Extraction Of Maxillary Second Molars Research Articles

Bilateral distalization of maxillary first molars in a group of adult patients after extraction of maxillary second molars using infra-zygomatic mini-implants: A prospective clinical trial

It is now possible to predictably distalize maxillary first molars in nongrowing patients with the infra-zygomatic gear distalizer and to improve malocclusions without having to extract the premolars and regardless of the patient's compliance. The purpose of this study was to investigate the amount and rate of distal movement of the maxillary first molars using our proposed appliance after extraction of maxillary second molars. Ten nongrowing female patients successfully treated with our proposed appliance were the subjects of this study. The amount, rate, and type of distalization, were analyzed through upper jaw cone beam computed tomography (pre- and post-treatment) and scanned casts taken on a monthly interval. The average amount of distalization of the maxillary first molars was 4.03 mm at the crown level and 2.88 mm at the root level. The rate of distalization had an average of 0.61 mm per month with a maximum of 0.79 mm in the first month because of the regional acceleratory phenomena after extracting the maxillary second molar. The maxillary first molars were distalized in a significant manner and all patients reached a Class I relation within an average duration of 6.4 months. The proposed appliance proved to be a viable noncompliance modality to distalize maxillary first molars correcting maxillary Class II malocclusions characterized by maxillary protrusion or maxillary incisor crowding.

Surgical-Orthodontic Treatment of Class III Malocclusion with Anterior Open Bite

A 21-year-old female came with chief complaints of inability to incise food and poor esthetics. The patient presented with a concave facial profile, long face with a steep mandibular angle, incompetent lip closure, and acute nasolabial angle. Intraorally, she had negative 6 mm overjet, 3 mm open bite and dental crowding. She was diagnosed as severe skeletal Class III malocclusion and anterior open bite. The treatment plan included orthodontic treatment with orthognathic surgery and extraction of maxillary second molars, which were supra-erupted and tipped buccally. The pre-operative orthodontic alignment took 11 months. The surgical correction included maxillary Le Fort I osteotomy with 4 mm advancement, mandibular intraoral vertical ramus osteotomy with 6.5 mm setback and genioplasty. The total surgical-orthodontic treatment time was 16 months. The final result presented a straight profile with stable occlusion. The patient’s facial and dental esthetics, masticatory function, and quality of life were all significantly improved after surgical-orthodontic treatment.

Low-level laser therapy prevents medication-related osteonecrosis of the jaw-like lesions via IL-1RA-mediated primary gingival wound healing

BackgroundMedication-related osteonecrosis of the jaw (MRONJ) is a serious debilitating disease caused by anti-resorption and anti-angiogenesis drugs, significantly affecting patients' quality of life. Recent studies suggested that primary gingival wound healing may effectively prevent the development of MRONJ. This study aimed to evaluate the effects of low-level light therapy (LLLT) on promoting gingival wound healing in extraction sockets of MRONJ-like mice and preventing the occurrence of MRONJ. Furthermore, we explored underlying mechanisms.MethodsMice were randomly divided into the Ctrl, Zol, and Zol + LLLT groups. Administration of zoledronate and tooth extraction of bilateral maxillary second molars were used to build the MRONJ model, and LLLT was locally administered into the tooth sockets to examine the effect of LLLT. Next, to explore the function of IL-1RA, we performed LLLT with interleukin-1 receptor antagonist (IL-1RA) neutralizing antibody (named Zol + LLLT + IL-1RA NAb group) or negative control antibodies for tooth extraction in subsequent rescue animal experiments. Stereoscope observations, micro-computed tomography, and histological examination were conducted to evaluate gingival wound healing and bone regeneration in tooth sockets. The effects of LLLT on the migration capacities of zoledronate-treated epithelial cells were assessed in vitro.ResultsLLLT promoted primary gingival wound healing without exposed necrotic bone. Micro-computed tomography results showed higher bone volume and mineral density of the tooth sockets after LLLT. Histology analysis showed complete gingival coverage, obvious bone regeneration, and reduced soft tissue inflammation, with down-regulated pro-inflammation cytokines, like interleukin-1 beta (IL-1β) and tumor necrosis factor-α (TNF-α), and up-regulated IL-1RA expression in the gingival tissue in the LLLT group. The rescue assay further showed that the effects of LLLT promoting gingival wound healing and preventing MRONJ might be partially abolished by IL-1RA neutralizing antibodies. In vitro studies demonstrated that LLLT accelerated zoledronate-treated epithelial cell migration.ConclusionsLLLT might promote primary gingival wound healing and contribute to subsequent bone regeneration of the tooth extractions in MRONJ-like lesions via IL-1RA-mediated pro-inflammation signaling suppression.

