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From 1000 current orthodontic treatments, a percentage of 23.3 (233 patients) was selected for extraction therapy. The indication and the prognosis were analysed from various viewpoints to deduce suggestions for the application in practice. The advantages described and the possibilities of use meet the demands on efficient orthodontic therapy.
Increasing numbers of adult patients are seeking orthodontic care and some, despite significant skeletal malocclusions, elect not to have combined orthodontic-surgical treatment. The purpose of this article is to outline some of the diagnostic and therapeutic principles that can be used in the adult nonsurgical orthodontic patient. The importance of realistic goal setting in the face of compromised occlusions is emphasized. Diagnosis should include evaluation of all three dimensions and recognize the limitations of therapy in each dimension for the nongrowing patient. Periodontal considerations, extraction decisions, and retention regimens are of vital importance to the achievement and maintenance of an optimum result. Clinical records will demonstrate four commonly seen problems and their resolution.
In view of the growing consensus that traditional cephalometric analyses yield data of dubious scientific validity, this study was undertaken using an alternative technique, termed finite element analysis (FEA). The study was based on 14 triangular finite elements spanning seven datum (nodal) points delineating cephalometric form. These points were delineated on lateral cephalographs taken immediately before and following the completion of orthodontic treatment for two samples of boys aged 12-16 years. Although both samples exhibited Class I molar occlusions with anterior over-crowding, one sample required bilateral maxillary and mandibular first premolar extraction prior to orthodontic treatment, while the other sample did not. FEA revealed greater cephalometric size and shape changes in the 'non-extraction' than 'extraction' samples. Such sample contrasts, however, varied depending upon the finite element included in the analysis. Further studies are therefore required to delineate the specific finite element configurations to provide precise descriptions of cephalometric change.
Recent surveys of children have shown the use of general anaesthesia for extractions by GDPs has declined while its use in hospitals may actually have increased. Shaw and Weatherill argue the aim should be to reduce its use.
Timing of treatment is one of the main themes. The development of orthodontics in the United Kingdom is described against the background of a state-funded system. The scope and limitations of extraction therapy and removable appliance therapy are discussed. The principles of functional appliances are also described, as is the need for flexibility in appliance systems, to bring about maximum effect.
Absolute distal movement of upper first molars together with distal tipping, but no significant extrusion, occurred with cervical traction. Distal movement of the maxillary first molars was more stable in the group where maxillary 2nd molars had been extracted. With Andresen treatment a restraining effect took place on the upper molars, while mesial movement of the lower first molars contributed to correction of the molar relationship.
Successful treatment of the adult patient with an open bite dental or skeletal pattern often presents a difficult challenge. While the causes of open bite may be multifactorial in nature, there are specific diagnostic criteria that may allow for an orthodontic treatment modality incorporating extraction therapy with retraction of incisors. Two case presentations illustrate treatment of adult patients with open bites due to proclined incisors. The diagnostic criteria and mechanics for appropriate and successful treatment are discussed. Although the selection of extraction therapy for correction of anterior open bite has a narrow range of application in the overall scheme of open bite treatment, this treatment method has certain areas of application in which success may be anticipated.
A case report of a Class II, Division 1 malocclusion with a deep overbite and severe overjet. The case was treated with the extraction of four first premolars and differential force mechanics. No adjuncts such as functional appliances, headgear, or surgery, were used. [This case was presented to the American Board of Orthodontics in partial fulfillment of the requirement for the certification process conducted by the Board.]
Thirty-four children with lower premolar crowding were treated by extraction of second molars. Thirteen cases had mechanical lower arch treatment started not less than 6 months after extractions. The remainder had no treatment in the lower arch. The change in premolar crowding was measured, and the reasons why spontaneous alignment occurred in some cases and not in others were examined.
The patient was a 9-year-old girl with a skeletal Class II malocclusion characterized by maxillary protrusion, excessive overjet and deep overbite. The patient's maxillary left central incisor was deeply impacted. During the first stage, a lingual arch was employed after surgical exposure. During the secondary stage, all four first premolar teeth were extracted and then edgewise mechanotherapy was performed. The total treatment time was 6 years. The malocclusion was treated satisfactorily and resulted in correction of the esthetic and functional flaws after 1 year out of retention.
The effect of deciduous tooth extraction in the late mixed dentition on the eruption of succedaneous teeth was studied in ten Macaca nemestrina. Nineteen deciduous teeth were extracted: nine maxillary and ten mandibular left deciduous first molars. Regardless of sex, arch, chronologic or dental age, all first premolars on the experimental side erupted before those on the control side and this pattern was statistically significant. Extraction of deciduous molars in the late mixed dentition is seen to accelerate eruption of first premolars in Macaca nemestrina. This could be the result of eliminating the need for deciduous tooth root resorption during the normal process of eruption.
