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PubMed1992

The influence of extraction and nonextraction orthodontic treatment on brachyfacial and dolichofacial growth patterns.

The effects of extraction and nonextraction orthodontic treatment mechanics on patients with dolichofacial and brachyfacial growth patterns between one and two standard deviations were studied. Groups underwent treatment of either nonextraction or extraction of four premolars with the appropriate mechanics for the facial type. Changes in the facial axis and correlation between maxillary molar movement and facial axis change were measured. A positive correlation was found between the amount of anteroposterior movement of the upper molar and change in the facial axis in brachyfacial and dolichofacial patients undergoing nonextraction treatment. A weak correlation was found in the extraction treatment groups. No statistically significant difference was found in the facial axis change among any of the groups studied, regardless of facial type or plan of treatment. There were indications of a more severe opening of the facial axis (Ba-Na plane to constructed gnathion) with greater degrees of maxillary molar distal movement in both facial patterns studied.

Adolescent↗
PubMed1993

The effect of extraction of four second permanent molars on the incisor overbite.

Changes in incisor overbite were compared in 33 subjects who had four second molars extracted and 33 untreated subjects. There was an average increase in overbite of 0.7 mm in the extraction group, significantly different from an average decrease of -0.8 mm in the control group. The tendency to increase in overbite was greater in subjects whose presenting overbite was already reduced. The mechanism responsible for overbite reduction appeared to be a slight distal movement of the dentition, with retroclination of incisors and increase in inter-incisal angle.

Adolescent↗
PubMed1989

[A comparative study of cephalometric variation of the skeletal and dentoalveolar structures after treatment with the Begg, Ricketts and edgewise technic in cases of Class I and Class II malocclusions treated with and without extractions].

Eliminating, in a first step, the growth effect on the modifications of the skeletal and alveolo-dental structures thanks to the cephalometric analysis of cases not treated, we study the therapeutic control of skeletal Classes I and II (treated with or without extraction) successively in the BEGG, RICKETTS and EDGEWISE technics. For that, we analyse statistically the cephalometrics variations comparing the differents angles and measurements of the RICKETTS, TWEED and STEINER analyses before and after treatment. Thus, we evaluate the bi-dimensionnals, antero-posterior and vertical modifications that an take place during the treatment respectively in the three technics.

Alveolar Process↗
PubMed1984

Clinical application of prostaglandin E1 (PGE1) upon orthodontic tooth movement.

Chemically produced prostaglandin E1 (PGE1) was administered in clinical cases of orthodontic tooth movement. In the first phase, lingual arch springs were applied on both sides of the maxilla to upper first premolars which were scheduled for extraction. One side received submucosal injections of PGE1 and the other received vehicle injections. The rate of tooth movement in the buccal direction approximately doubled on the side of several PGE1 injections as compared to the control side. In the second phase, the PGE1 injections were applied in canine-retraction cases for up to 3 weeks in first-premolar-extraction cases. The rate of distal canine movement was almost double on the side receiving PGE1 injections as compared to the vehicle-injected side. In the third phase, the PGE1 injections were applied on routine canine retraction in first-premolar-extraction cases. The rate of distal canine movement was almost 1.6-fold on the side of PGE1 injections as compared to the vehicle-injected side. Throughout this study, no side effects were observed macroscopically in the gingiva and roentgenographically in the alveolar bone, except for a slight pain reaction consistent with orthodontic tooth movement.

Alprostadil↗
PubMed1991

A longitudinal study of the condition of first permanent molars in a group of adolescents with special reference to elective orthodontic tooth extraction.

The aim of this study was to investigate changes in the condition of first permanent molars over the teenage years, with special reference to adolescents who lost premolar teeth for orthodontic purposes. A total of 453 South Wales schoolchildren (219 males and 234 females) were examined at the ages of 11-12 and 19-20 years. At 11-12 years, 89.6 per cent of the cohort had all four first permanent molars, while 3.3 per cent had already lost these teeth. Of those first permanent molars present, 61.7 per cent had some caries experience. At age 19-20, 80.6 per cent of subjects retained four first permanent molars while 4.4 per cent had none. Of the first permanent molars present, 80.6 per cent had been affected by caries. In 60 per cent of the 186 subjects (75 males and 111 females) who had lost premolar teeth in the course of orthodontic treatment, a sound premolar was extracted in preference to a first permanent molar which already had evidence of dental disease. At age 19-20 years, the majority of the first permanent molars were restored and otherwise sound, though a small number which had been restored at age 11-12 years had been lost due to caries.

Adolescent↗
PubMed1989

[Impact of early extraction of the 1st molars on vertical dimension].

Early extractions of first permanent molars, done on twenty cases without any orthodontic treatment, have not shown, following the Student's analysis, any statistical difference relative to a pilot group as far as the angles. SN- ANS- PNS, SN-OP, SN-GoGn, FMA, Y-axis are concerned. On the other hand, it has been revealed a closure of the angle ANS- Xi- MP associated with an opening of the mandibular arch.

