Influence of premolar extractions on the facial profile evaluated by the Holdaway analysis

Abstract

Purpose: This retrospective study aimed at assessing patients treated with extraction of premolars through cephalometry in lateral teleradiography, comparing the effect of different tooth extraction protocols on the facial profile. Methods: For this study, 87 patients (31 boys and 56 girls) were selected from the private practices of three dentists certified by the Brazilian Board of Orthodontics and Facial Orthopedics. These patients were treated with fixed edgewise appliance and divided into three groups, according to the sequence in which premolars were extracted "Group 40" comprised 22 patients treated with extractions of the first two superior premolars, adopted as the control group; "Group 44" comprised 43 patients treated with extractions of the four first premolars; and "Group 45" comprised 22 patients treated with extractions of first superior premolars and second inferior premolars. The Holdaway analysis was used to quantify and compare the group profiles before and after treatment. Results: Student's t-tests showed a profile improvement in all groups. When groups were compared, ANOVA showed that only the Inferior sulcus to the H line showed differences in incremental changes resulting from the treatment. Group 44 showed a significantly higher difference than Group 40. Conclusion: We conclude that the protocols produce similar facial appearances.

Do premolar extractions necessarily result in a flat face? No, when properly indicated

“…Among the several decisions, the professional should determine if the success of intervention requires dental extractions. 2 , 10 , 13 , 15 The extractions with orthodontic purpose, for correction of tooth crowding or intermaxillary discrepancies, have been controversial since the concepts of normal occlusion were initially enhanced, in the early 20 th century. 3 , 11 , 16 , 17 , 27 - 29 Any tooth may be extracted, depending on each case, to provide more satisfactory esthetic and functional outcomes.…”

“…Moreover, there are contradictory opinions about the facial profile changes when different sequences of premolar extractions are analyzed. 8 , 11 , 15 - 21 Some investigators 22 - 24 suggest more studies to define the effects of the different premolar extraction sequences, as well as to quantify the cumulative effect of aging after this treatment approach on the facial profile. 10 …”

<p>Posisi kondilus setelah perawatan ortodontik pada maloklusi kelas II divisi 1 dengan pencabutan premolar</p><p>Condylar position after orthodontic treatment in class II division 1 malocclusion with premolar extraction</p>

“…4 Retraksi gigi anterior dan perbaikan inklinasi insisif merupakan upaya yang dilakukan untuk mencapai overjet dan overbite yang normal, mengurangi kecembungan wajah, membuat bibir dapat menutup dengan rileks dan memperoleh wajah yang harmonis. 4 Penelitian Odaci et al 4 tahun 2013 melaporkan bahwa pencabutan gigi dapat menyebabkan perubahan pola oklusi. Pencabutan gigi menyebabkan perubahan tekanan pengunyahan ketika gigi atas dan bawah berkontak.…”

“…Penelitian Odaci et al 4 melaporkan bahwa pencabutan gigi menyebabkan perubahan pola oklusi akibat integritas atau kontinuitas struktur gigi terputus. Perawatan ortodontik yang berlangsung sekitar dua tahun dilaporkan menyebabkan perubahan posisi kondilus.…”

“…Gaya yang berasal dari alat ortodontik memberikan kesempatan pada otot mandibula dan kondilus untuk melakukan adaptasi pada posisi yang baru agar mencapai stabilitas yang lebih baik. 4 Tujuan penelitian adalah menganalisis posisi kondilus pada akhir perawatan ortodontik dengan pencabutan premolar pada maloklusi kelas II divisi 1. 4,5…”