Premolar Extraction Treatment Research Articles

Evaluation of Upper Airway Dimension in all Four First Premolar Extraction Cases

Objective: To find out any noticeable size difference in the superior airway at the end of premolar extraction treatment and to find out the effects of extraction on axial inclinations of anterior teeth. Methodology: It was a retrospective quasi-experimental study that consisted of 30 orthodontic patients in which all four first premolars were extracted. The orthodontic treatment of the participants was done at Department of Orthodontics, Jinnah Medical and Dental College, Karachi. The data was collected from January 2020 to March 2020. Sampling technique selected was consecutive which is a non- probability type of sampling. The cases included in this study were skeletal and dental class I having class I molar relationship with crowding that required all four first premolar extractions. Patients having syndromes or in need of orthognathic surgery were excluded from this study. The analysis was done on Lateral Cephalometric radiograph which was captured in the beginning and another one once treatment was completed. On these radiographs, changes in the soft palate and upper airway widths were measured. Results: No appreciable alterations observed in the superior airway and soft palate widths. The difference observed in the upper incisors inclination was significant when compared to their pretreatment values. Conclusion: No appreciable change has been noted in the airway dimensions after extraction of premolars. The extractions done as a part of orthodontic treatment results in a great improvement in the correction of proclinations of anterior teeth and reduction of lip procumbency. Key Words: Premolar extractions, Lateral Cephalogram, Airway

Comparison of treatment effects from total arch distalization using modified C-palatal plates versus maxillary premolar extraction in Class II patients with severe overjet.

This study aimed to compare the skeletodental and soft tissue changes with total arch distalization using a modified C-palatal plate (MCPP) and maxillary first premolar extraction treatment in Class II malocclusion patients with severe overjet. The sample consisted of 46 adult patients who had Class II Division 1 malocclusion with severe overjet; 25 of them received non-extraction treatment with MCPPs (age, 22.5±7.2years), and 21 received maxillary first premolar extraction treatment (age 23.4±6.5years). A total of 26 variables were measured on pre- and post-treatment lateral cephalograms. To evaluate the differences between pretreatment and post-treatment in each group, t tests and Wilcoxon rank-sum tests were used. To compare the amount of change between the two groups, MANOVA test was used. The overjet was significantly reduced in the MCPP and extraction groups by 4.8mm and 5.4mm, respectively. However, the two groups had no significant difference in the sagittal, vertical and angular changes of the maxillary incisors. In addition, regarding soft tissue changes, the MCPP and extraction groups showed an increased nasolabial angle of 7.5° and 9.4°, decreased upper lip to the true vertical line of 1.8mm and 2.2mm, respectively (P<.001). There was no significant difference in the skeletal changes between the MCPP and extraction groups, and the reduction in overjet was similar in the groups. These results suggest that MCPP might be a viable treatment option for total arch distalization in Class II malocclusion patients with severe overjet.

Effects of miniscrew-assisted orthodontic treatment with premolar extractions on upper airway dimensions in adult patients with Class II high-angle malocclusion

The primary aim of this study was to investigate the change in upper airway dimensions and in mandibular position after miniscrew-assisted treatment with premolar extractions in adult patients with Class II high-angle malocclusion. The secondary aim was to determine the correlation between changes in upper airway dimensions and changes in mandibular position in these patients. Eighteen adult patients with Class II high-angle malocclusion (mean±standard deviation age=21.2±2.9years) were selected retrospectively. All patients underwent 4 premolar extractions, and 2 miniscrews were implanted in the maxilla to intrude molar height. Cone beam computed tomography images were taken pretreatment and posttreatment for every patient. The primary outcome variable for the upper airway was the minimal cross-sectional area of the upper airway (CSAmin), and the primary outcome variables for the mandible were mandibular rotation (Mp-SN angle), mandibular horizontal position (SNB angle), and mandibular vertical position (ANS-Me distance). The CSAmin significantly increased by 47.2mm2(t=-2.26, P=0.04) after orthodontic treatment. The mandible significantly rotated counterclockwise by 0.9° (t=2.20, P=0.04) after treatment, which consisted of forward movement of 1.2° (t=-4.30, P=0.00) and upward movement of 1.3mm (Z=-1.98, P=0.05). Furthermore, the change of the CSAmin showed a significant correlation with the change of the ANS-Me (P=0.01). By using miniscrews to intrude maxillary molars, orthodontic premolar extraction treatment results in mandibular counterclockwise rotation, and upper airway dimensions increase in Class II high-angle young adult patients. The increase of the upper airway dimensions significantly correlates to the upward movement of the mandible.

