We assessed website quality and reliability using the DISCERN instrument, Journal of American Medical Association (JAMA) benchmarks, and Health on the Net (HON) code. In addition, we measured readability using the Flesch Reading Ease Score (FRES), Simplified Measure of Gobbledygook (SMOG), and Flesch-Kincaid Grade Level (FKGL).

RESULTS

Out of 600 search results, 195 websites met the inclusion criteria. None of the websites were HON-code accredited. DISCERN assessments revealed low content quality, with none of the websites achieving high-quality status. The JAMA benchmarks showed limited compliance with the four items, with currency being the most frequently achieved. Readability assessments indicated generally high readability, with FKGL scores suggesting easy comprehension for the average readers.

CONCLUSION

While Arabic web-based information on clear aligners is highly readable, its credibility and quality require significant improvement. Websites should adhere to medical information standards, subject content to rigorous assessments, and seek accreditation to ensure reliability. Enhancing the accessibility and comprehensibility of health-related content will empower individuals to make informed health decisions. Addressing limitations, such as social media and video content evaluation, and conducting comparisons with English websites in future research will provide a more comprehensive understanding of the landscape of online orthodontic information.

Assessment of the outcomes and stability after mandibular incisor extraction in orthodontic patients: A systematic review and meta-analysis

Background

This study assessed the stability of the outcomes after mandibular incisor extraction (MIE) using intercanine width and peer assessment rating (PAR) scores in orthodontic patients.

Methods

PubMed, Cochrane Library, Science Direct, Google Scholar, Ovid, and SciELO were systematically searched without restrictions until August 2022. A risk of bias assessment was performed using Newcastle-Ottawa Scale (NOS). The Grading of Recommendations, Assessment, Development, and Evaluation tool was used to assess the quality of evidence. Random effects meta-analysis was performed using RevMan software.

Results

Seven retrospective studies met the inclusion criteria and were included. Meta-analysis identified a statistically significant reduction in intercanine width with MIE after the retention period. The mean difference in post-retention changes concerning intercanine width (MD=0.14, 95% CI: -2.17-1.89; P<0.00001) was significantly higher in premolar extraction (PE) compared to incisor extraction and significantly less in non-extraction compared to incisor extraction (MD=0.72, 95% CI: -0.59-2.03; P<0.00001). Improvements in PAR scores from the start of treatment to the retention period indicated a high outcome standard (>70%) with MIE treatment, with no significant difference in the reduction percentage compared to premolar and non-extraction groups.

Conclusion

With the existing retrospective studies of limited evidence, treatment outcomes with MIE were found to show good improvements in PAR scores. Some reduction in the intercanine width was evident after the retention period, which was observed even with the other two treatment modalities that were compared. Hence, with careful evaluation, MIE could be considered a valid treatment option.

Long-term stability of mandibular incisor alignment in patients treated nonextraction with or without interproximal enamel reduction

INTRODUCTION

This study aimed to compare long-term mandibular incisor stability in nongrowing patients with moderate crowding treated nonextraction with and without interproximal enamel reduction (IPR).

METHODS

Forty-two nongrowing patients with Class I dental and skeletal malocclusion with moderate crowding were divided into 2 groups with an equal number of patients depending on whether IPR was used (IPR group) or not (non-IPR group) during treatment. All patients were treated by the same practitioner and used thermoplastic retainers full-time for 12 ± 1 months at the end of the active treatment. Changes in Peer Assessment Rating scores, Little's irregularity index (LII), intercanine width (ICW), and mandibular incisor inclination (IMPA and L1-NB°) were evaluated using pretreatment, posttreatment, and 8 ± 1 years postretention dental models and lateral cephalograms.

RESULTS

At the end of the treatment, Peer Assessment Rating scores and LII decreased, and ICW, IMPA, and L1-NB° increased significantly (P <0.001) in both groups. At the end of the postretention period, in both groups, LII increased, and ICW decreased significantly (P <0.001) compared with posttreatment values, whereas IMPA and L1-NB remained stable. When treatment changes were compared, increases in ICW, IMPA, and L1-NB were significantly (P <0.001) higher in the non-IPR group. When postretention changes were compared, the only significant difference between 2 groups was observed in ICW. The decrease in ICW was significantly higher in the non-IPR group.

CONCLUSIONS

Long-term stability of mandibular incisor alignment in Class I nongrowing patients with moderate crowding treated nonextraction with and without IPR was similar.

A qualitative evaluation of attitudes toward extractions among primary care orthodontists in Great Britain

INTRODUCTION

The need to extract permanent teeth as part of orthodontic treatment has been keenly debated over many decades. Changes in the frequency of extraction have been well documented; however, we continue to lack an understanding of what influences clinicians' decisions regarding extracting permanent teeth.