Cephalometry↗
PubMed1989

The closure of residual extraction spaces by means of traction screws: a report of two cases.

In those cases judged to be suitable for treatment by extractions in both arches and the use of upper removable appliances alone, the closure of excess residual space relies on mesial drift of the buccal segments. If opposing residual spaces are unequal in extent, there is a risk that space closure will be incomplete. Two cases are presented where a removable appliance was used to move a buccal segment mesially using a traction screw, and thereby close the excess residual space.

Adolescent↗
PubMed1987

Lower premolar extraction/removable plastic Herbst treatment for mandibular retrognathia.

The patient was a 12-year-old girl with a Class I malocclusion characterized by maxillary arch width constriction, dental crowding, and mandibular retrognathia. Treatment goals related to the chief compliant were anterior mandibular repositioning, maxillary arch expansion, and dental alignment. Because the preexisting overjet was minimal and prevented adequate anterior repositioning of the mandible, lower first premolar extraction was recommended to increase the overjet and allow greater anterior repositioning. Treatment was divided into four stages: (1) extraction of mandibular first premolar teeth, alignment, space closure, and an increase in the overjet, (2) anterior mandibular repositioning with a removable plastic Herbst appliance, (3) arch alignment and detailing of the occlusion with full fixed appliances and a tooth positioner, and (4) retainers. At the end of treatment, the patient had an acceptable dental alignment with a Class III molar relationship and an improvement in facial appearance.

Activator Appliances↗
PubMed1992

The duration of orthodontic treatment.

Characteristics of the patient, the treatment plan, and the practitioner's office were examined to evaluate causes for variation in the duration of orthodontic treatment. From six offices 118 patients were evaluated. All patients were treated in a single phase with fixed appliances. Appliances were worn for an average of 23.1 months. The mean duration for offices ranged from 19.4 to 27.9 months. Thirty-eight percent of the patients had extractions, and 32% wore headgear. Fifty percent of the variation in treatment duration among patients was explained by a five-step multiple regression equation. The variables entering this equation were (1) number of extracted premolars, (2) number of broken appointments, (3) pretreatment mandibular plane angle, (4) pretreatment ANB angle, and (5) pretreatment Salzmann Index. Observations within each office suggested that the time spent by individual clinicians in detailed finishing, which would not be detected by measures such as the Salzmann Index, was an important source of unexplained variation in treatment duration.

Adolescent↗
PubMed1996

The use of tensor analysis to investigate facial changes in treated class II division 1 malocclusions.

This retrospective cephalometric study examined the facial changes brought about by treatment in 62 Class II division 1 children, using tensor analysis. Thirty-two children were treated with Fränkel appliances, whilst the remaining thirty received premolar extractions, headgear, and conventional Edgewise mechanics. Each child was matched for age and sex with an untreated individual in whom the occlusion was deemed satisfactory and the treatment changes were compared with those expected during normal development. Results indicated that vertical facial development predominated in both treated groups: this exceeded the increase expected in an untreated population . The Fränkel group exhibited the greater gain in lower face height, with changes confined almost entirely to the mandible. Effective mandibular position improved but there was no increase in body length. The incisors were more favourably positioned within the face with similar improvements in the soft tissues. Thus, although facial balance was better following a non-extraction Fränkel approach, control of the vertical dimension was inadequate. The fixed appliance group exhibited a smaller increase in lower facial height and no favourable mandibular development: maxillary retraction was the most striking skeletal alteration. By removing the traditional, fixed, superimpositional framework of the cranial base, tensor analysis highlights vertical and mandibular changes not easily detected by conventional cephalometry.

Adolescent↗
PubMed1991

Mandibular growth and third molar impaction in extraction cases.

The position of mandibular third molars was studied in 60 patients from the pedodontic and orthodontic departments at the Federal University of Rio de Janeiro. All individuals received orthodontic treatment with an edgewise appliance following the extraction of first premolars. Examination of superimposed pretreatment and posttreatment cephalometric radiographs led to the observation that mandibular growth is directly related to the positioning of mandibular third molars. Third molar impactions were more likely to occur in cases with a predominance of vertical growth. The larger ascending ramus, the diminution in total length of the mandible and the larger mesial inclination of the crowns also seem to be indicative of third molar impaction.

Adolescent↗
PubMed2000

Non-extraction treatment of a thirteen-year-old boy with a Class III skeletal discrepancy and severe crowding in both the upper and lower dentitions.