Molar extraction alters gastric mucosa and ghrelin expression in rat stomach: A preliminary study

Objectives: Ghrelin is a key regulator of food intake and is considered a hunger hormone that affects cognition, memory, glucose metabolism, and antidepressant effects. Altered occlusion, such as a loss of molars, has been thought to retard digestive function. However, the association between occlusion and digestive function remains poorly understood. Here, we aimed to explore the effect of bilateral maxillary molar extraction on the gastrointestinal mucosa of growing rats and the expression of ghrelin and its receptor, growth hormone secretagogue receptor (GHSR). Material and Methods: Twenty-four male 5-week-old Wistar rats were divided into control (CON) and experimental (EXP) groups (n = 12/group). The rats in the EXP group underwent extraction of the bilateral maxillary first, second, and third molars under general anesthesia. Rats in the CON group underwent a sham operation. All rats in both the CON and EXP groups were fed a powder diet and water ad libitum. The body weight of all rats was monitored throughout the EXP period. Rats in both the CON and EXP groups were euthanized on days 14 and 28, and the stomachs were isolated and subjected to histological analysis. Paraffin serial sections were prepared using a microtome for hematoxylin-eosin and immunohistochemical staining using anti-ghrelin and anti-GHSR antibodies. The distribution and expression of ghrelin-immunopositive and GHSR cells were detected and observed under a light microscope. Data were statistically analyzed using t-tests (P < 0.05). Results: There were no significant differences in body weight between the CON and EXP groups throughout the EXP period. Histological analysis showed that the area of the submucosa (ASM), and the number of ghrelinimmunopositive cells were significantly decreased in the EXP group compared with the CON group on day 14. Alternatively, there was no significant difference in the ASM and the number of ghrelin-immunopositive cells between the CON and EXP groups on day 28, whereas the number of ghrelin receptors showed no differences across groups. Furthermore, the number of eosinophilic blood cells significantly increased in the EXP group on days 14 and 28. Conclusion: Our findings suggest that bilateral maxillary molar extraction may trigger stomach mucosal changes and alter digestive function through ghrelin expression in rats. This is the first report that occlusal deficiency could alter ghrelin expression in the mucosa of the rat stomach, thus raising concerns about the consequential role of ghrelin.

Effect of carbonate apatite as a bone substitute on oral mucosal healing in a rat extraction socket: in vitro and in vivo analyses using carbonate apatite

BackgroundLow bone quantity and quality are serious problems that affect the prognosis of implants in the cosmetic field. Therefore, artificial bone substitutes are frequently used. However, whether there is a difference in the effect of either bone substitute on soft tissue healing is unclear given their greatly different absorbability. In this study, we used hydroxyapatite (HAp) and carbonate apatite (CO3Ap) as bone substitutes to analyze the epithelial and connective tissue healing after tooth extraction.MethodsIn vitro, oral mucosa-derived epithelial cells (OECs) collected from 4-day-old Wistar rats were seeded on HAp or CO3Ap and evaluated for adhesion, proliferation, migration, apoptosis, and morphology. Fibroblasts (FBs) were also analyzed for their ability to express collagen. In vivo, the extraction of maxillary right first (M1) and second molars (M2) of 6-week-old male Wistar rats was performed, followed by insertion of HAp or CO3Ap granules into the M1 and M2 sites. The oral mucosal healing process was then evaluated histochemically after 7 and 14 days.ResultsIn vitro, high collagen expression by FBs in the CO3Ap group was observed and the surface analysis showed spreading of the FBs on the CO3Ap surface. However, the activity of OECs was suppressed on CO3Ap. Two weeks after CO3Ap implantation, soft tissue healing was observed, and recovery of the connective tissue was observed on the remaining CO3Ap.ConclusionsOur results suggest that the formation of soft tissues, including connective tissue, was promoted by CO3Ap in the extraction socket within a short period.