Influence of Premolar Extraction or Non-Extraction Treatment on Third Molar Eruption: A Comparative Study

Influence of Premolar Extraction or Non-Extraction Treatment on Third Molar Eruption: A Comparative Study

Occlusal outcome after orthodontic treatment with preadjusted straight-wire and standard edgewise appliances : Aretrospective cohort study.

PurposeOrthodontic fixed appliances have been proven to be effective in treating a wide variety of malocclusions, and different types of appliances have emerged during recent decades. However, the comparative effects of different appliances have not been adequately assessed. Thus, the aim was to assess the occlusal outcome of orthodontic treatment with preadjusted straight-wire (SWIRE) and standard edgewise (SEDGE) appliances.MethodsIn all, 56 patients (mean age: 13.5 years; 45% male) receiving extraction-based treatment with either SWIRE or SEDGE appliances were included. Between-group differences in the occlusal outcome assessed with the American Board of Orthodontists Objective Grading System (ABO-OGS) and treatment duration were analyzed statistically at the 5% level.ResultsThe average ABO-OGS score was 31.3 ± 7.2 points and 34.0 ± 10.4 points in the SWIRE and SEDGE groups with no statistically significant difference between groups (P = 0.26). Treatment duration was significantly shorter in the SWIRE group compared to the SEDGE group, with an average difference of −6.8 months (95% confidence interval [95% CI] = −9.6 to −4.0 months; P < 0.001). Likewise, fewer visits were needed with SWIRE compared to SEDGE appliances with an average difference of −7.2 visits (95% CI = −10.3 to −4.2 visits; P < 0.001). Adjusting for the influence of any potential confounders did not considerably impact the results.ConclusionSimilar treatment outcomes were observed after premolar extraction treatment with SWIRE and SEDGE appliances. On the other hand, SEDGE appliances were associated with prolonged treatment duration and more visits needed to complete treatment compared to SWIRE appliances.Supplementary Information The online version of this article (10.1007/s00056-020-00273-z) contains supplementary material, which is available to authorized users.

Comparison of Orthodontic Treatment with Different Premolar Extraction Modalities İn Terms of Soft Tissue Profile

Objectives:To evaluate the differences of changes in soft tissue profile and dentoskeletal parameters between different premolar extraction and non-extraction treatment modalities. Materials and Methods: 50 patients with skeletal Class I malocclusion was divided into three groups. Group 1 consisted 17 patients (mean age:16.76±1.68 years) treated with maxillary and mandibular first premolar extractions; Group 2 consisted 16 patients (mean age:15.81±1.19 years) treated with maxillary and mandibular second premolar extractions, and Group 3 consisted 17 patients (mean age:16.29±1.15 years) treated with non-extraction protocol. From the pre-treatment (T0) and post-treatment (T1) cephalometric radiographs, 13 measurements for dentoskeletal and 15 for soft tissue parameters were assessed. To determine changes due to treatment, and to compare differences among the groups, Wilcoxon Signed-Rank and Kruskal-Wallis tests were performed, respectively.Results: Mx1-SN, Mx1-FH, Mx1-NA, IMPA and Md1-NB values decreased significantly in Group 1 and 2, compared to Group 3 (p&amp;lt;0.001). According to the vertical reference line (VRL-li) and E-plane (E-LL), the lower lip showed statistically significant change (retraction) in Group 1 and 2, compared to non-extraction group (p&amp;lt;0.05). The mean change value for the upper and lower lip thicknesses in Group 1 and 2 were greater than in Group 3 (p&amp;lt;0.05). Group 1 and 2 did not show significant difference in any dentoskeletal and soft tissue measurements between each other. Conclusions:Soft tissue profile change following extraction treatment was similar regardless of the extracted teeth. However extraction treatment modalities resulted in significant profile changes especially in the lower lip with regard to the non-extraction control group.

