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Alcaraz Ros GDD, Eduardo Bravo Vallejo G, Peloso RM, Martins Gambardela-Tkacz C, Cotrin P, Maria Salvatore de Freitas K, Roberto de Freitas M. Smile attractiveness in patients treated with or without 4 premolar extractions: A 36-year follow-up. Am J Orthod Dentofacial Orthop 2024; 165:618-627. [PMID: 38456851 DOI: 10.1016/j.ajodo.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 12/01/2023] [Accepted: 12/01/2023] [Indexed: 03/09/2024]
Abstract
INTRODUCTION This study aimed to assess the smile attractiveness in patients treated with or without 4 premolar extractions at a 36-year follow-up. METHODS The sample comprised 52 patients with Class I and II malocclusion divided into 2 groups. Group 1 consisted of 15 patients treated without extractions (10 females and 5 males), with a mean pretreatment, posttreatment, and long-term posttreatment (T3) age of 13.2, 15.1, and 49.8 years, respectively. The mean treatment time was 1.9 years, and the mean long-term follow-up period was 34.7 years. Group 2 consisted of 37 patients (25 females and 12 males) treated with 4 premolar extractions, with a mean pretreatment, posttreatment, and long-term posttreatment age of 13.3, 15.7, and 53.6 years, respectively. The mean treatment time was 2.3 years, and the mean long-term follow-up period was 37.9 years. The mean retention time was 2 years for both groups. Frontal smiling photographs were obtained at long-term follow-up. Smile attractiveness was evaluated in an online questionnaire in which the evaluator could rate the smiling photographs with a 10-point scale. The randomly selected evaluator sample consisted of 62 laypeople, 33 dentists, and 89 orthodontists. Independent t tests, 1-way analysis of variance, and Tukey tests were used for intergroup comparisons at P <0.05. RESULTS The smile attractiveness on the long term was similar in the groups treated with 4 premolar extractions (4.70 ± 1.35) or without extractions (4.51 ± 1.46). Women and orthodontists were more critical in assessing smile attractiveness than men, dentists, and laypeople. CONCLUSIONS After long-term posttreatment, the smile attractiveness was similar in patients treated with 4 premolar extractions or without extractions.
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Affiliation(s)
| | | | - Renan Morais Peloso
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil
| | | | - Paula Cotrin
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil
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Kochar GD, Londhe S, Chopra SS, Kohli S, Kohli VS, Kamboj A, Verma M. Treatment effects and lip profile changes following premolars extraction treatment vs fixed functional treatment in Class II division 1 malocclusion: A randomized controlled clinical trial. Dental Press J Orthod 2023; 28:e232140. [PMID: 37222338 DOI: 10.1590/2177-6709.28.2.e232140.oar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 11/24/2021] [Indexed: 05/25/2023] Open
Abstract
OBJECTIVE The objective of this two-arm parallel randomized controlled trial was to evaluate the treatment effects and lip profile changes in skeletal Class II patients subjected to premolars extraction treatment versus fixed functional treatment. METHODS Forty six subjects fulfilling inclusion criteria were randomly distributed into Group PE (mean age 13.03±1.78 years) and Group FF (mean age 12.80±1.67 years) (n=23 each). Group PE was managed by therapeutic extraction of maxillary first premolars and mandibular second premolars, followed by mini-implant-supported space closure; and Group FF, by fixed functional appliance therapy. Skeletal, dental, and soft-tissue changes were analyzed using pre and post-treatment lateral cephalograms. Data obtained from this open label study was subjected to blind statistical analysis. RESULTS Extraction treatment resulted in greater increase of nasolabial angle (NLA: 3.1 [95% CI 2.08, 4.19], p<0.001), significant improvement of upper lip (UL-E line: -2.91 [95% CI -3.54, -2.28], p<0.001, UL-S line: -2.50 [95% CI -2.76, -2.24], p<0.001, UL-SnPog': -2.32 [95% CI -2.90, -1.74], p<0.01) and lower lip position (LL-E line: -0.68 [95% CI -1.36, 0.00], p<0.01, LL-S line: -0.55 [95% CI -1.11, 0.02], p<0.01, and LL-SnPog': -0.64 [95% CI -1.20, -0.07], p<0.01), lip thickness (UL thickness: 2.27 [95% CI 1.79, 2.75], p<0.001; LL thickness: 0.41 [95% CI -0.16, 0.97], p<0.01), upper lip strain (UL strain: -2.68 [95% CI -3.32, -2.04], p<0.001) and soft tissue profile (N'-Sn-Pog': 2.68 [95% CI 1.87, 3.50], p<0.01). No significant difference was observed between the groups regarding skeletal changes in the maxilla and mandible, growth pattern, overjet, overbite, interincisal angle and soft tissue chin position (p>0.05). Premolar extraction treatment demonstrated significant intrusion-retraction of maxillary incisors, better maintenance of maxillary incisor inclination, and significant mandibular molar protraction; whereas functional treatment resulted in retrusive and intrusive effect on maxillary molars, marked proclination of mandibular anterior teeth, and significant extrusion of mandibular molars. Both treatment modalities had similar treatment duration. Implant failure was seen in 7.9% of cases, whereas failure of fixed functional appliance was observed in 9.09% of cases. CONCLUSIONS Premolar extraction therapy is a better treatment modality, compared to fixed functional appliance therapy for Class II patients with moderate skeletal discrepancy, increased overjet, protruded maxillary incisors and protruded lips, as it produces better dentoalveolar response and permits greater improvement of the soft tissue profile and lip relationship.
