Orthodontic space closure after first molar extraction without skeletal anchorage

Abstract

The aim of the study was an analysis of effects and side-effects during mesialization of second molars after extraction of the first permanent molars using the anterior dentition/premolars (PM) as an anchorage unit. A total of 35 patients were examined retrospectively who had undergone unilateral or bilateral first permanent molar extraction in the upper or lower arch due to carious lesions. Space closure was carried out in all cases through mesialization of the second molar using an elastic chain fixed to an edgewise stainless steel archwire and tying the anterior dentition/PM together with a continuous laceback ligature. Tooth movement was assessed from lateral cephalograms, orthopantomograms (OPGs) and images of the patient's study casts taken before and after the end of therapy. Space closure after first molar extractions by mesialization of the second molars without skeletal anchorage was largely achieved by bodily forward movement of the teeth, including a small tipping component or tooth-uprighting component when molars were already mesially inclined. Unilateral and bilateral mesialization of the second molars led to retrusion in the maxilla and mandible [(∆incl.=-3.6° (max., bil.), ∆incl.=-4.2° (mand., bil.)] and to translational retraction [(∆s=-2.3 mm (max., bil.), ∆s=-1.6 mm (mand., bil.)] of the incisors. Examination of the soft tissues revealed an increased posterior displacement of the upper and lower lips to the esthetic line [(∆s=-2.8 mm (max. bil.), ∆s=-2.2 mm (mand., bil.)]. In cases of unilateral mesialization less than 50% of the patients had a slight midline deviation in the mandible towards the extraction side. Side effects during mesialization of the second molars without skeletal anchorage in the anterior dentition/PM were observed primarily affecting the incisors integrated into the anterior anchorage unit. These side-effects resulted in posterior displacement of the soft tissues, including a change in profile. This must be taken into consideration when taking this therapeutic approach.