Comparison of achieved and predicted tooth movement of maxillary first molars and central incisors: First premolar extraction treatment with Invisalign.

To compare achieved and predicted tooth movements of maxillary first molars and central incisors in first premolar extraction cases treated with Invisalign. The present study included 30 patients who received maxillary first premolar extraction treatment with Invisalign. The actual posttreatment model was registered with the pretreatment model on the palatal stable region and superimposed with the virtual posttreatment model. Achieved and predicted tooth movements of maxillary first molars and central incisors were compared using paired t-test. Linear mixed-effect model analyses were used to explore the influence of age (adolescents vs adults), attachment (G6-optimized vs 3-mm vertical, 3-mm horizontal, and 5-mm horizontal), and initial crowding on the differences between predicted and achieved tooth movement (DPATM). First molars achieved greater mesial tipping, mesial translation, and intrusion than predicted. Central incisors achieved less retraction and greater lingual crown torque and extrusion than predicted. Adolescents showed greater DPATM in the mesiodistal translation of first molars and labiolingual translation of central incisors and smaller DPATM in the occlusogingival translation of the first molars and crown torque of the central incisors than adults. The 3-mm vertical attachment group showed greater DPATM in the mesiodistal translation of the first molars vs the G6-optimized attachment group. Initial crowding had an inverse correlation with DPATM in angulation and mesiodistal translation of the first molars. First molar anchorage control and central incisor retraction were not fully achieved as predicted in first premolar extraction treatment with Invisalign. Age, attachment, and initial crowding affected the differences between predicted and achieved tooth movement.

Study of soft-tissues borderline class I malocclusion on tooth extraction and non-extraction process using medical IoT device

Tooth extraction is the process of removing the tooth or cures the damage teeth from the socket present in the bone. During the tooth extraction and non-extraction process, the reaction of soft tissue identification is difficult to decide which may create problem after making the tooth extraction process. Due to the complexity of soft tissue identification process, it is more difficult to estimate the longevity of teeth and borderline class I malocclusion. So, in this paper analyze the detailed profile of the soft tissues present in the borderline class I malocclusion by using the wearable IoT device in teeth. Along with this medical IoT device, facial patterns, pathologies, tooth-arch discrepancy, compliance and cephalometric discrepancy have been examined continuously for making the decision about tooth extraction and non-extraction process. In addition to this, gathered information helps to create the treatment plan that helps to minimize the disease serious rate. Then the analyzed study has been examined by collecting sample data from 100 female patients in which 50 patients data is collected in terms of premolar extraction treatment patients and other 50 patients data is gathered from premolar extraction non-treatment process which is implemented using MATLAB implementation process. From the collected data, soft-tissue reaction has been examined effectively and decision also handled successfully.

Advances in studies on distal molar movement with temporary anchorage devices

Crowding and protrusion of the dentition are often the chief complaint of orthodontic patients. For patients with severe crowding or protrusion, orthodontist often improve their profile with premolar extraction treatment. However, for patients with mild crowding and protrusion, orthodontist usually achieve treatment objective using distal molar movement with temporary anchorage devices (TAD). The present article reviewed the advances in the use of TAD in total arch distalization, including therapeutic effect measured in three-dimensions, factors that affected distal movement and the stability of curative effect.

Comparison of anterior crowding relapse tendency in patients treated with incisor extraction, premolar extraction, and nonextraction treatment

Background and aimRelapse of incisor crowding is usually a serious challenge for orthodontists, and achieving long-term stable occlusion after treatment is one of the primary goals of orthodontic treatment. Stability of aligned incisors is unpredictable, and the difference is attributed to the type of malocclusion, treatment procedures, patient co-operation, or soft tissue growth and adaptability. Considering controversies in this issue, this study is aimed to compare various treatment plans used for incisor alignment in order to find the most useful one, which achieves long-term stability. MethodsThe study included 120 study casts from 40 patients with the mean age of 23.1 years and range of 15 to 38 years. The patients were treated with either nonextraction, single extraction, or premolar extraction and were evaluated at three time points, including T1 (before treatment), T2 (after treatment), and T3 (after retention). ResultsRelapse were observed in all three groups. The mean of mandibular incisor irregularity index was 0.37 ± 0.31, 0.37 ± 0.41, and 0.51 ± 0.47 in the nonextraction, premolar extraction, and incisor extraction groups, respectively. One-way analysis of variance suggested that there was no significant difference among the three groups in this regard (P = 0.2). ConclusionsGiven the results of this study, it appears that treatment modality in terms of extraction or nonextraction is not a major determinant in posttreatment relapse.