A thirteen-year-old boy presented with a Class III skeletal tendency in association with severe crowding in both the upper and lower arches. Whilst there was not a frank posterior crossbite, it was felt that the upper arch was narrow and that the lower arch was similarly constricted. Taking this into account along with the fact that his upper lip was flat and the nasolabial angle obtuse, it was decided to pursue a non-extraction treatment, with the aim of providing by expansion an extra 16 mm of space in the upper arch and 8 mm in the lower arch to accommodate the full dentition, and with a view to extracting third molar teeth later. This proved to be successful, albeit over an extended period of time, with active treatment taking nearly three and a half years. A realistic alternative would have been to remove four bicuspid teeth and pursue an orthodontic/surgical approach to treatment. In retrospect, and with the benefit of reviewing his records without surgical intervention, the treatment plan decided upon has been well justified.

Adolescent↗
PubMed1998

Use of nickel titanium closed-coil springs to align unerupted teeth: a case report.

We describe a case in which a patient with a class II division I incisor relationship on a skeletal II base was transferred midway through a treatment that consisted of aligning the upper and lower arches with fixed appliance orthodontics in preparation for a mandibular advancement osteotomy. The lower second molars had previously been extracted; the lower third molars were left unerupted and some distance from the lower first molars. To provide a good occlusion at the end of treatment, it was decided to expose and approximate the lower third molars to the distal aspect of the lower first molars with the use of nickel titanium closed-coil springs; this was to be done before the osteotomy.

Adult↗
PubMed1993

Discriminant analysis: a model for the prediction of relapse in Class III children treated orthodontically by a non-extraction technique.

Discriminant analysis has been used to predict the long-term outcome of treatment in children with Class III malocclusions considered suitable for orthodontic correction by a non-extraction technique. Thirty-four children, whose treatment included the application of headgear to the mandibular dentition, formed the basis of this study. Records were examined at the start of treatment and at least 2 years out of all retention. For 25 of these patients, the treatment outcome was unambiguous and from these data a four-variable discriminant model was generated using a step-wise selection procedure, run under SPSS. This afforded 100 per cent correct prediction of the relapse status of all 25 children. The model provided realistic predictions for the remaining nine cases and for seven out of eight other children considered suitable for treatment without extractions, but by a variety of different techniques. The model was not suitable for the prediction of treatment outcome in children who required extractions: these represented a distinctly different sub-group of Class III individuals. Thus, using four measurements taken from the start of treatment records, the eventual outcome of orthodontic treatment can reliably be estimated, provided that the model is restricted to the sub-group of Class III children for whom it was designed. If the discriminant model predicts that this form of therapy will relapse, an alternative approach may be chosen.

Cephalometry↗
PubMed1996

Straight talk about extraction and nonextraction: a differential diagnostic decision.

At one stage or another, orthodontics is usually a space management procedure, particularly during the correction of a Class I or Class II malocclusion. Orthodontists use space that is available or create space to correct malocclusions. There are anterior, posterior, lateral, and vertical dimensions of the dentition and its supporting structures. If the muscular balance is normal, the clinician should try to respect these dimensions. The orthodontic clinician should not be an extractionist or a nonextractionist. Rather, the clinician should use differential diagnostic skills and artistic ability to arrive at the most appropriate treatment outcome for each patient.

Decision Making↗
PubMed2000

Treatment of a Class I bimaxillary protrusive malocclusion with a high mandibular plane angle: An American Board of Orthodontics case report.

A case report of the orthodontic treatment of a male adolescent with a Class I bimaxillary protrusive malocclusion, complicated by a vertical growth pattern and high mandibular plane angle. Treatment consisted of extraction of maxillary second premolars, mandibular first premolars, use of a transpalatal bar, occipital pull headgear, and light wire mechanics. An acceptable result was achieved, with a decrease in the facial axis, decrease in lip strain, and an attractive full smile. This case report was presented to the American Board of Orthodontics in partial fulfillment of the requirements for the certification process conducted by the Board.

Bicuspid↗
PubMed1985

Extraction of four second molars.

The cases presented here clearly demonstrate that the removal of second permanent molars can be effective in many cases where removal of first or second bicuspids would otherwise be recommended. Third molars can be useful components of the dentition. The Author has found that when the proper diagnosis is made and the extraction of second molars is recommended, third molars will assume their position in juxtaposition to the first permanent molar in over 75% of the cases. Although we used several methods of measuring developing mandibular third molars, we were unable to predict accurately and consistently which teeth would erupt in the proper upright position (Fig. 10). With rare exception, maxillary third molars will erupt uneventfully, but in the mandibular arch there is a much greater possibility that it may be necessary to upright or reposition the third molars.

Adolescent↗
PubMed1987

The criteria for lower second molar extraction.

The benefits of lower second molar extraction are substantially reduced if the third molar fails to erupt into a satisfactory position. The selection criteria offered by the literature have been tested in a sample of 51 patients. Prediction is uncertain and cases should be followed until such time as a satisfactory third molar position has been achieved. Failure may be unilateral and more often on the right side. The need for follow-up treatment is subjective but may be as many as one in five patients.

Adolescent↗