Objective: The objective of this study was to evaluate the effects of the four first premolars extraction compared with a non-extraction treated control group on the lower anterior facial height. Methods: Electronic search was conducted on PubMed, Cochrane, Scopus, Lilacs, Scielo, clinical trials, and opengrey.eu databases; only article published in English were included. The eligibility criteria were extraction of four first premolars compared with a non-extraction control group treated with fixed mechanotherapy. Anterior Nasal Spine to Menton (ANS-Me) (mm) was taken as the primary outcome; Frankfurt mandibular plane angle (FMA) and Nasion to Menton (N-Me) were selected as secondary outcomes. Non-randomized Studies-of Intervention (ROBINS-I) tool was used for the quality assessment and risk of bias. Heterogeneity was analyzed using statistical tests, including chi-squared-based Q-statistic, tau-square, and I-squared statistics. Review Manager was used for quantitative assessment and meta-analysis. Results: Five retrospective studies were included for quantitative assessment and three were included in the meta-analysis due to certain missing data. Extraction of four first premolars did not affect both primary and secondary outcomes with P = .65, P = .93, and P = .91, respectively, for ANS-Me, FMA, and N-Me. Conclusion: This review and meta-analysis concluded that there was no statistically significant effect of extraction of four first premolars on lower anterior facial height.
Clear aligners have become increasingly popular in recent years due to patients’ esthetic and comfort needs. Many movements are still unachievable, highlighting the limitations of clear aligner therapy. Moreover, it is expensive and many patients cannot afford it for orthodontic correction. Long-term fixed orthodontic devices are painful for patients, with complaints of discomfort and ulceration during their treatment. This can be reduced by minimizing the duration of appliance wear, as driftodontics allows the teeth to adjust naturally without applying any active force. The duration of active fixed orthodontic therapy is significantly reduced compared to the hybrid approach (partial fixed appliances combined with clear aligners) as well as conventional fixed orthodontic therapy. In this case report, after all first premolar extractions, physiologic drift was used to decrowd the arches and an active TPA to correct unilateral crossbite within five months only, followed by another 5 months of active fixed orthodontic appliance. Over a total period of 10 months, we achieved a bilateral Class I molar and canine relationship with significant improvement in lip competency.
Treatment of Class II div 2 malocclusion has always been a challenge for an orthodontist which requires a careful diagnosis and a treatment planning including occlusal, functional, and esthetic considerations. Additionally, the presence of impacted mandibular canine increases the complexity of the treatment as more clinical efforts and time is required to dis-impact mandibular canine, as mandible has a dense cortical bone. This case report represents the management of a class II div 2 malocclusion with impacted mandibular canine treated with camouflage in a 14 years old patient. The impacted canine was orthodontically guided into occlusion and a good esthetic and functional results were achieved.
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