editorial DOI: https://doi.org/10.1590/2177-6709.22.3.009-010.edt

Stability of orthodontic treatment and dental extractions David Normando1, Guilherme Janson2

“Success is the ability to go from failure to failure without losing your enthusiasm” Winston Churchill, British politician and writer.

Today’s orthodontics has substantially reduced the need for extractions. One of the reasons for this change in approach is based on the findings of studies published in the early 1980s by researchers at the University of Washington, who reported similar rates of teeth alignment relapse in cases treated with or without premolar extractions.1,2 Thus, it was reported that the decision to extract teeth would not improve the chances of increased long term orthodontic treatment stability. However, Little  et  al1,2 focused their studies on the changes that occurred in teeth alignment. If one glimpses beyond crowding, an analysis of the literature will undoubtedly reveal that this assumption may be wrong, and the reverberating truth may in the future damage our ears, as it will certainly damage the patients’ teeth.

Regarding the stability of sagittal correction, more specifically in the treatment of Class II malocclusion, there used to be a dogma, still recurrent in Orthodontics, that the molars should be finished in a Class I relationship to provide greater treatment stability.3 Nevertheless, this assertion finds no support when treatment stability is analyzed comparatively, i.e., between protocols involving extractions of two maxillary premolars and nonextraction protocols.4 A recent systematic review indicated as inconclusive whether or not stability would be achieved to a greater or lesser degree if a Class II treatment were performed with or without extractions.5 On the other hand, there seems to be evidence, albeit relatively scant, indicating that cases with Class III malocclusion treated compensatorily with extractions of lower teeth are more stable than nonextraction cases.6,7

Adjunct Professor of Orthodontics, School of Dentistry, Universidade Federal do Pará (UFPA). Coordinator of the Graduate program in Dentistry at UFPA and the Specialization Course in Orthodontics at ABO-Pará. 2 Full Professor of Orthodontics at Bauru School of Dentistry, Universidade de São Paulo (FOB-USP). 1

How to cite: Normando D, Janson G. Stability of orthodontic treatment and dental extractions. Dental Press J Orthod. 2017 May-June;22(3):9-10. DOI: https://doi.org/10.1590/2177-6709.22.3.009-010.edt

© 2017 Dental Press Journal of Orthodontics


Dental Press J Orthod. 2017 May-June;22(3):9-10


Even if extractions appear to lessen the risk of relapse of compensatory orthodontic treatment of Class III malocclusion, the same results have been yielded by studies examining stability of non-surgical treatment of anterior open bite. Clinical studies have revealed that stability seems to improve when treatment in the permanent dentition is performed with extractions, be it in adolescents8 or in adults.9 It has been speculated that stability is improved in extraction treatments precisely because two mechanisms help in closing the anterior open bite, i.e., the “drawbridge principle,” and the mesialization of posterior teeth.8 But why should we broach this subject again? Thanks to the advent and popularization of skeletal anchorage there has been a vast increase in treatment approaches whereby sagittal skeletal errors are compensated by en mass distalization of the maxillary teeth in Class II cases,

or the mandibular teeth, in Class III cases. Furthermore, the option of intruding the posterior teeth in cases of anterior open bite with the help of skeletal anchorage devices has been increasingly gaining momentum. These treatment protocols boast the unique advantage of reducing the indication of extractions. Conversely, if the prospect of a lower chance of relapse of sagittal and vertical changes (anterior open bite) in extraction cases is true, it is highly likely that we are raising the risk of relapse with the aid of skeletal anchorage, in nonextraction cases. At this point, when opting for such a treatment protocol, it would be wise to inform the patient that we are embarking on a treatment with a higher risk of relapse. At least for now, while we wait for a scientific answer. David Normando, Guilherme Janson



Little RM, Wallen TR, Riedel RA. Stability and relapse of mandibular anterior


alignment-first premolar extraction cases treated by traditional edgewise

Dent Coll. 2016;57(1):29-35.

orthodontics. Am J Orthod. 1981 Oct;80(4):349-65. 2.


malocclusion by isolated extraction of mandibular teeth. Part 1: Occlusal

alignment from 10 to 20 years postretention. Am J Orthod Dentofacial Orthop.

situation 12 years after completion of active treatment. J Orofac Orthop. 2015 May;76(3):251-64.

Mailankody J. Enigma of Class II molar finishing. Am J Orthod Dentofacial


Orthop. 2004 Dec;126(6):A15-6; author reply A16-7. 4.