Treatment of Class II Malocclusion with Extraction of Maxillary and Mandibular Second Molars

If a third molar has satisfactory shape and position, it can be a good substitute of the second molar. A 21-year-old woman had been referred to the clinic. She wanted to get an orthodontic treatment before prosthetic treatment. To minimize prosthetic treatment, the maxillary and mandibular third molars were planned to substitute the second molars. After second molar extraction, the maxillary third molar erupted with a slight mesial angulation without any intervention, which was corrected with minor adjustment using fixed appliance. The mandibular third molar was successfully protracted by loop mechanics using stainless steel wire with a root-mesial moment.

Efficacy of Minimal Volume of Articaine Local Anesthetic for Buccal Infiltration During Extraction of Maxillary and Mandibular First and Second Molars: A Prospective Study

Efficacy of Minimal Volume of Articaine Local Anesthetic for Buccal Infiltration During Extraction of Maxillary and Mandibular First and Second Molars: A Prospective Study

Strategic maxillary second-molar extraction in Class II malocclusion

Maxillary second-molar extraction in Class II malocclusion is a controversial issue in orthodontics. This treatment protocol is rigorous and not routine. In this case report, we present the orthodontic treatment of a patient with a Class II malocclusion, maxillary crowding, and no mandibular first molars, treated with extraction of the maxillary second molars. The mechanotherapy and indications of maxillary second-molar extraction are discussed.

Treatment of dentoskeletal bimaxillary protrusion: additional extraction of maxillary second molars

This case report describes the orthodontic treatment of an 18-year-old female patient with Class II malocclusion with dentoskeletal bimaxillary protrusion. An acceptable treatment result was obtained with a four first premolar extraction and an additional maxillary two second molar extraction plan. Standard edgewise appliances were placed after the premolars were extracted. A positive soft tissue response to treatment was achieved, and the patient's profile was improved, with a reduction of lip protrusion and mentalis strain. Dentally, the interincisal angle improved significantly as both the maxillary and mandibular incisors were uprighted after space closure. The occlusion remained stable during 2 years of follow-up.

Effects of maxillary second molar extraction on dentofacial morphology before and after anterior open-bite treatment: a cephalometric study

The purpose of the present study was to probe into the effects of maxillary second molar extraction on dentofacial morphology by the use of cephalometric radiographs taken before and after anterior open-bite treatment. The subjects were 30 Japanese patients who had received multiloop edgewise archwire therapy without premolar extraction. They were divided into two groups. Group 1 consisted of 15 patients who had their maxillary second molars removed. Group 2 comprised 15 patients who had been treated without extraction of maxillary second molars. Lateral cephalograms were taken before and after treatment. Seventeen angular and 31 linear measurements were obtained from the lateral cephalograms. Paired and unpaired t tests were used to determine the significance of differences in measurements. The retrusion and extrusion of the maxillary incisors, the distal movement of the maxillary first molars, and the uprighting of the maxillary first premolars and the mandibular first molars were greater in group 1 than in group 2. Moreover, the maxillary first molars intruded significantly in group 1 but extruded insignificantly in group 2. Extraction of maxillary second molars, as well as nonextraction, can be an effective operating procedure for open-bite correction of the permanent dentition.

Molar extraction: A perspective on a clinical study

Though not frequent, the first or second molars are sometimes selected as candidates for the teeth extracted for orthodontic treatment. Most of molar extraction cases published in the journals show the typical Class II molar relation with extraction of maxillary second molars and mandibular third molars, or the Class I crowding case with extraction of four second molars. Meanwhile, a variety of molar extraction cases presents in Japanese patients. This study including 60 Japanese patients was conducted to reveal the facts on the treatment with first or second molar extraction and identify the pros and cons of the therapy. Clinical indications for molar extraction are proposed, which are classified into nine categories and each case in every category is shown. Some considerations during treatment and keys to successful results are also presented.