METHODS

Purposive sampling was undertaken to obtain representative views from primary care practitioners across Great Britain with a range of experience representing genders and wide geographic distribution. Twenty participants (9 female, 11 male) took part in in-depth, qualitative, 1-to-1 interviews based on a piloted topic guide. Interviews were conducted via video conferencing software with audio recording and verbatim transcription. Thematic analysis was performed with discussion and agreement to identify the main themes.

RESULTS

Five main themes were identified: (1) patient-related factors, such as age and features of the malocclusion, (2) operator factors, including the level of experience, (3) setting, with regard to geographic location and method of remuneration, (4) mechanical approaches, including variations in appliance systems; and (5) self-directed ongoing education, including both formal continuing professional development and informal learning from peers. These factors acted as barriers, enablers, or both in relation to nonextraction treatment.

CONCLUSIONS

Five key influences on extraction decisions among orthodontists in Great Britain were identified. Extraction choices appear to be influenced by various interrelated factors, evolving over time and with increased experience.

Accuracy of artificial intelligence for tooth extraction decision-making in orthodontics: a systematic review and meta-analysis

OBJECTIVE

This study aimed to analyze the accuracy of artificial intelligence (AI) for orthodontic tooth extraction decision-making.

MATERIALS AND METHODS

PubMed/MEDLINE, EMBASE, LILACS, Web of Science, Scopus, LIVIVO, Computers & Applied Science, ACM Digital Library, Compendex, and gray literature (OpenGrey, ProQuest, and Google Scholar) were electronically searched. Three independent reviewers selected the studies and extracted and analyzed the data. Risk of bias, methodological quality, and certainty of evidence were assessed by QUADAS-2, checklist for AI research, and GRADE, respectively.

RESULTS

The search identified 1810 studies. After 2 phases of selection, six studies were included, showing an unclear risk of bias of patient selection. Two studies showed a high risk of bias in the index test, while two others presented an unclear risk of bias in the diagnostic test. Data were pooled in a random model and yielded an accuracy value of 0.87 (95% CI = 0.75-0.96) for all studies, 0.89 (95% CI = 0.70-1.00) for multilayer perceptron, and 0.88 (95% CI = 0.73-0.98) for back propagation models. Sensitivity, specificity, and area under the curve of the multilayer perceptron model yielded 0.84 (95% CI = 0.58-1.00), 0.89 (95% CI = 0.74-0.98), and 0.92 (95% CI = 0.72-1.00) scores, respectively. Sagittal discrepancy, upper crowding, and protrusion showed the highest ranks weighted in the models.

CONCLUSIONS

Orthodontic tooth extraction decision-making using AI presented promising accuracy but should be considered with caution due to the very low certainty of evidence.

CLINICAL RELEVANCE

AI models for tooth extraction decision in orthodontics cannot yet be considered a substitute for a final human decision.

Evaluation of the stability of the palatal rugae using the three-dimensional superimposition technique following orthodontic treatment

OBJECTIVES

To determine the uniqueness and stability of the palatal rugae after orthodontic treatment.

METHODS

Cast models of untreated subjects (n=50) were obtained twice at intervals of 8-30 months. Cast models of patients who received non-extraction (n=50) and extraction (n=50) orthodontic treatment were obtained before and after treatment at intervals of 11-41 months and 14-49 months, respectively. All 300 cast models were scanned digitally. The palatal rugae were manually extracted and transformed into 3D point clouds using reverse engineering software. An iterative closest point (ICP) registration algorithm based on correntropy was applied, and the minimum point-to-point root mean square (RMS) distances were calculated to analyze the deviation of palatal rugae for scans of the same subject (intrasubject deviation [ISD]) and between different subjects (between-subject deviation [BSD]). Differences in ISD between each group and the deviation between ISD and BSD of all 150 subjects were evaluated.

RESULTS

Significant differences were found in the 150 ISD and 1225 BSD in each group, as well as the 150 ISD and 11175 BSD across all groups. The mean values of ISD in untreated, non-extraction and extraction group were 0.178, 0.229 and 0.333 mm, respectively. When the first ruga was excluded in the extraction group, the mean ISD decreased to 0.241 mm, which was not significantly different from that in the non-extraction group (p=0.314).

CONCLUSIONS

Orthodontic treatment can influence the palatal rugae, especially in cases of extraction. Furthermore, variation mainly existed in the first ruga in cases of extraction. However, palatal rugae are still unique and may be used as a supplementary tool for individual identification.

CLINICAL SIGNIFICANCE

This study indicates that palatal rugae might be applied in the evaluation of orthodontic tooth movement and forensic individual identification. The registration algorithm based on correntropy provides a credible, precise, and convenient method for palatal rugae superimposition.