Soft tissue changes following extraction vs. nonextraction orthodontic fixed appliance treatment: a systematic review and meta‐analysis

The aim of this systematic review was to assess the effect of systematic extraction protocols during orthodontic fixed appliance treatment on the soft tissue profile of human patients. Nine databases were searched until December 2016 for controlled clinical studies including premolar extraction or nonextraction treatment. After elimination of duplicate studies, data extraction, and risk-of-bias assessment according to the Cochrane guidelines, random-effects meta-analyses of mean differences (MD) or standardized mean differences (SMD) and their 95% CIs were performed, followed by subgroup, meta-regression, and sensitivity analyses. Extraction treatment was associated with increased lower lip retraction (24 studies; 1,456 patients; MD = 1.96 mm), upper lip retraction (21 studies; 1,149 patients; MD = 1.26 mm), nasolabial angle (21 studies; 1,089 patients; MD = 4.21°), soft-tissue profile convexity (six studies; 408 patients; MD = 1.24°), and profile pleasantness (three studies; 249 patients; SMD = 0.41). Patient age, extraction protocol, and amount of upper incisor retraction during treatment were significantly associated with the observed extraction effects, while the quality of evidence was very low in all cases due to risk of bias, baseline confounding, inconsistency, and imprecision. Although tooth extractions seem to affect patient profile, existing studies are heterogenous and no consistent predictions of profile response can be made.

Lip Curve Changes in Patients with Premolar Extraction and Non-Extraction Treatment

Lip Curve Changes in Patients with Premolar Extraction and Non-Extraction Treatment

Comparison of treatment effects between four premolar extraction and total arch distalization using the modified C-palatal plate.

ObjectiveThe purpose of this study was to compare the skeletal, dental, and soft-tissue treatment effects of nonextraction therapy using the modified C-palatal plate (MCPP) to those of premolar extraction (PE) treatment in adult patients with Class II malocclusion.MethodsPretreatment and posttreatment lateral cephalographs of 40 adult patients with Class II malocclusion were retrospectively analyzed. The MCPP group comprised 20 patients treated with total arch distalization of the maxillary arch while the PE group comprised 20 patients treated with four PE. Fifty-eight linear and angular measurements were analyzed to assess the changes before and after treatment. Descriptive statistics, paired t-test, and multivariate analysis of variance were performed to evaluate the treatment effects within and between the two groups.ResultsThe MCPP group presented 3.4 mm of retraction, 1.0 mm of extrusion, and 7.3° lingual inclination of the maxillary central incisor. In comparison, the PE group displayed greater amount of maxillary central incisor retraction and retroclination, mandibular incisor retraction, and upper lip retraction (5.3 mm, 14.8°, 5.1 mm, and 2.0 mm, respectively; p < 0.001 for all). In addition, the MCPP group showed 4.0 mm of distalization and 1.3 mm of intrusion with 2.9° distal tipping of the maxillary first molars.ConclusionsThese findings suggest the MCPP is an effective distalization appliance in the maxillary arch. The amount of incisor retraction, however, was significantly higher in the PE group. Therefore, four PE may be recommended when greater improvement of incisor position and soft-tissue profile is required.

Effects of unilateral premolar extraction treatment on the dental arch forms of Class II subdivision malocclusions.