Janson G, Valarelli FP, Beltrão RT, de Freitas MR, Henriques JF. Stability of anterior open-bite extraction and nonextraction treatment in the permanent

Janson G, Camardella LT, Araki JD, de Freitas MR, Pinzan A. Treatment stability in

dentition. Am J Orthod Dentofacial Orthop. 2006 June;129(6):768-74.

patients with Class II malocclusion treated with 2 maxillary premolar extractions


or without extractions. Am J Orthod Dentofacial Orthop. 2010 July;138(1):16-22. 5.

Zimmer B, Schenk-Kazan S. Dental compensation for skeletal Class III

Little RM, Riedel RA, Artun J. An evaluation of changes in mandibular anterior 1988 May;93(5):423-8.


Yoshizumi J, Sueishi K. Post-treatment stability in Angle Class III sases. Bull Tokyo

Medeiros RB, Araújo LFC, Mucha JN, Motta AT. Stability of open-bite treatment in adult patients: A systematic review. J World Fed Orthod. 2012;1(3):e97-101.

Maniewicz Wins S, Antonarakis GS, Kiliaridis S. Predictive factors of sagittal stability after treatment of Class II malocclusion. Angle Orthod. 2016 Nov;86(6):1033-41.

© 2017 Dental Press Journal of Orthodontics


Dental Press J Orthod. 2017 May-June;22(3):9-10

Stability of orthodontic treatment and dental extractions.

Stability of orthodontic treatment and dental extractions. - PDF Download Free
449KB Sizes 5 Downloads 10 Views

Recommend Documents

Effect of orthodontic treatment involving first premolar extractions on mandibular third molar angulation and retromolar space.
Third molars present more problems than other teeth because they are the last teeth to erupt, and so it is important to assess their development when designing an orthodontic treatment plan. The aim of this study was to compare the angulation of the

Dental extractions and risk of bleeding in patients taking single and dual antiplatelet treatment.
Our aim was to evaluate the effects of single and dual antiplatelet treatment on postoperative bleeding in patients having dental extractions. The prospective clinical study included 160 patients who were taking antiplatelet drugs. The first group (n

Contribution of prosthetic treatment considerations for dental extractions of permanent teeth.
Background. Tooth loss is an easily identifiable outcome that summarizes a complex suite of factors in an individual's history of dental disease and its treatment by dental services over a lifetime. Assessment of overall tooth loss data is essential

Orthodontic treatment mediates dental pulp microenvironment via IL17A.
Orthodontic treatment induces dental tissue remodeling; however, dental pulp stem cell (DPSC)-mediated pulp micro-environmental alteration is still largely uncharacterized. In the present study, we identified elevated interleukin-17A (IL17A) in the d

Pain Measurement through Temperature Changes in Children Undergoing Dental Extractions.
Background and Objective. Pain evaluation in children can be a difficult task, since it possesses sensory and affective components that are often hard to discriminate. Infrared thermography has previously been used as a diagnostic tool for pain detec

Comparison of 4% articaine and 0.5% bupivacaine anesthetic efficacy in orthodontic extractions: prospective, randomized crossover study.
Articaine and bupivacaine are both amide-type local anesthetic (LA) agents, of almost equal potency. However, lidocaine is considered the gold standard and is the most widely used anesthetic agent because of its potency, safety, and efficiency. Artic

Perception of children and mothers regarding dental aesthetics and orthodontic treatment need: a cross-sectional study.
The normative orthodontic treatment need, established by dental professionals during the dental appointment, becomes ineffective when it does not evaluate all the factors that influence the decision-making process, including individuals' perception a

Long-term orthodontic and surgical treatment and stability of a patient with Beckwith-Wiedemann syndrome.
Beckwith-Wiedemann syndrome (BWS) is a congenital growth disorder. Children born with BWS develop enlarged organs, including the tongue, a large body, and other signs. A woman with BWS was treated and followed for 30 years. Treatment consisted of ton

Psychosocial impact of dental aesthetics and desire for orthodontic treatment among Chinese undergraduate students.
The objective of this study is to evaluate the psychosocial impact of dental aesthetics in undergraduate students in the People's Republic of China and to investigate the association between normal orthodontic treatment needs, psychosocial impact of

Bone stability around dental implants: Treatment related factors.
The bone bed around dental implants is influenced by implant and augmentation materials, as well as the insertion technique used. The primary influencing factors include the dental implant design, augmentation technique, treatment protocol, and surgi