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The esthetic impact of extraction and nonextraction treatments on Caucasian patients.

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.

Adolescent↗

Differential diagnosis and treatment planning for the adult nonsurgical orthodontic patient.

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.

Adolescent↗

Congenitally missing mandibular second premolar: treatment outcome with orthodontic space closure.

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.

Anodontia↗

Profile changes in patients treated with and without extractions: assessments by lay people.

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.

Adolescent↗

A retrospective cephalometric study of Class I patients.

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.

Adolescent↗

Time and tide.

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.

Activator Appliances↗

A cephalometric study to compare the effects of cervical traction and Andresen therapy in the treatment of class II division 1 malocclusion. Part 2--Dentoalveolar changes.

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.

Activator Appliances↗

Nonsurgical treatment of open bite in nongrowing patients.

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.

Adult↗

Reproducibility and use of low-concentration skin prick test.

We aimed to evaluate the reproducibility of the skin prick test performed with serial 1:4 dilutions of commercial standardized extracts in comparison with serum-specific IgE and the undiluted commercial extract. Twenty-four subjects sensitized to one (17 cases) or two (seven cases) inhalant allergens were selected and submitted to duplicate skin prick tests with concentrated commercial allergenic extracts or with serial 1:4 dilutions of the same extracts in two different examinations 7 days apart. Blood samples were obtained from 17 of the 24 patients for specific IgE determination. No statistically significant within-patient variations in the area of the wheal in skin prick tests done 1 week apart were found up to the eighth dilution (1:256) of the commercial allergen. On a patient-by-patient basis, only some dilutions showed a statistically significant correlation between allergen-specific IgE and the wheal area elicited by the same allergen, and a significant correlation was found between the wheal elicited by 10 mg/ml histamine and both the concentrated and diluted allergens (up to the sixth dilution). In polysensitized patients, the allergen producing the largest wheal when used in concentrated form did not produce the same result when diluted. The skin prick test with low-potency allergens was reproducible in individual patients even after a 7-day interval up to a 1:256 dilution of the commercial extract, although there was no clear correlation with allergen-specific IgE concentration. In polysensitized patients, the use of high-potency or low-potency allergens for skin prick tests can lead to different conclusions regarding the relative importance of each allergen.

Adolescent↗

Extraction of maxillary first bicuspids and mandibular lateral incisors, combined with orthognathic surgery to correct a severe class II skeletal malocclusion.

This is a case report of a 21-year-old female with a Class II Division 1 malocclusion. The maxillary arch was constricted with an associated anterior open bite. The lower facial height was excessive, and the mandibular plane angle was high. The treatment options were limited due to a previously extracted mandibular right lateral incisor. The patient was successfully treated by a surgical rapid palatal expansion procedure, extraction of the mandibular left lateral incisor, extraction of the maxillary first premolars at the time of a 3-piece Lefort 1 maxillary osteotomy procedure, and a bilateral sagittal split osteotomy advancement procedure.

Adult↗

Orthodontic treatment outcome in a First Nations population in Alberta, Canada: a comparative study.

The primary objective of this study was to determine whether there was a significant difference in the degree of improvement after orthodontic treatment between a sample of First Nations orthodontic patients and a control sample of non-First Nations orthodontic patients. The secondary objective was to determine whether there was a difference in the severity of malocclusions being treated in a sample of the First Nations patients compared with a control sample of the non-First Nations patients. Several factors that might affect treatment outcome, such as missed appointments, treatment duration, oral hygiene, extractions, dental classification, and geographic location, were also studied. A sample of 60 First Nations patients and a control group of 60 non-First Nations patients between the 11 and 18 years of age who had been treated with full fixed orthodontic appliances were evaluated. The weighted peer assessment rating (PAR) index was applied to pretreatment and posttreatment study models to address the study's main objectives. The results showed that the First Nations group had greater PAR scores pretreatment than did the controls, and their weighted PAR scores improved more with treatment. Posttreatment PAR scores were similar between the 2 groups. In addition to First Nations status, only extractions and geographic location affected PAR improvement scores.

Adolescent↗

An American Board of Orthodontics case report.

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.]

Bicuspid↗

Second molar extraction in the treatment of lower premolar crowding.

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.

Adolescent↗

The use of general anaesthesia for orthodontic extractions.

AIM: The aims of the study were to evaluate 1) the uptake of general anaesthesia 2) the dental factors influencing use of general anaesthesia for routine orthodontic extractions. RESEARCH DESIGN: Retrospective cross-sectional. PARTICIPANTS: All patients, aged 16 years and under (n=145), currently undergoing orthodontic treatment at the University Dental Hospital of Manchester, who had received extractions, for their current course of treatment. METHOD: Patients were asked to complete a questionnaire after appliance adjustment. MAIN OUTCOME MEASURES: 1) type of anaesthesia received for the most recent orthodontic extractions 2) whether a choice of anaesthesia was given 3) number of permanent teeth removed for the current course of orthodontic treatment 4) previous experience of general anaesthesia. RESULTS: The response was 87%. Twenty-two per cent of patients received general anaesthesia, 64% local anaesthesia and 14% inhalation sedation. Sixty-five per cent of patients were not given a choice of anaesthesia for extractions. Stepwise logistic regression analysis revealed that a patient was more likely to receive a general anaesthetic if: 1) they had received a GA in the past (for fillings or extractions) 2) more than four teeth were extracted. CONCLUSIONS: Local anaesthesia was predominantly used for orthodontic extractions although the use of general anaesthesia was still quite high. The majority of patients were not given a choice of anaesthesia for routine extractions. Previous exposure to general anaesthesia and removal of more than four teeth increased the likelihood of a patient receiving general anaesthesia.

Adolescent↗

A case of Class II malocclusion associated with a deeply impacted maxillary central incisor.

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.

Cephalometry↗

Orthodontic treatment of a patient with hypophosphatemic vitamin D-resistant rickets.

Hypophosphatemic vitamin D-resistant rickets, when developed later in life, is less severe and may not be characterized by rickets or other osseous deformities. A Japanese girl, age nine years and one month, was first seen in the Dental Hospital of Osaka University, complaining of the crowding of the maxillary teeth. At one year of age, the patient was admitted to Osaka University Hospital for her leg deformities. Although the patient has been administered 4 micrograms 1 alpha/-hydroxyvitamin D3 and 1.0 g phosphorous daily, the serum phosphate has been low and never reached normal level. This case was a Class II division 2 malocclusion with severe anterior crowding and retarded mandibular growth. We treated her with a functional appliance (elastic open activator), followed by the extraction of four premolars and the use of an edgewise appliance. No unfavorable root resorption or bone defect occurred. Good occlusion was achieved and the facial features were pleasing.

Bicuspid↗