A retrospective study evaluating posttreatment symmetry in dental arch form and midlines was carried out in Class II subdivision patients treated with unilateral and bilateral maxillary premolar extractions. Using Geomagic (version 14; Geomagic, Research Triangle Park, NC) and MATLAB (version 8.4; MathWorks, Natick, Mass) software, best-fit curves expressed as quartic polynomials were generated for 13 Class II subdivisions treated with unilateral extractions and 20 treated with bilateral maxillary premolar extractions. Transverse and sagittal measurements were recorded to assess symmetry. Dental models were superimposed on constructed reference planes to generate average posttreatment arches. Statistical comparisons were performed with the significance level set at P≤0.05. The unilateral extraction group showed significant differences in transverse arch forms between the right and left sides in the anterior, anterior-middle, and middle segments of the arch, and all regions other than the posterior segment in the sagittal dimension. Significant differences were found between groups in the anterior and anterior-middle segments of the arch transversely, the middle and middle-posterior segments sagittally, and the midline deviation relative to the midsagittal plane. Superimposed average arches showed similar results. Unilateral maxillary extraction treatment generally results in a narrower and more posteriorly displaced arch form on the extraction side, with a deviated maxillary midline toward the extraction side of the arch.

Soft tissue treatment changes with fixed functional appliances and with maxillary premolar extraction in Class II division 1 malocclusion patients

The aim of this study was to compare the soft tissue changes and post-treatment status after complete fixed functional appliance non-extraction and maxillary premolar extraction treatment in patients with Class II division 1 malocclusion. The sample consisted of 96 lateral cephalograms of 48 patients, divided into two groups. Group 1 consisted of 23 patients treated with fixed functional appliance associated with fixed appliances, with initial and final mean ages of 12.71 and 15.16 years, respectively, mean treatment time of 2.44 years and initial mean overjet of 6.83 mm. Group 2 comprised 25 patients treated with extraction of two maxillary premolars with initial and final mean ages of 13.05 and 15.74 years, respectively, mean treatment time of 2.67 years and initial mean overjet of 7.01 mm. t-Tests were used to compare treatment changes and the final cephalometric statuses between the groups. According to the results, there was no inter-group difference regarding the soft tissue changes and post-treatment status. The use of exclusively one type of fixed functional appliance in group 1 and performance of only one type of mechanics during space closure in group 2 were not always possible. Late pubertal patients with Class II division 1 malocclusion treated with fixed functional appliances associated with fixed appliances present similar soft tissue results as two-maxillary premolar extraction treatments.

Comparison of temporary anchorage devices and transpalatal arch-mediated anchorage reinforcement during canine retraction.

Objective:The purpose of this study was to compare the dental and skeletal effects of canine retraction using conventional anchorage reinforcement systems and comparing them with the usage of TADs.Materials and Methods:The sample consisted of 50 patients having Class I malocclusions with bimaxillary protrusion indicated for first premolar extraction, and allocated into two groups. The first group consisted of 25 patients with a mean age of 18,7 years (min:14, max:22 years, 16 girls and 9 boys) that TADs were applied as an anchorage mechanic between attached gingiva of upper second premolar and first molar teeth. The second group consisted of 25 patients with a mean age of 19,4 years (min:15, max:23 years, 14 girls and 11 boys) that conventional molar anchorage with Transpalatal arch (TPA) was applied for the anchorage mechanics against canine retraction.Results:The results showed that mean mesial movement and the tipping of the first molars in TAD group between T0 - T1 were insignificant (P > 0,05), however in the TPA group were significant (P<0,01). Vertical movement of the molars were not significant when two groups were compared (P>0,05).Conclusion:Although TPA is a useful appliance, it doesn't provide an effective anchorage control on anteroposterior movement maxillary first molar teeth concerning first premolar extraction treatment. TADs are more convenient to provide absolute anchorage during maxillary canine retraction in contrast to transpalatal arch.

Evaluation of bracket failure rate in orthodontic patients bonded with and without primer

Abstract Introduction Primers are considered widely essential for bonding orthodontic brackets. However, their role in minimizing bracket failure rates has been frequently questioned. Objective To investigate the difference in the bracket failure rate in direct bonding with and without the use of orthodontic primer. Setting and design A prospective, single blinded clinical study at a private clinical practice in Ras Al Khaimah, United Arab Emirates. Methods and material 38 class I bimaxillary protrusion patients requiring all first premolar extraction treatment were assigned to primer and non primer group (19/group) and bonded in a standardized manner. They were followed up from strap up till the end of treatment and bracket failure rate during the entire treatment was recorded, assessed and compared. Statistical analysis Statistical significance between the two groups was checked using Fischer’s exact test ( P less than .05 was considered significant). Result Debonding in non primer group was more than in primer group but not statistically or clinically significant. Conclusion The bonding of brackets without using orthodontic primer is possible; however, further research is advocated.