Stress distribution analysis in anterior teeth caused by several retraction mechanics

Introduction:

Orthodontic retraction of the anterior teeth is indicated when the patient has a malocclusion with protrusion of the incisors. Several mechanics are indicated to perform this retraction.

Objective:

The objective of this study was to compare the strains generated by four different types of retraction mechanics along the roots of the anterior teeth.

Methods:

A photoelastic model simulating an arch with first premolars extraction was made. Sixty retraction archwires were prepared, including fifteen for each type of mechanics evaluated: sliding, teardrop loop spring, T-loop spring and double key loop archwire. The strains were observed in two perspectives: occlusal and oblique. In the occlusal perspective, strains were compared among the six anterior teeth. From the oblique perspective, strains were compared among the thirds of the left canine root.

Results:

In the occlusal perspective, the teardrop loop spring mechanics presented greater strains, followed by T-loop spring, double key loop archwire and sliding mechanics. In all mechanics, strains were more concentrated in the canines than in the incisors. From the oblique perspective, the teardrop loop mechanics generated greater strains in the cervical regions of the canine, and in the apical regions, no differences were found in strains among the four types of mechanics. In the same mechanics, greater strains were present in the cervical zones.

Conclusion:

The teardrop loop spring retraction mechanic presented the greatest mean strain, and the sliding retraction mechanic presented the lowest mean strain on the root of anteroinferior teeth in the occlusal and oblique perspectives.

Predictors of orthodontic treatment conclusion: A historical cohort study

INTRODUCTION

The study investigated which patient and orthodontic treatment factors act as predictors for the conclusion of the ongoing treatment in a dental clinic of a specialization program in Orthodontics.

METHODS

Data were collected from the records of patients treated from 1997 to 2015. Potential predictors for treatment conclusion were investigated: patient-related factors (PRFs) and treatment-related factors (TRFs). PRFs were sex, age, face balance, Angle malocclusion classification, open bite, denture, facial pattern, facial profile, buccal corridor, crossbite, maxillary deficiency, and sagittal mandibular behavior; and TRFs were therapeutic approaches, treatment modality, extractions, and Bolton discrepancy. The initial and final treatment dates were collected. Descriptive data analysis, univariate, and multivariate logistic regression were performed (5% significance).

RESULTS

Of the 903 records, 561 patients were included in the study. It was demonstrated that starting the treatment at a young age (PRF) and the presence of crossbite (TRF) are predictive factors for the treatment conclusion. A vertical facial pattern (dolichofacial or brachyfacial) and a greater number of extractions for orthodontic reasons may contribute positively to the conclusion of the treatment. The frequency of treatment inconclusion was higher during the first 2 years of treatment (more than 50% of the patients that initiated the treatment).

CONCLUSIONS

Young age at the beginning of treatment and the presence of crossbite malocclusion can increase the chance of treatment conclusion.

Frequency of premolar teeth extractions for orthodontic treatment

It is of interest to evaluate the frequency of premolar extractions during orthodontic treatment in patients reporting to the Saveetha dental hospital in Chennai from 2019-2020. We used the records from 987 patients who underwent orthodontic treatment from June 2019 to March 2020 in a dental hospital for this analysis. Digital case records of patients who underwent therapeutic extractions of premolars were isolated. A sample dataset of 340 case records were selected for this study. Data shows that 34.4% of subjects underwent premolar extractions amongst a total of 987 subjects who underwent orthodontic treatment. 89.4% of patients were Angle's Class I malocclusion patients, and the rest were Class II patients. However, no premolar extractions were done in Class III patients. Data also shows that 67.1% of subjects underwent all 4 first premolar extractions and 13.2% underwent only upper first premolar extractions. Thus, a significant association was found between Type of Malocclusion and the Type of premolar extractions with p < 0.05. Moreover, only 34.4% of patients underwent premolar extractions and the majority of them underwent all 4 first premolar extractions.

Dissipating tooth-mass discrepancy caused by a set of mandibular incisor anomalies

Dental anomalies are complicating factors of orthodontic treatment, especially when 1 or more anterior teeth are affected. In this case report, a girl, aged 12.5 years with a retrognathic chin; number, size, and position anomalies of the mandibular incisors; and bilateral Class I molar relationship sought orthodontic treatment. Tooth-size ratio discrepancy was dissipated without extraction or prosthetic rehabilitation, and the initial molar relationship was maintained, as well as the straight soft tissue profile. Tipping of maxillary and mandibular incisors, crown torque of canines, restoration of anomalous incisor, and maxillary interproximal enamel reduction were key points for successful treatment. After 18 months, the orthodontic records showed stable results, excellent static and functional occlusion, and good smile esthetics and facial appearance, in addition to a high degree of patient satisfaction with the achieved results.

Long-term occlusal changes and patient satisfaction in patients treated with and without extractions: 37 years after treatment

INTRODUCTION

The objective of this research was to evaluate the treatment outcomes, long-term occlusal changes, and patient satisfaction after 37 years of nonextraction and extraction treatments.

