SEARCH · PubMed Health
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
This case report describes the retreatment of a patient with a Class II Division 1 malocclusion; she had the same anteroposterior discrepancy after undergoing fixed appliance treatment with extraction of 4 first premolars.
In establishing the indication for extraction therapy, careful consideration should be given to the unharmonious relationship of the jaw and teeth, the apical bone, the anlage of the wisdom teeth and hypodontia. Beginning with the narrow, contracted dental arch, where extractions are indicated most frequently, the different groups of anomalies are discussed. The most important rules and the optimal time are dealt with at the end of the present review article.
Oral habits should be of primary clinical concern to orthodontists because they may cause malocclusion, and/or interfere with treatment progress. Generally habit control should be achieved prior to correction of the malocclusion in an effort to remove any etiological factors in development and maintenance of the malocclusion. It is also important for the clinician to understand that habit-breaking treatment may require an extended treatment time because habits may have been present for long periods of time and may be related to underlying psychological problems. The present report documents the treatment of maxillary protrusion in a patient in which a thumb-sucking habit had persisted from infancy until almost age 12. Elimination of the habit was accomplished prior to correcting the malocclusion and for stability of the result. Orthodontic treatment consisted of extracting two maxillary premolars followed by full treatment with fixed appliances. Long-term postretention records show good stability of the corrected malocclusion.
The present study was undertaken to examine the long-term periodontal status of teeth orthodontically moved into extraction sites. Patients were examined 14 to 34 years after active orthodontic treatment involving extraction of four first premolars. Three groups were established: one with closed tooth contacts and parallel adjacent teeth, one with closed tooth contacts and tipped adjacent teeth, and one with open contacts between adjacent teeth. Within each group accumulation of plaque, gingival health status, probing pocket depth, and probing attachment level of interproximal tooth surfaces, facing extraction sites and adjacent control sites between canine and lateral incisor were compared. Significantly more probing attachment loss was found in extraction sites with open tooth contacts (P less than 0.01) and with parallel adjacent teeth and closed tooth contacts (P less than 0.05) than in control sites. However, the mean differences were less than 0.5 mm, which may not be considered clinically significant. Tipping of teeth into the extraction sites had no long-term detrimental effect on the probing attachment level. No differences in accumulation of plaque and in gingival health status were observed.
The purpose of this investigation was to analyse the long-term effects of activator treatment on the dental arches and arch relationships, the dento-facial skeleton and the function of the masticatory system. A follow-up study was performed on 112 patients treated 10-20 years previously with activators as the sole orthodontic appliance. In connection with activator treatment extractions of permanent teeth were performed on 66 patients while 46 patients were treated without tooth extractions. The investigation consisted of four separate portions (Parts I-IV).
Undergraduate students (n = 451) at a Finnish university were studied. For analysis, the subjects were divided into two birth cohorts: those born before 1955, and those born in that year or later. Information about previous orthodontic appliance therapy was obtained from the students by using a structured questionnaire. Missing permanent teeth (second and third molars excluded) were recorded at a dental examination. Every 10th student had received orthodontic treatment; the proportion of orthodontically treated subjects was higher for females (14%) than for males (5%). Seven percent of students born in 1954 or earlier and 15% of the younger students had had orthodontic treatment before 1977. In 39% of subjects, at least one permanent tooth was missing while only 12% had lost more than two permanent teeth. The tooth missing most often was the permanent mandibular first molar (in 23% of subjects). Frequency of tooth loss was the same in males and females. At least one permanent tooth was missing in 48% of the older and in 31% of the younger students. At least one first molar had been lost by 36% of the older students and 20% of the younger ones. Fewer first molars but more permanent teeth anterior to the first molars were missing in subjects who had had orthodontic treatment than in subjects who had not had such treatment. Among Finnish students the frequency of extraction of permanent teeth because of caries is decreasing, and the frequency of orthodontic treatment is increasing. Females are more likely to seek orthodontic treatment than males are.