Rapidly growing periodontal enlargement

CLINICAL PRESENTATION A 26-year-old white man came to the dental clinic with a complaint of rapid, progressive loosening of his upper teeth. Clinical examination showed Class III mobility in the right posterior maxillary teeth, without detectable mucosal or alveolar abnormalities. Periapical radiographs demonstrated irregular bone around the roots of the maxillary right second and third molars (Fig 1), a feature that was not apparent from bite-wing radiographs taken during a routine dental exam 1 month before his current presentation. Although the clinical course and radiographic findings were considered unusual, a working diagnosis of rapidly progressive adult-onset periodontitis was made, and the patient was appointed for extraction of the right maxillary second and third molars. The extractions were accomplished without difficulty; however, no hard or soft tissue was submitted for histopathologic examination. A follow-up appointment 1 week later showed normal postoperative healing. Two months after the extractions, the patient presented with right maxillary and left periorbital swelling, as well as complaints of decreased left visual acuity, jaw pain, and fever. Left-sided proptosis and decreased function of

Inadequacy of mandibular anchorage—Five years later

With some slight changes, I can only repeat my former statements on this subject. If a case requires mandibular anchorage, the orthodontist should plan deliberately to protect that anchorage in the best way available for that particular case. In this worthy endeavor, the following suggestions are offered: 1. 1. When deciduous teeth are present in the mandibular arch, little or no Class II elastic pressure should be used. In treatment, extraoral anchorage should be considered. 2. 2. In most mandibular anchorage situations, one should plan to use every available precautionary measure to prevent disturbance of resistance units, including extraoral anchorage (at least as a supplementary technique). The various types of mechanics should be considered, and the one which seems most suitable to the case at hand should be chosen. The lingual, labiolingual, edgewise, Johnson, Universal, or Crozat man should not hesitate to step across an imaginary boundary and use the mandibular appliance which common sense dictates is best for the case he is treating. Sectional treatment in the maxillary arch can result in lighter stress on mandibular anchorage, and that stress exists for a shorter time. Directing major tooth movement through cancellous bone channels, rather than against compact areas, should also reduce stress requirements. One should plan to move only those teeth that must be moved. Normal shift of individual teeth may be expected following the development of space provided by movement of other teeth or following the removal of interference. 3. 3. In selected cases, mandibular anchorage hazards should be reduced by extraction of maxillary second molars or maxillary first premolars. 4. 4. During retention, one should continue to observe tendencies for disturbance in the mandibular arch, whether they are due to treatment or to natural causes. Probably most cases should have equilibration by either the qualified orthodontist, a qualified general dentist, or a periodontist. One should note particularly whether the mesiolingual inclined plane of the maxillary canine is striking the distobuccal inclined plane of the mandibular canine, either in occlusion or in excursions of the mandible. This might cause mesial tipping of mandibular canines and crowding of mandibular incisors. If it is impossible to prevent considerable crowding by any available means, it may be desirable, under the conditions previously mentioned, to extract one lower incisor. Stripping might alleviate slight discrepancies. 5. 5. The various steps in treatment should be timed, if possible, in relation to new growth studies. Since mandibular growth usually picks up at puberty, elastic therapy may be used if necessary, in Class II cases during this stage of growth. It is wise to time for a younger age in girls than in boys, for growth in boys is not only later but more prolonged. As our knowledge of the growth of the denture and the face gradually increases, we probably will pay more attention to circumventing the abnormal and aiding and abetting the normal than to mechanical devices. Indeed, some are already “guiding growth,” as it were, with the perhaps more knowledgeable use of the simple appliances of yesteryear, notably such devices as bite plates and cervical gear. 6. 6. I must add a compelling additional thought. In 1955 I quoted the late Charles Waldo's 36 paper, entitled “A Practical Approach to the Problem of Orthodontics.” Since then, Wilson 37 has added the paper that he read at the 1959 Golden Anniversary Luncheon of the American Association of Orthodontists in Detroit. Both of these papers should be read and reread. They stress the real responsibility of orthodontics. What has this to do with mandibular anchorage? Nothing directly, but the ideas expressed in these two papers are intimately connected with anything that we might do or hope to do in orthodontics.

The extraction of maxillary second molars to reduce growth stimulation: Case report

A DISCUSSION which took place three years ago before this society prompts the selection of the following case report today. It is also a case which I submitted to the American Board of Orthodontia. It is, briefly, a case of the Angle Class II, Division 1 type with three molars congenitally missing in the mandible and all six molars present or forming in the maxilla. Besides the usual orthodontic procedures, the case was treated by the extraction of the maxillary second molars. Fig. 1 shows the original models of a girl, 13 years of age, and the condition of the teeth when treatment was begun. The lack of room for the eruption of the maxillary canines and their position anteriorly can be seen, also the relationship of the molars. One must keep in mind the missing molars, two on the mandibular left side and one on the mandibular right side.