METHODS

Fifty-seven patients with Class I and Class II malocclusion were divided into 2 groups. Group 1 included 16 patients treated with nonextraction therapy, with mean initial (T1), final (T2), and long-term posttreatment (T3) ages of 13.2, 15.0, and 50.3 years, respectively. Mean treatment time (T2 - T1) and long-term follow-up time (T3 - T2) were 1.8 and 35.2 years, respectively. Group 2 included 41 patients treated with extraction of 4 first premolars, with mean ages at T1, T2, and T3 of 13.3, 15.6, and 53.6 years, respectively. Mean treatment (T2 - T1) and long-term follow-up (T3 - T2) times were 2.3 and 37.9 years, respectively. The Peer Assessment Rating (PAR) index and Objective Grading System (OGS) indexes were evaluated at T1, T2, and T3 stages. The subjects also answered an online questionnaire regarding esthetic and occlusal self-perception at T3. Intergroup comparison was performed with t tests.

RESULTS

The PAR index improved with treatment and similarly worsened at T3 for both groups. OGS scores were close to the passing score at T2 for both groups. The nonextraction group presented worse OGS scores at T3 than the extraction group. Nonextraction patients perceived more changes in alignment over time, but overall satisfaction was similar.

CONCLUSIONS

The PAR index improved with treatment, and the PAR and OGS scores showed a significant increase, indicating great occlusal changes in the long-term stage. The nonextraction group showed more occlusal changes and perceived more changes in their alignment over time, but overall patient satisfaction was similar in both groups.

Long-Term Outcomes of Nonextraction Treatment in a Patient with Severe Mandibular Crowding

OBJECTIVE

To describe a clinical case with a severe mandibular crowding treated without extraction and showing a long-term outcome.

METHODS

A 14-year-old boy in permanent dentition showed a class I molar and cuspid relationship, a severe deep bite of 8 mm, a constricted V-shaped upper arch with moderate crowding, and a severe crowding of about 12 mm in the lower arch. The panoramic X-ray showed an impacted upper right canine. The treatment started with the placement of a transpalatal bar and 0.022 × 0.028 in standard edgewise appliances in the upper arch and a lip bumper bonded on the second lower molars. Initial leveling of the teeth was accomplished with light Australian round wires. Finishing was then performed with rectangular wires. The phase with fixed appliances lasted 2 years and 9 months, and the patient was motivated and cooperative throughout the treatment, although with poor oral hygiene. The patient was treated without extractions.

RESULTS

The space was gained with the first and second upper molar derotations using the transpalatal bar and the gingival lip bumper in the lower arch. The upper right canine was well positioned, and the maxillary arch form was improved. The severe lower crowding was completely corrected, and a good overbite was achieved.

CONCLUSION

A conservative, nonextraction treatment approach for this patient with class I malocclusion with severe mandibular crowding was effective, and the results have remained stable after a long-term follow-up (10 years).

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.

The extraction of first, second or third permanent molar teeth and its effect on the dentofacial complex

The extraction of permanent molar teeth was first introduced in 1976 as a substitution for premolar extraction in cases with mild crowding. Since then, a number of studies have investigated the effect of permanent molar extraction on dentofacial harmony. Undertaking the procedure of molar extraction is most commonly recommended in response to factors such as: gross caries, large restorations and root-filled teeth, along with its application in the management of anterior open bite and reduction in crowding in facial regions. It has been indicated, however, that before undertaking the extraction of molar teeth it is important to investigate the potential influence of the procedure on other molars, with particular consideration of their eruption path. This is due to the doubt as to the effect of the exact molar teeth extraction and their consequences. In light of this, This review was undertaken to investigate and compare the effect of first, second and the third molar teeth extraction and their subsequent dentofacial complex changes.

Efficiency of class III malocclusion treatment with 2-premolar extraction and molar distalization protocols

INTRODUCTION

Different treatment protocols have been implemented for management of Class III malocclusion with aim of achieving ideal occlusal goals. The aim of current study was to compare the efficiency of Class III treatment with mandibular 2-premolar extraction and mandibular molar distalization protocol.

METHODS

This retrospective cross sectional study was conducted on pre-treatment and post-treatment dental casts of 60 orthodontic patients who had Class III malocclusion and were treated with a mandibular dentition distalization and mandibular 2-premolars extraction protocol. The study was conducted at orthodontic departments of Dental Section, Faisalabad Medical University/Punjab Medical College and de'Montmorency College of Dentistry, Pakistan. The sample was classified into 2 groups. Group A consisted of 30 patients (20 females, 10 males) (mean age, 18.02years) treated with distalization protocol and Group B consisted of 30 patients (18 females, 12 males) (mean age, 18.97years) treated with mandibular 2-premolars extraction protocol. To compare the efficiency of the treatment protocol in each group, the initial and final occlusal results were assessed on dental models using PAR index while treatment efficiency was assessed using a treatment efficiency index (TX). The groups were compared with t and Mann-Whitney tests.