Orthodontic extraction frequency describes the percentage of an orthodontic patient population experiencing extractions of one or more permanent teeth, excluding third molars. It is a useful statistical measure of the many variables associated with the extraction-nonextraction decision. For a study sample of 537 North American white orthodontic patients, the frequency of tooth extraction was determined as 42.1 percent. This is compared with a range of 6.5 percent to 83.5 percent reported in the world dental literature. Factors responsible for the enormous differences in orthodontic extraction frequency are explored. The study of extraction frequency offers a simple, valuable aid for the clinician to understand better the nature of his patient population, his treatment methods, and his rationalizations.
The purpose of this follow-up prospective longitudinal study was to determine what changes occurred in the condyle/fossa relationship after treatment. Orthodontic posttreatment records, including corrected tomograms of 106 white patients (58 Class I and 48 Class II Division 1), from a pretreatment sample of 232 patients, were analyzed. The average pretreatment age was 13.6 +/- 3.0 years. The average length of treatment was 2.3 +/- 0.6 years for the Class I group and 2.8 +/- 0.9 years for the Class II Division 1 group. With orthodontic treatment, the condyle became more concentrically positioned, and a significant (P <.05) decrease in left and right anterior, posterior, and superior joint spaces was observed in most subjects. There was no statistically significant correlation between changes in the condyle/fossa relationship based on age, gender, skeletal or dental variables, signs or symptoms of temporomandibular disorder, headgear use, type of elastics, or nonextraction vs extraction treatment.
The long-term effects of extraction and nonextraction edgewise treatments were compared in 63 patients with Class II, Division 1 malocclusions who were identified by discriminant analysis as being equally susceptible to the two strategies. A lateral cephalogram, study models, and a self-evaluation of the esthetic impact of treatment were obtained from each of the 33 extraction and 30 nonextraction subjects. The average posttreatment interval was 14.5 years. Although the two strategies produced significant, long-lived differences in the convexity of the profile and the protrusion of the dentition (the nonextraction patients were about 2 mm "fuller"), half of the nonextraction patients and three fourths of the extraction patients ultimately presented with less than 3.5 mm of lower incisor irregularity. The two groups showed an essentially identical pattern of posttreatment relapse/settling that was related more to the differential growth of the jaws than to the posttreatment position and orientation of the denture. Because in the end the various tooth movements tended to cancel one another, excess mandibular growth was also the most important net contributor to the molar and overjet corrections. In the process, both groups showed a marked forward displacement of the mandible, both at the chin and at the condyle. Finally, although it is probable that most of the present sample would today be treated by expansion, the 30 patients who actually received this presumably correct treatment rated their appearance no more highly than did the extraction subjects.(ABSTRACT TRUNCATED AT 250 WORDS)
The effects of a passive lingual arch on lower incisor and molar positions after extraction of first bicuspids are analyzed. Results indicate that a lingual arch can be effective in maintaining arch length, while still allowing normal changes in incisor, cuspid and second bicuspid positions.
Orthodontists have traditionally viewed structural discrepancies as the major limitation of treatment. In reality, it is the soft tissues that more closely determine therapeutic modifiability. The boundaries of dental compensation for an underlying jaw discrepancy are established by pressures exerted on the teeth by the lips, cheeks, and tongue; limitations of the periodontal attachment; neuromuscular influences on mandibular position; and the contours of the soft tissue facial mask. The ability of the soft tissues to adapt to changes in tooth-jaw relationships are far narrower than the anatomic limits in correcting occlusal relationships. The tolerances for soft tissue adaptation from equilibrium, periodontal, and facial balance standpoints are in the range of 2 to 3 mm for expansion of the mandibular arch and even less for changes in condylar position. Thus, analysis of the soft tissues is the critical step in orthodontic decision making, and this can only be accomplished through physical examination of the patient. Although quantitative measurements cannot be rigorously applied, guidelines for soft tissue assessment, with particular emphasis on facial esthetics, are proposed. From this perspective, a contemporary philosophy of orthodontic practice is offered, with general indications and contraindications for nonextraction, extraction, and surgical treatment.
