Abstract
BackgroundTo evaluate the relative influence of different criteria in the choice between extraction and nonextraction treatment in current orthodontics, and to assess how the percentage of extractions has evolved over time.Material and MethodsPre-treatment records (panoramic radiograph, lateral cephalogram, study casts and photographs) of fourteen cases in permanent dentition (adult or adolescent) with class I molar relationship and moderate anterior crowding were evaluated by 28 orthodontists. For each case, each orthodontist filled out a questionnaire reporting his treatment plan proposal (extraction or nonextraction) and the importance of specific parameters in his decision-making process, using categorical scales. Orthodontists practicing for more than 15 years were also asked to compare this decision with the one they would have taken at the beginning of their professional career.ResultsThe two most important factors in the decision-making were the soft tissue profile and the amount of crowding. The least important factor was the presence of third molars. In cases of nonextraction treatment, the lack of space was managed mostly by dental expansion and stripping. Twenty percent of the case evaluations revealed extraction(s) decisions. Among the orthodontists practicing for more than 15 years, the current extraction rate reached 24%, whereas the same orthodontists reported they would have extracted in 39% of the cases in the past.ConclusionsThe present study suggests that soft tissue profile has a higher impact than traditional criteria such as cephalometric measurements in the extraction decision. This is associated with a decreased extractions rate compared to the past. Key words:Orthodontics, extractions, survey, treatment planning.
Highlights
The discussion about extractions in orthodontics started in the early 1900s, when Angle argued in favor of nonextraction treatments: he believed that orthodontic forces would be associated with growth and achieving of alignment of the whole dentition [1]
When the 14 experienced orthodontists (>15 years of experience) were asked if they would have made the same decision at the beginning of their career, the percentage of extraction treatments increased to 39% at the start of their career, which was significantly higher than the percentage of extractions they would have recommended today (24%) (p
79 out of 392 decisions lead to extraction treatments, and our data find that more extractions would have been recommended by these same clinicians 15 years ago
Summary
The discussion about extractions in orthodontics started in the early 1900s, when Angle argued in favor of nonextraction treatments: he believed that orthodontic forces would be associated with growth and achieving of alignment of the whole dentition [1]. Tweed was eventually discouraged by the resulting protrusive faces and treatment relapse He decided to retreat some patients with extractions and concluded that carefully and consistent planned extractions allowed him to improve patient’s appearance as well as treatment stability [3]. Conclusions: The present study suggests that soft tissue profile has a higher impact than traditional criteria such as cephalometric measurements in the extraction decision. This is associated with a decreased extractions rate compared to the past
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