RESULTS

There were no significant differences in the initial age, treatment time, treatment efficiency and any occlusal feature between the groups.

CONCLUSION

Treatment efficiency of Class III malocclusions with mandibular 2-premolar extractions or mandibular dentition distalization protocol is similar.

Extraction of premolars for orthodontic reasons on the decline? A cross-sectional survey of BOS members

OBJECTIVE

To obtain the opinion of British Orthodontic Society (BOS) members in relation to possible patterns of prescription of orthodontic extractions over the past 5-10 years and to relate any changes identified to treatment objectives, facial and smile aesthetics, and treatment strategies and adjuncts.

DESIGN

Cross-sectional questionnaire.

SETTING

On-line survey of BOS members.

METHODS

A 14-item on-line questionnaire was sent to orthodontic practitioners for completion. The questionnaire covered demographics, possible changes in frequency of prescribed extractions with specific information concerning the effect of patient age, and the influence of other factors including alternative approaches to space creation, evolving treatment mechanics, smile and facial aesthetics, and retention protocols.

RESULTS

Two hundred and eight responses were obtained with 95.6% (n = 199) reporting reduced extraction prescription over the last 5-10 years. Overall, 29.9% and 35.5% felt that their threshold for extractions had increased by more than 2 mm in adolescents and adults, respectively. Facial (n = 145; 69.7%) and smile (n = 127; 61.1%) aesthetics, and increased use of inter-proximal reduction (n =  102; 49%) were the factors most frequently reported as having either a moderate or major influence on this trend. Based on ordinal logistical regression analyses, no significant relationship was found between threshold for extractions and work setting (P =  0.675; O.R. 0.51; 95% CI: 0.39, 1.85) or level of orthodontic experience (P =  0.15; O.R. 1.02; 95% CI: 0.15, 1.05), although a higher threshold for extractions was more likely among users of conventional than self-ligating brackets (P =  0.001; O.R. 4.74; 95% CI: 1.95, 11.5).

CONCLUSIONS

A reduced tendency to prescribe orthodontic extractions over the past 5-10 years among British Orthodontic Society members was identified. Comparative clinical research exploring the relative merits of extraction and non-extraction approaches could be timely.

Potential risks of orthodontic therapy: a critical review and conceptual framework

This review examines some of the potential risks of orthodontic therapy along with their evidence base. The risks of orthodontic treatment include periodontal damage, pain, root resorption, tooth devitalization, temporomandibular disorder, caries, speech problems and enamel damage. These risks can be understood to arise from a synergy between treatment and patient factors. In general terms, treatment factors that can influence risk include appliance type, force vectors and duration of treatment whilst relevant patient factors are both biological and behavioural. Hence, the natural variation between orthodontic treatment plans and patients gives rise to variations in risk. A good understanding of these risks is required for clinicians to obtain informed consent before starting treatment as well as to reduce the potential for harm during treatment. After considering each of these risks, a conceptual framework is presented to help clinicians better understand how orthodontic risks arise and may therefore be mitigated.

Comparison of 4 and 6 weeks of rest period for repair of root resorption

Background

The study was designed to evaluate and compare the rest periods of 4 and 6 weeks for healing of orthodontically induced root resorption craters.

Methods

The study was conducted with a split-mouth design, with the right and left mandibular first premolars of 14 subjects serving as the two groups of the study. The right premolars constituted group A and the left ones, group B. Intrusive force was applied on these teeth for a period of 6 weeks, followed by retaining the teeth for 4 weeks (group A) and 6 weeks (group B) as rest periods before extraction. The extracted teeth were prepared for histologic examination with haematoxylin and eosin staining and studied under a light microscope. The histological sections were scored based on the level of repair (none, partial, functional, or anatomic) seen in the deepest craters in the apical third region of the roots. The mean values of the scores in the two groups were compared using Mann-Whitney U test.

Results

All the teeth showed healing in their deepest craters. The teeth in group A showed partial repair more frequently (84.6%), with the remaining (15.4%) showing functional repair. The teeth in group B showed anatomic repair more frequently (60%), with the remaining (40%) showing functional repair. The mean level of repair was higher in group B (2.6 ± 0.5) as opposed to that in group A (1.15 ± 0.37). The difference between these values was of very high significance (P < 0.05).

Conclusions

Longer rest period of 6 weeks showed more advanced healing than a shorter rest period of 4 weeks. Six weeks of rest period is adequate only for the functional repair of resorption craters.