Temporomandibular joint sounds are often recognized as a clinical sign of temporomandibular disorders. The purpose of this study was to examine changes in the occurrence and resolution of these sounds in patients before and after orthodontic treatment with full fixed appliances. From a pool of 324 patients who came to a university postgraduate orthodontic clinic specifically for treatment of a malocclusion, 160 were examined before and after orthodontic treatment. When joint sounds were either reported or detected clinically, the patients underwent an audiovisual examination to more precisely and objectively record the occurrence and timing of the sound during mandibular opening and closing. No statistically significant difference could be found in the change in occurrence of joint sounds among patients treated with extraction and nonextraction treatment strategies. Overall, fewer patients had joint sounds at the end of the active stage of orthodontic treatment than before treatment. Also, fewer patients demonstrated reciprocal clicking after treatment than before treatment. Therefore it appeared that orthodontic treatment did not pose an increased risk for developing temporomandibular joint sounds irrespective of whether extraction or nonextraction treatment strategies were used. A progression of signs or symptoms to more serious problems was not apparent over the time period studied.
The prevalence of signs and symptoms attributed to craniomandibular disorders (CMD) was established in an orthodontically treated sample. The effect of orthodontic therapy upon this prevalence was studied by monitoring three groups of patients whose treatment procedures were different. The first group was treated with functional appliances, the second with Begg light wire, and the third with chin cups. In addition, the effect of extraction upon the prevalence was studied by monitoring three groups in which different extraction decisions had been made: four first premolars extracted, all other types of extraction, and no extraction. Based upon the finding of similar prevalences after 20 years of observation, it appears that neither orthodontic treatment nor extraction has a causal relationship with the signs and symptoms of CMD recorded during this study.
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.
This investigation was designed to compare the esthetic effects of extraction and nonextraction treatments. Panels of 58 laypersons and 42 dentists evaluated randomly presented pre- and posttreatment profiles of 70 extraction and 50 nonextraction Class I and II Caucasian patients. The samples were similar at the outset; however, at the end of treatment, the extraction patients' faces were, on average, 1.8 mm "flatter" than the faces of nonextraction subjects. The flatter faces were preferred by both panels, dentists more so than laypersons. In general, nonextraction treatment was seen as having little effect on the profile, whereas the perceived effect of extraction treatment was a statistically significant function of initial soft tissue protrusion-the greater the initial protrusion, the greater the benefit. The point at which a reduction in protrusion produces a perceived improvement was explored by way of regression analysis. Both panels saw extraction as being potentially beneficial when the lips were more protrusive than 2 to 3 mm behind Ricketts' E-plane. It is concluded that extraction treatment can produce improved facial esthetics for many patients who present with some combination of crowding and protrusion.
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.
Orthodontic treatment for patients with congenitally missing mandibular second premolars can be challenging. Treatment options include keeping the deciduous second molar, extracting the molars and allowing the space to close spontaneously, autotransplantation, prosthetic replacement, and orthodontic space closure. Space closure with orthodontic appliances is demonstrated in this case report.
The purpose of this study was to assess the profile changes in subjects with Class II, Division 1 malocclusions who were treated either with or without the extraction of the four first premolars. The assessments were made by 39 lay persons. Profile silhouettes on 91 (44 extraction and 47 nonextraction) patients were evaluated at three stages: pretreatment, posttreatment, and approximately 2 years after treatment. Photographs matched for age and sex were also evaluated on 20 normal untreated subjects (10 males and 10 females). All rater assessments were analyzed statistically as to the effects of the following variables: (a) occlusion, i.e., normal or Class II, (b) treatment rendered, i.e., extraction or nonextraction, (c) gender, i.e., male or female, and (d) stage of observation, i.e., pretreatment, end of treatment or in retention. The current findings indicate that (1) before treatment, lay persons perceived the profile of normal patients more favorably than untreated patients with Class II, Division 1 malocclusions. (2) Immediately after treatment, raters perceived the changes in the profile of the extraction group more favorably than those in the nonextraction and normal groups. (3) At the end of the observation period (approximately 2 years posttreatment), raters did not evaluate the profile of any of the groups as being more favorable, but all groups were perceived more favorably than at the initial observation. (4) Raters perceived the profile changes with treatment more favorably in female subjects than in male subjects. In conclusion, orthodontic treatment seems to have a favorable effect on the profiles of both the extraction and nonextraction groups, both short- and long-term. Therefore, when based on proper diagnostic criteria, the posttreatment changes in the facial profile were perceived as favorable in both the extraction and nonextraction Class II, Division 1 groups when compared with the pretreatment profile.