Maxillary arch width and buccal corridor changes with orthodontic treatment. Part 1: Differences between premolar extraction and nonextraction treatment outcomes

In this retrospective study, we examined and compared the pretreatment and posttreatment arch widths and buccal corridor changes in subjects who had received orthodontic treatment either with or without premolar extractions. Pretreatment and posttreatment casts, frontal smiling photographs, and lateral cephalograms of 30 extraction and 27 nonextraction patients were analyzed to determine any significant differences in arch widths, buccopalatal inclinations of the teeth, and buccal corridor widths and areas, both within and between the 2 groups. Relationships between buccal corridor measurements and corresponding arch widths and buccopalatal inclinations of the teeth were also examined. There was a significant increase in the posttreatment maxillary intercanine width in the extraction group but not in the nonextraction group. Both the pretreatment and posttreatment arch widths between the maxillary first molars and at the level of the posterior rugae were greater in the nonextraction group than in the extraction group. There were no significant differences in any buccal corridor widths or areas measured between the extraction and nonextraction subjects. Because they reflect different morphologies, there are likely to be significant differences in average maxillary anterior and posterior posttreatment arch widths in those treated with or without extractions. However, these arch width differences are not likely to be discernible in extraction and nonextraction patients as differences in the buccal corridor widths and areas.

Comparison of esthetic outcome after extraction or non-extraction orthodontic treatment in class II division 1 malocclusion patients

Introduction:The extraction of premolars as a practical form of orthodontic therapy has been accepted for many years, but there remains a controversy regarding the effect of premolar extraction to improve esthetics as well as dentoskeletal relationship. The esthetic impact of the soft-tissue profile might play a major role in deciding on premolar extraction or non-extraction treatment, particularly in borderline patients. This cephalometric study was undertaken to compare the post-treatment soft-tissue profiles of successfully managed Class II, Division 1 malocclusions treated with either all first premolar extractions or treatment with a non-extraction therapy.Materials and Methods:The sample consisted of 100 post-pubertal female patients of Class II Division I malocclusion. Group 1, treated with four first premolar extractions, consisted of 50 female patients with a mean age of 14 years 1 month. Group 2, treated without extractions, consisted of 50 patients with a mean age of 13 years 5 months. Pre-treatment and post-treatment lateral cephalometric radiographs were evaluated. The pre-treatment to post-treatment stage comparison and the intergroup comparison of the treatment changes were conducted between extraction and non-extraction groups of Class II malocclusion samples with t-tests.Results:The soft-tissue facial profiles of the extraction and non-extraction samples were the same following active treatment except for a more retruded lower lip and a more pronounced lower labial sulcus in those patients subjected to extraction.Conclusions:The extraction or non-extraction decision, if based on sound diagnostic criteria, seems to have no systematic detrimental effects on the facial profile.

A comparison of second premolar extraction and mini-implant total arch distalization with interproximal stripping

The effect of total arch distalization using orthodontic mini-implants (OMIs) combined with interproximal stripping (IPS) and second premolar extraction was investigated in Class I malocclusion patients. A total of 66 consecutively treated Class I malocclusion (Class I molar relationship; 0 mm < overbite and overjet < 4.5 mm) patients ranging in age from 17 to 44 years who received single-phase treatment were included in this study. Pre- and posttreatment lateral cephalograms and dental casts were measured and compared statistically. In the distalization with IPS group, 3.6 mm and 3.8 mm of crowding in the upper and lower arches, respectively, were resolved, and 3.8 mm and 3.2 mm of upper and lower incisor retraction, respectively, were achieved simultaneously by the treatment. As a result of the second premolar extraction treatment, 3.9 mm and 3.6 mm of crowding in the upper and lower arches, respectively, were resolved, and 3.3 mm and 3.2 mm of incisor retraction, respectively, were achieved during treatment. There was no statistically significant difference in the amount of crowding and incisor retraction between the two groups. Total arch distalization using an OMI with IPS did not yield a significantly different treatment result compared to second premolar extraction treatment.