Attitudes of orthodontists and laypersons towards tooth extractions and additional anchorage devices

Background

This study investigated the attitudes of orthodontists and laypersons towards the choice of extracting second premolars, rather than first premolars, based on tooth condition and the use of additional anchorage devices.

Methods

Questionnaires were sent to two groups: 324 orthodontists who were members of the Thai Association of Orthodontists, and 100 randomly selected Thai laypersons aged above 20 years and who were unrelated to the field of dentistry. Descriptive and chi-square statistics were used to analyze the data.

Results

Questionnaires were returned by 142 orthodontists (43.8%) and completed by 100 laypersons. The larger the size of the caries lesion in the maxillary second premolar was found, the more orthodontists and laypersons both chose to extract a carious maxillary second premolar instead of a healthy maxillary first premolar. For orthodontists, the use of mini-implant anchorage was significantly related to their extraction decision. Orthodontists who were familiar with mini-implants usage would choose to extract the second premolar at a lower size of extent of caries. Besides, when larger sizes of caries lesions in maxillary second premolars were considered, laypersons tended to have greater acceptance of the use of additional anchorage devices in order to keep the healthy maxillary first premolar.

Conclusions

In this study, tooth condition and the use of anchorage devices are currently the main considerations by both orthodontists and laypersons when selecting the teeth to be extracted for orthodontic treatment.

Changes in occlusal function after extraction of premolars: 2-year follow-up

OBJECTIVE

To determine the effects of extraction and the number of teeth extracted on changes in occlusal function by measuring occlusal contact area and force before and after orthodontic treatment with a fixed appliance.

MATERIALS AND METHODS

Female patients treated with a fixed appliance were divided into nonextraction (n = 36), two maxillary premolar extraction (n = 31), and four premolar extraction (n = 18) groups. Bite pressure-sensitive films were used to analyze the occlusal contact area and force. Measurements were performed before treatment (Pre-Tx), immediately afterward (After-Tx), and 2 years later (2Y After-Tx). The data were analyzed using a linear mixed model and the post hoc Bonferroni test.

RESULTS

The occlusal contact area and force after treatment decreased significantly compared with Pre-Tx values but were increased 2 years later in all groups. There were no significant differences in occlusal contact area or force during the entire observation period among the three groups (P > .05). The occlusal contact area and force in the nonextraction and two maxillary premolar extraction groups recovered to Pre-Tx levels 2 years later (P > .05). The occlusal contact area in the four premolar extraction group was significantly lower than the Pre-Tx level after 2 years of retention (P < .05).

CONCLUSIONS

The occlusal contact area and force showed a tendency to decrease immediately after treatment and then gradually increase to pretreatment levels during the observation period. However, the occlusal contact area did not recover fully after 2 years in the four premolar extraction group.

Extraction frequencies at a university orthodontic clinic in the 21st century: Demographic and diagnostic factors affecting the likelihood of extraction

INTRODUCTION

The aims of this study were to report contemporary orthodontic extraction frequencies at a university center and to investigate what patient-related factors might influence the likelihood of extraction.

METHODS

The records of 2184 consecutive patients treated at the University of North Carolina from 2000 to 2011 were analyzed. Year-by-year rates for overall orthodontic extractions and for extraction of 4 first premolars were calculated. Logistic regression, adjusting for all recorded patient risk factors for extraction, was used to examine both the changes in extraction frequencies over time and the influence of individual patient factors on the odds of extraction.

RESULTS

Small linear decreases in orthodontic extraction frequency overall (OR, 0.91; 95% CI, 0.88-0.95) and in extraction of 4 first premolars (OR, 0.95; 95% CI, 0.90-0.99) were seen. The overall extraction rate was 37.4% in 2000, and it fell just below 25% from 2006 onward. Four first premolar extraction rates ranged from 8.9% to 16.5%. Extractions were significantly more likely as crowding and overjet increased (OR, 1.2; 95% CI, 1.14-1.25; OR, 1.1; 95% CI. 1.07-1.19), as overbite decreased (OR, 0.8; 95% CI, 0.77-0.89), with Class II dental or skeletal relationships (OR, 1.5; 95% CI, 1.12- 2.05; OR, 1.4; 95% CI, 1.04-1.85), and for nonwhite patients (OR, 3.0; 95% CI, 2.2-4.06 for other races; OR, 4.1; 95% CI, 3.03-5.66 for African Americans).

CONCLUSIONS

Extractions were just as likely to be associated with Class II dental and skeletal problems and with open-bite problems as with crowding alone.

[Comprehensive assessment of atypical-extraction orthodontic treatment]

OBJECTIVE

To discuss through retrospective study associated factors influencing orthodontists to develop orthodontic treatment plans and to calculate constituent ratio of a typical extraction in orthodontic treatment.