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Kouskoura T, Ochsner T, Verna C, Pandis N, Kanavakis G. The effect of orthodontic treatment on facial attractiveness: a systematic review and meta-analysis. Eur J Orthod 2022; 44:636-649. [PMID: 35984326 DOI: 10.1093/ejo/cjac034] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Facial and smile attractiveness are significant motivating factor for patients to seek orthodontic treatment. Although there is a general belief that orthodontic treatment improves facial appearance, this has yet not been systematically evaluated. OBJECTIVE The objective of this study was to assess the current evidence on the effect of orthodontic treatment on facial attractiveness. SEARCH METHODS Systematic and unrestricted search of nine databases were performed up to January 2022. SELECTION CRITERIA Studies evaluating facial attractiveness before and after orthodontic treatment. DATA COLLECTION AND ANALYSIS Extracted data included study design and setting, sample size and demographics, malocclusion type, treatment modality, and method for outcome assessment. Risk of bias was assessed with the ROBINS-I tool for non-randomized studies and with RoB-2 for randomized controlled trials (RCTs). Random-effects meta-analyses of mean differences and their 95% confidence intervals (CIs) were performed. RESULTS Twenty studies were included in data synthesis; three randomized controlled clinical trials and 17 non-randomized clinical studies of retrospective or prospective design. One of the RCTs was found to have low risk of bias, one presented some concerns and the third showed a high risk of bias. All non-randomized studies showed either unclear or high risk of bias. Data syntheses showed that orthodontic treatment improved facial attractiveness ratings by 9% when compared with untreated controls (MD: 9.05/95% CI: 4.71; 13.39). A combination of orthodontics and orthognathic surgery also showed a positive effect of 5.5% (MD: 5.51/95% CI: 1.55; 9.47) when compared with orthodontic treatment alone. There was no difference in effect between extraction and non-extraction treatments (MD: -0.89/ 95% CI: -8.72; 6.94) or between different types of Class II correctors (MD: 2.21/95% CI: -16.51; 20.93). LIMITATIONS With the exception of two RCTs, included studies were of unclear or low quality. CONCLUSIONS Orthodontic treatment has a clinically weak effect on facial attractiveness when compared to no treatment. The same is true when a combined orthodontic/surgical treatment is compared to orthodontics alone. REGISTRATION PROSPERO #: CRD42020169904.
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Affiliation(s)
- Thaleia Kouskoura
- Department of Pediatric Oral Health and Orthodontics, University Center for Dental Medicine Basel UZB, University of Basel, Switzerland
| | - Tatjana Ochsner
- Department of Pediatric Oral Health and Orthodontics, University Center for Dental Medicine Basel UZB, University of Basel, Switzerland
| | - Carlalberta Verna
- Department of Pediatric Oral Health and Orthodontics, University Center for Dental Medicine Basel UZB, University of Basel, Switzerland
| | - Nikolaos Pandis
- Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Switzerland.,Private Practice, Corfu, Greece
| | - Georgios Kanavakis
- Department of Pediatric Oral Health and Orthodontics, University Center for Dental Medicine Basel UZB, University of Basel, Switzerland.,Department of Orthodontics and Dentofacial Orthopedics, Tufts University School of Dental Medicine, Boston, MA, USA
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Extraction vs. Nonextraction on Soft-Tissue Profile Change in Patients with Malocclusion: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2021; 2021:7751516. [PMID: 34589550 PMCID: PMC8476252 DOI: 10.1155/2021/7751516] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/07/2021] [Accepted: 08/25/2021] [Indexed: 12/23/2022]
Abstract
Objectives We aimed to summarize the current evidence regarding the impact of extraction vs. nonextraction in orthodontic treatment on patients' soft-tissue profile with malocclusion. Methods Between April 30th and November 30th, 2020, we searched PubMed and SCOPUS for published papers from inception to November 2020 using "orthodontic," "extraction," "nonextraction," and "Malocclusion." Included studies were summarized, and relevant data were extracted and analyzed using Review Manager 5.4. Results Pooled data from four controlled trials demonstrated a nonsignificant difference between extraction and nonextraction in terms of SNA (MD = 0.50, 95% CI: -0.37, 1.38; p = 0.26), SNB (MD = 0.11, 95% CI: -1.23, 1.44; p = 0.88), FMA (MD = 1.82, 95% CI: -2.39, 6.02; p = 0.40), IMPA (MD = 0.06, 95% CI: -8.83, -8.94; p = 0.99), overjet (MD = -1.47, 95% CI: -6.21, 3.26; p = 0.54), and overbite (MD = 0.50, 95% CI: -1.40, 2.40; p = 0.60). On the other hand, the extraction method significantly increased the ANB compared with the nonextraction group (MD = 0.78, 95% CI: 0.25, 1.31; p = 0.004). Conclusion The current evidence demonstrated that nonextraction protocols for orthodontic treatment are a safe and effective alternative to extraction protocols; individually tailored treatment strategies should be applied. More randomized controlled trials are critically needed to safely make an evidence-based treatment conclusion.