A four-unit symmetrical premolar extraction case demands meticulous levelling, overjet reduction, space closure, rotating, paralleling and torqueing to justify the gambit of having extracted the teeth at the commencement of treatment. This involves the patient in complex therapy which may, for any of several reasons, be contra-indicated for that particular patient, though a decision based on the plaster casts alone may have upheld such an approach. The purpose of this article is to discourage automatic decisions to extract first premolars in orthodontic extraction cases. The clinician is offered a classification of special cases in which an alternative should be sought, based on careful consideration of the general dental, facial, physical, psychological and economic state of the patient.
Contemporary orthodontic practice is diverse, both in the variety of clinical problems treated and in the methods used. Practices differ with respect to their patient composition as well as in many variables relative to treatment protocols. Such heterogeneity makes it difficult to make valid generalizations concerning the characteristics of orthodontic treatment procedures or outcomes; yet data and methods are required for assessment of issues of efficacy and utility. The frequency of orthodontic extractions is an objective criterion that distinguishes practices and may also be related to differences in treatment outcome variables, such as duration. Following a telephone survey to estimate extraction rates in the practices of 238 Michigan orthodontists, five practices with very high or low reported rates were chosen for this pilot study. Our primary aim was to determine whether a systematic relationship existed between the relative frequency of extraction treatments and the duration of active appliance therapy. Records of 438 patients from these practices were examined. The extraction rates of the practices ranged from a low of 25% to a high of 84%. Treatment duration was affected by several variables, such as the number of arches treated, the number of treatment phases, and the practice selected. When the data for all five practices were pooled, and all of the extraction versus nonextraction treatments were compared, the mean durations of treatment were 31.2 and 31.3 months, respectively. Data from individual practices, however, indicated that extraction treatment in each of the practices was of longer duration than nonextraction therapy. These differences in duration were 3.0, 6.6, 2.4, 3.0, and 7.3 months in the five practices.(ABSTRACT TRUNCATED AT 250 WORDS)
This paper describes normal and problem development in lower incisor positioning and offers options for management of crowded cases. The following guidelines were recommended, (1) lower incisor crowding of 2 mm or less and with an intercanine width greater than 28mm will usually resolve spontaneously, (2) lower incisor crowding of 3-4 mm is best managed by discing of the primary dentition, (3) crowding assessment of 5-9 mm requires extraction of primary teeth with probable placement of a supportive lingual arch and, (4) crowding greater than 10 mm requires fixed appliance therapy and careful orthodontic management with attention to the severity of the malocclusion.
Severe impaction of lower second molars often leads to their extraction to avoid potential damage to the first molar root. We present a case in which we used the clinical application of simple biomechanical principles to allow us to upright bilaterally impacted lower second molars into the desired location in a fairly short time.
The aim of this retrospective study was to evaluate the effectiveness of orthodontic treatment in terms of two outcome variables, namely, the percentage change in a valid and reliable occlusal index, the Peer Assessment Rating (PAR) score, and the duration of treatment. Data were collected from the records of 250 patients with Class II, Division 1 malocclusions who were treated in the Orthodontic Department of the University of Pittsburgh between 1977 and 1989. The relationships between the outcome and the treatment variables were analyzed with multiple regression techniques. Those variables significantly associated with the duration of treatment (p < 0.01) were (1) the pretreatment PAR score, (2) the number of treatment stages, (3) the percentage of appointments attended, (4) the number of appliance repairs, and (5) whether the patient was treated with or without extractions. The only variable that influenced the percentage change in PAR was the pretreatment PAR score (p < 0.01).
Orthodontists are often concerned about the prognosis of root-filled teeth, particularly when extractions are required for orthodontic treatment. This review provides guidance on assessing the quality of root fillings, as well as the factors which affect the prognosis of root-filled teeth. The implications of previous traumatic injuries and the likelihood of root resorption during orthodontic tooth movement are discussed.
We have all been into treatment and lost sight of the "plan" we were so familiar with at the treatment planning stage. Eighteen to 21 months into treatment, we are faced with extraction decisions or surgical planning that should have been addressed at 9 or 12 months. This case report illustrates a treatment plan with several variables that were dependent upon treatment responses. It also illustrates planning a gingival graft to increase the crown length of a first premolar after the canine was substituted as the lateral incisor.