METHODS

Systematic sampling was performed among 7 344 orthodontic patients, who received orthodontic treatment from April 2012 to March 2014 in the Department of Orthodontics, West China Hospital of Stomatology, Sichuan University. The study included statistical data on factors that may influence development of treatment plans. Samples were used to calculate extraction-ratio and atypical-extraction-ratio. Research focused on associated factors influencing development of treatment plans while evaluating correlation significances of each factor. Finally, treatment outcomes of atypical-extraction were compared with those of typical-extraction.

RESULTS

Among studied patients, 55.31% (406/734) received orthodontic extraction treatment. In orthodontic-extraction-treated patients, typical-extraction accounted for 59.11% (240/406), orthodontists-selected atypical-extraction accounted for 23.15% (94/406), and passive atypical-extraction accounted for 17.73% (72/406). With statistical analysis, we inferred associated factors influencing development of treatment plans as follows: sex and age of patients, sex of orthodontists, accurate condition of specific teeth, Angle's classification, and degree of midline deviation. Tooth loss before treatment also directly influences passive atypical-extraction. Statistically significant factors were not obtained. Significant difference of treatment outcome was not observed between atypical-extraction and typical-extraction-orthodontic treatment (P>0.05).

CONCLUSIONS

Above mentioned factors may influence orthodontists to develop treatment plans. However, orthodontists should also consider expected results of treatment strategies to prepare individual treatment plans on the basis of comprehensive analysis. 
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[Effect of dental arch length decrease during orthodontic treatment in the upper airway development. A review]

INTRODUCTION

A possible relation between an upper airway space decrease and the development of obstructive sleep apnea syndrom explains the importance to know the effect of the modification of dental arch length on the upper airway during orthodontic treatment.

OBJECTIVES

The aim of this article is to expose recent knowledge about upper airway development and dental arch length decrease factors, to determine the influence of this decrease on upper airway development.

METHODS

A review was done to determine the upper airway normal development, to define dental arch to specify if an ideal position of dental arch on apical base exists. All of the length dental arch decrease factors during orthodontic treatment (dental extraction, dental agenesis and dental malpositions) and their upper airway resounding were searched.

RESULTS

Some authors found a diminution of upper airway space after premolars extractions while others didn't found this diminution after extractions premolars when incisor retraction is finished. A decrease of transversal maxillary diameter and nasal cavity may be due to absence of permanent teeth.

CONCLUSION

The effect of dental arch length decrease during orthodontic treatment in the upper airway development was not scientifically proved. However we had to be vigilant and adapt our orthodontic treatment case by case to avoid an upper airway modification.

Efficiency of Class II subdivision malocclusion treatment with 3 and 4 premolar extractions

INTRODUCTION

In this study, we compared the efficiency of Class II subdivision malocclusion treatment with symmetric and asymmetric extractions.

METHODS

A sample of 71 patients with complete Class II subdivision malocclusion was selected: group 1 consisted of 40 patients treated with 4 premolar extractions with an initial mean age of 13.37 years, and group 2 had 31 patients treated with 3 premolar extractions (2 maxillary premolars and 1 mandibular premolar on the Class I side) with an initial mean age of 14.44 years. To compare the efficiency of each treatment protocol, the initial and final occlusal results were evaluated on dental casts with the Peer Assessment Rating occlusal index, and time spent in treatment was calculated from the clinical charts. The amounts of initial and final midline deviation and improvement of midline deviation correction were also evaluated. Efficiency was calculated as the rate between occlusal improvement by the treatment time. The groups were compared with t and Mann-Whitney tests.

RESULTS

The results showed that group 2 had a significantly smaller final amount of midline deviation and a greater correction of midline deviation.

CONCLUSIONS

Treatment efficiency of type 1 Class II subdivision malocclusions with 3 or 4 premolar extractions is similar. However, treatment with 3 premolar extractions provides a better occlusal success rate.

Outcome of premolar extractions on Bolton's overall ratio and tooth size discrepancies in South India

AIMS AND OBJECTIVES

Attainment of ideal occlusion is often restricted by disproportionate sizes of individual teeth, which is otherwise termed as tooth size discrepancy (TSD). While extraction of teeth for orthodontic purposes is not uncommon, there is considerable resistance against this school of thought. The extraction of premolars, in particular, received considerable attention because of the potential TSD that could result following the extraction of premolars. The aim of the present study was to identify the consequence of premolar extractions on Bolton's overall ratios in South Indian population.

MATERIALS AND METHODS

One hundred participants were recruited into the study through purposive nonproportionate quota sampling. Pretreatment dental casts of the study participants were measured for mesiodistal tooth widths to determine Bolton's overall ratio before the hypothetical tooth extractions were performed. The hypothetical extractions were executed in four different combinations as follows: (a) Maxillary and mandibular first premolars, (b) maxillary first premolars and mandibular second premolars, (c) maxillary second premolars and mandibular first premolars, and (d) maxillary and mandibular second premolars. Bolton's overall ratios were calculated after the hypothetical tooth extractions were performed. Statistical analysis was done using the Statistical Package for the Social Sciences, version 20 software.

