Assessment of facial profile changes in patients treated with maxillary premolar extractions

Abstract

Objective: Evaluate the facial profile changes of orthodontic treatment with extraction of two upper first premolars, from the perspective of orthodontists, dentists and lay people. Methods: Facial profiles of radiographs taken before and after treatment of 70 patients with Class II, division 1 malocclusion were traced. The silhouettes of the 70 patients were randomly assembled in an album with, being two profiles on each sheet of the same patient. Then, 30 orthodontists, 30 dentists and 30 lay people chose the more esthetic facial profile (A or B), and the amount of change they perceived between the two profiles before and after treatment, according to a visual analog scale (VAS). Results: The results revealed that 83 examiners preferred the posttreatment profiles, and only three dentists and four lay people chose the profiles pre-treatment more frequently. Thus, the orthodontists often chose the profiles after treatment, followed by dentists, with no statistically significant differences found between dentists and lay people. There were significant differences within groups in the preference of pre-and post-treatment profile. Furthermore, the three groups of evaluators indicated that pre and post-treatment profiles did not differ substantially. Conclusions:The treatment of Class II, division 1 malocclusion with extraction of two first premolars has a positive effect on facial profile esthetics. Objetivo: avaliar as alterações do perfil facial decorrentes do tratamento ortodôntico com extrações de dois primeiros pré--molares superiores, sob a óptica de ortodontistas, cirurgiões-dentistas e leigos. Métodos: foram traçados os perfis faciais das telerradiografias pré-e pós-tratamento de 70 pacientes com má oclusão de Classe II, divisão 1, e foi montado um álbum com as silhuetas dos 70 pacientes, de forma aleatória, sendo dois perfis em cada folha do mesmo paciente. A seguir, 30 ortodontistas, 30 cirurgiões-dentistas e 30 leigos escolheram o perfil facial mais estético (A ou B), e a quantidade de alteração que percebiam entre os dois perfis pré-e pós-tratamento, de acordo com a escala visual analógica (EVA). Resultados: os resultados revelaram que 83 examinadores preferiram o perfil pós-tratamento, sendo que somente três cirurgiões-dentistas e quatro leigos escolheram com maior frequência os perfis pré-tratamento. Assim, os ortodontistas escolheram mais frequentemente os perfis pós-tratamento, seguidos pelos cirurgiões-dentistas, sem diferença estatisticamente significativa entre cirurgiões-dentistas e leigos. Houve diferença estatisticamente significativa intragrupos na preferência do perfil pré-e pós-tratamento. Além disso, os três grupos de avaliadores indicaram que os perfis pré-e pós-tratamento não diferiram substancialmente. Conclusões: o tratamento da má oclusão de Classe II, divisão 1, com extração de dois primeiros pré-molares produziu um efeito positivo na estética do perfil facial.Palavras-chave: Extração dentária. Má oclusão Classe II de Angle. Ortodontia corretiva. Percepção.

Esthetic perception of facial profile changes after extraction and nonextraction Class II treatment

“…The results demon st rated a stat ist ically significant difference (p=0.003) in the opinion of lay individuals and orthodontists, even though both evaluated the posttreatment profile as more pleasant (Table 4). This corroborates the study by Almeida-Pedrin et al 20 , who analyzed the facial profile changes promoted by orthodontic treatment with the extraction of two maxillary first premolars, and revealed that 83 out of 90 examiners preferred the posttreatment profile.…”

“…14,17,18 However, aspects that influence examiners' perceptions of facial attractiveness may be eliminated by using profile silhouettes. 15,19,20,21,22 The concept that orthodontic treatment by extraction of premolars damages facial profile esthetics often keeps the orthodontist back from choosing this option in devising the treatment planning. In this respect, over the years, orthodontists have been investigating the relationship between facial profile esthetics and orthodontic treatment by tooth extraction.…”

“…Similar results were found in studies analyzing the soft tissue profile after orthodontic treatment with extraction. 11,20,23,24 Conversely, it has been reported that the greatest benefit of treatment by extraction is achieved in cases with greater dental protrusion, marked crowding, and thick and protruded lips. 10,11,26 However, in individuals presenting a thin upper lip and an increased nasolabial angle at pretreatment, extraction may affect the upper lip positioning negatively and increase the nasolabial angle.…”

The esthetic profile preferences of Class II malocclusion patients treated with extraction or non-extraction

“…The researchers noted that the premolar extraction treatment might not result in a less pleasant facial profile than a nonextraction protocol does, as long as the treatment option is adequate. This result was also confirmed by another study 15 assessing the facial impact of orthodontic treatment with the extraction of the upper premolars. They concluded that the therapeutic effect of this treatment, when properly indicated, would be always positive.…”

“…However, once an intervention is required, it is necessary that the professional takes extreme care for the preservation and accentuation of the pleasant characteristics. Lately, the laypersons' perception regarding esthetic appearance has been attributed as much importance as that of the professionals [15][16] .…”