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Rocha AD, Casteluci CEVF, Ferreira FPC, Conti AC, Almeida MR, Almeida-Pedrin RR. Esthetic perception of facial profile changes after extraction and nonextraction Class II treatment. Braz Oral Res 2020; 34:e003. [PMID: 32022222 DOI: 10.1590/1807-3107bor-2020.vol34.0003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 12/10/2019] [Indexed: 11/21/2022] Open
Abstract
This retrospective study evaluated facial profile pleasantness determined by two protocols of Class II treatment. The sample comprised facial profile silhouettes obtained retrospectively from the pretreatment (T1) and posttreatment (T2) cephalograms of 60 patients (42 males and 18 females) divided into two groups. One group of 30 patients (mean age of 12.84 years) was treated with the extraction of maxillary first premolars (mean treatment time of 2.7 years), and the other group of 30 patients (mean age of 12.81 years) was treated with a mandibular advancement appliance (Forsus) (mean treatment time of 2.49 years). The facial profile silhouettes (T1 and T2) were randomly distributed in an album containing one patient per sheet. The examiners consisted of 60 orthodontists and 60 lay individuals, who analyzed the profiles in regard to facial pleasantness, using the Likert scale. A comparison between stages T1 and T2 of the two treatment protocols and between the examiners was performed by mixed-design analysis of variance at a significance level of 5%. The results demonstrated a significant difference between T1 and T2 (greater scores for T2 compared to T1), and between lay individuals and orthodontists (orthodontists assigned higher scores), but with no significant difference between the treatment protocols. Both protocols produced positive effects on the facial profile esthetics, from the standpoint of lay individuals and orthodontists.
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Affiliation(s)
| | | | | | - Ana Claudia Conti
- Universidade do Norte do Paraná - Unopar, Orthodontic Department, Londrina, PR, Brazil
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Mendes LM, Janson G, Zingaretti Junqueira-Mendes CH, Garib DG. Long-term profile attractiveness in Class II Division 1 malocclusion patients treated with and without extractions. Am J Orthod Dentofacial Orthop 2019; 155:362-371. [PMID: 30826039 DOI: 10.1016/j.ajodo.2018.04.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 04/01/2018] [Accepted: 04/01/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This study evaluated the influence of Class II treatment protocols in profile attractiveness. METHODS Sixty-eight patients with initial full Class II Division 1 malocclusion, orthodontically treated an average of 15 years before, and matched by sex, age, time after treatment, orthodontic outcomes, and overjet, were compared. Three groups were formed, according to the treatment protocol: NE, nonextraction (n = 20; mean age 29.94 years, 15.62 years after treatment); 2E, 2-premolar extractions (n = 27; mean age 30.56 years, 15.09 years after treatment); and 4E, 4-premolar extractions (n = 21; mean age 32.29 years, 17.20 years after treatment). Cephalometric measurements and profile silhouettes were obtained from posttreatment and long-term posttreatment lateral cephalograms. With a 10-point numeric scale, 77 orthodontists and 77 laypeople rated profile attractiveness of each silhouette on a website. RESULTS The raters' posttreatment and long-term posttreatment scores, respectively, were: NE 4.76 and 4.32; 2E 5.35 and 5.08; and 4E 4.53 and 4.33. CONCLUSIONS The posttreatment profile attractiveness was significantly higher in the 2E than in the 4E group, and in the NE group it was similar to the others. The long-term profile attractiveness in the 2E group was significantly greater compared with the NE and 4E groups.
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Affiliation(s)
- Lucas Marzullo Mendes
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil.
| | - Guilherme Janson
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil
| | | | - Daniela Gamba Garib
- Department of Orthodontics, Bauru Dental School, and Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
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