RESULTS

It was observed that extractions performed in any of the combinations followed in this study resulted in a decrease of overall Bolton's ratios. However, the discrepancy in tooth size was highest with the extraction of all first premolars, whereas least discrepancy was recorded with all second premolars extraction. It was also found that, based on the combination of teeth chosen for extraction, there was significant difference in Bolton's overall ratios between males and females.

CONCLUSION

In formulating a treatment plan involving premolar extraction, significant tooth size discrepancies could change mutually after extraction.

Extraction protocols for orthodontic treatment: A retrospective study

BACKGROUND AND OBJECTIVES

Various extraction protocols have been followed for successful orthodontic treatment. The purpose of this study was to evaluate the extraction protocols in patients who had previously undergone orthodontic treatment and also who had reported for continuing orthodontic treatment from other clinics.

MATERIALS AND METHODS

One hundred thirty eight patients who registered for orthodontic treatment at the Faculty of Dentistry were divided into 10 extraction protocols based on the Orthodontic treatment protocol given by Janson et al. and were evaluated for statistical significance.

RESULTS

The descriptive statistics of the study revealed a total of 40 (29%) patients in protocol 1, 43 (31.2%) in protocol 2, 18 (13%) in protocol 3, 16 (11.6%) in protocol 5, and 12 (8.7%) in Type 3 category of protocol 9. The Type 3 category in protocol 9 was statistically significant compared to other studies. Midline shift and collapse of the arch form were noticed in these individuals.

CONCLUSION

Extraction of permanent teeth such as canine and lateral incisors without rational reasons could have devastating consequences on the entire occlusion. The percentage of cases wherein extraction of permanent teeth in the crowded region was adopted as a treatment option instead of orthodontic treatment is still prevalent in dental practice. The shortage of orthodontists in Malaysia, the long waiting period, and lack of subjective need for orthodontic treatment at an earlier age group were the reasons for the patient's to choose extraction of the mal-aligned teeth such as the maxillary canine or maxillary lateral incisors.

Frequency of orthodontic extraction

INTRODUCTION

The option of dental extraction for orthodontic purposes has been debated for more than 100 years, including periods when it was widely used in treatment, including the present, during which other methods are used to avoid dental extractions. The objective was to analyze the frequency of tooth extraction treatment performed between 1980 and 2011 at the Orthodontic Clinic of Universidade Estadual do Rio de Janeiro (UERJ).

MATERIAL AND METHODS

The clinical records of 1484 patients undergoing orthodontic treatment were evaluated. The frequency of extractions was evaluated with regard to sex, Angle's classification, the different combinations of extractions and the period when orthodontic treatment began. Chi-square test was used to determine correlations between variables, while the chi-square test for trends was used to assess the frequency of extractions over the years.

RESULTS

There was a reduction of approximately 20% in the frequency of cases treated with tooth extraction over the last 32 years. The most frequently extracted teeth were first premolars. Patients with Class I malocclusion showed fewer extractions, while Class II patients underwent a higher number of extraction treatment. There were no statistically significant differences with regard to sex.

CONCLUSION

New features introduced into the orthodontic clinic and new esthetic concepts contributed to reducing the number of cases treated with dental extractions. However, dental extractions for orthodontic purposes are still well indicated in certain cases.

Stability of class II subdivision malocclusion treatment with 3 and 4 premolar extractions

BACKGROUND

The purpose of this study was to compare the occlusal stability of class II subdivision malocclusion treatment with 3 and 4 first premolar extractions. A sample of 156 dental casts from 52 patients with class II subdivision malocclusion was divided into two groups according to the extraction protocol. Group 1 comprised 24 patients treated with 3 premolar extractions and group 2 included 28 patients treated with 4 premolar extractions.

METHODS

Peer assessment rating (PAR) indexes were measured on the dental casts obtained before (T1) and after treatment (T2) and at a mean of 6.9 years after the end of treatment (T3). The groups were matching regarding sex distribution, pretreatment, posttreatment and long-term posttreatment ages, and treatment and long-term posttreatment times. They were also comparable concerning the initial malocclusion severity and the occlusal results at the end of treatment. Stability evaluation was calculated by subtracting the posttreatment from the long-term posttreatment index values (T3 - T2). T tests were used to compare the amount and percentage of long-term posttreatment changes.

RESULTS

There were no intergroup differences regarding the amount and percentage of long-term posttreatment changes.

CONCLUSION

Treatment of class II subdivision malocclusion with 3 and 4 premolar extractions have a similar long-term posttreatment occlusal stability.