Extraction of peg-shaped lateral incisors

Abstract

Regarding the case report, “Treatment of a patient with Class II malocclusion, impacted maxillary canine with a dilacerated root, and peg-shaped lateral incisors” (Tausche E, Harzer W. Am J Orthod Dentofacial Orthop 2008;133:762-70), the authors comprehensively treated an interesting and challenging case of impacted canines and dilacerated roots. After reading the article carefully, we have several queries. The authors stated that the patient had a concave profile but mention no evidence of root resorption of the peg-shaped lateral incisors. The SNA and SNB angles were favorable for a nonextraction treatment plan. We all know that overall facial esthetics equally depend on hard- and soft-tissue distributions. Why did they opt to extract the peg-shaped laterals in this patient? Extraction treatment has deleterious effects, and avoiding restoration of the maxillary lateral incisors at the cost of the soft-tissue profile seems to be a drawback rather than a benefit, considering the patient's posttreatment profile. Upper lip thickness increases until 14 to 16 years of age and then becomes stable.1Subtelny J. A longitudinal study of soft tissue facial structures and their profile characteristics, defined in relation to underlying skeletal structures.Am J Orthod. 1959; 45: 481-507Abstract Full Text PDF Scopus (277) Google Scholar, 2Mamandras A. Growth of lips in two dimensions A serial cephalometric study.Am J Orthod. 1984; 86: 61-66Abstract Full Text PDF PubMed Scopus (21) Google Scholar On the other hand, soft-tissue evaluation after 18 years of age (postpubertal period) shows decreased lip thickness.3Sarnas K. Solow B. Early adult changes in the skeletal and soft tissue profiles.Eur J Orthod. 1980; 2: 1-12Crossref PubMed Scopus (117) Google Scholar This decrease can be explained by the loss of subcutaneous tissue or alterations in muscle tonus in the perioral area.4Ricketts R. Planning treatment on the basis of the facial pattern and an estimate of its growth.Angle Orthod. 1957; 27: 14-37Google Scholar The patient's treatment was finished at 16 years of age, but nose thickness continues to increase until 18 years with no sexual dimorphism,5Hoffelder E.B. Santayana de Lima E.M. Martinelli F.L. Bolognese A.M. Soft-tissue changes during facial growth in skeletal Class II individuals.Am J Orthod Dentofacial Orthop. 2007; 131: 490-495Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar so the esthetic implications concerning the size and shape of the nose are relevant to achieving an esthetic result. It might have been wiser to finish the patient with a more prominent profile. Although the finished occlusion is perfect, lip prominence and overall facial harmony evident in the posttreatment photographs are less than desirable, and the future aging process will further aggravate the situation. Author's responseAmerican Journal of Orthodontics and Dentofacial OrthopedicsVol. 134Issue 3PreviewWe thank Drs Sadia Naureen and Ayesha Anwar for their interest in our case report, “Treatment of a patient with Class II malocclusion, impacted maxillary canine with a dilacerated root, and peg-shaped lateral incisor” (Tausche E, Harzer W. Am J Orthod Dentofacial Orthop 2008;133:762-70). Full-Text PDF