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Dental compensation for skeletal Class III malocclusion by isolated extraction of mandibular teeth

Part 1: Occlusal situation 12 years after completion of active treatment

Kompensation der skelettalen Klasse III mit isolierten Unterkieferextraktionen

Teil 1: Die okklusale Situation 12 Jahre nach Behandlungsabschluss

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Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie Aims and scope Submit manuscript

Abstract

Objectives

The purpose of this work was to statistically evaluate the outcomes achieved by isolated extraction of mandibular teeth (second premolars or first molars) for Class III compensation.

Materials and methods

Part A of the study dealt with the quality of outcomes at the end of active treatment, using weighted Peer Assessment Rating (PAR) scores determined on the basis of casts for 25 (14 female and 11 male) consecutive patients aged 16 ± 1.7 years at the time of debonding. These results were compared to the scores in a randomly selected control group of 25 (14 female and 11 male) patients who were 14.7 ± 1.9 years old at debonding. Part B evaluated the long-term stability of the outcomes based on 12 (all of them female) patients available for examination after a mean of 11.8 years. The mean weighted PAR scores obtained in both study parts were analyzed for statistical differences using a two-tailed paired Student’s t-test at a significance level of p ≤ 0.05.

Results

Mean weighted PAR scores of 4.76 ± 3.94 and 3.92 ± 3.44 were obtained in the Class III extraction group and the control group, respectively, at the end of active treatment. This difference was not significant (p = 0.49). Among the 12 longitudinal patients, the mean score increased from 4 ± 3.46 at debonding to 6.25 ± 3.67 by the end of the 11.8-year follow-up period. This difference was significant (p = 0.0008).

Conclusion

Treatment of Class III anomalies by isolated extraction of lower premolars or molars can yield PAR scores similar to those achieved by standard therapies. These scores, while increasing significantly, remained at a clinically acceptable level over 11.8 years. Hence this treatment modality—intended for cases that border on requiring orthognathic surgery—may also be recommended from a long-term point of view.

Zusammenfassung

Zielsetzung

In der vorliegenden Untersuchung soll die Methode der isolierten Extraktionstherapie von unteren Prämolaren und Molaren zur kompensatorischen Behandlung relevanter Klasse-III-Anomalien einer statistischen Überprüfung unterzogen werden.

Material und Methode

Im Studienteil A (Qualität Ende aktiv) wurden die Abschlussmodelle von 25 konsekutiv behandelten Patienten (n = 25, 14 weiblich, w, 11 m, mittleres Alter zum Zeitpunkt des Debonding: 16 Jahre, SD ± 1,7) mit dem gewichteten PAR – Index bewertet und die Ergebnisse mit denen einer randomisierten Kontrollgruppe (n = 25, 14w, 11 m, mittleres Alter 14,7 Jahre, SD ± 1,9) verglichen. Für den Studienteil B (Qualität longitudinal) wurden 12 weibliche Patienten im Mittel 11,8 Jahre später nachuntersucht. Die gewichteten PAR-Indizes von beiden Zeitpunkten wurden miteinander verglichen. Die Ergebnisse beider Studienteile wurden einer statistischen Testung mittels zweiseitigem gepaarten t-Test nach Student mit einem Signifikanzniveau von p ≤ 0,05 unterzogen.

Ergebnisse

Studienteil A (Qualität Ende aktiv): Der mittlere gewichtete PAR-Index für die Klasse-III- Extraktionsgruppe betrug 4,76 (SD ± 3,94) und für die Kontrollgruppe 3,92 (SD ± 3,44). Der Unterschied war statistisch nicht signifikant (p = 0,49). Studienteil B (Qualität longitudinal): Der PAR-Index nahm von 4 (SD ± 3,46) zum Zeitpunkt des Debonding auf 6,25 (SD ± 3,67) zum Zeitpunkt der Nachkontrolle nach im Mittel 11,8 Jahren zu. Der Unterschied war statistisch signifikant (p = 0,0008).

Schlussfolgerung

In der Behandlung von relevanten Klasse-III-Anomalien mit isolierten Extraktionstherapien unterer Prämolaren und Molaren lassen sich PAR-Indizes realisieren, die denen für Standardtherapien ermittelten Werten ähnlich sind. Die Indizes nehmen über einen Zeitraum von 11,8 Jahren zwar signifikant zu, verbleiben jedoch auf einem klinisch akzeptablen Niveau, sodass die Behandlungsmethode im Grenzbereich zur orthognathen Chirurgie auch bei longitudinaler Beobachtung empfohlen werden kann.

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Compliance with ethical guidelines

Conflict of interest. Bernd Zimmer and Sarah Schenk-Kazan state that there are no conflicts of interest.

Consent was obtained from all patients identifiable from images or other information within the manuscript. In the case of underage patients, consent was obtained from a parent or legal guardian.

Einhaltung ethischer Richtlinien

Interessenkonflikt. Bernd Zimmer und Sarah Schenk-Kazan geben an, dass kein Interessenkonflikt besteht.

Alle Patienten, die über Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts zu identifizieren sind, haben hierzu ihre schriftliche Einwilligung gegeben. Im Falle von nicht mündigen Patienten liegt die Einwilligung eines Erziehungsberechtigen oder des gesetzlich bestellten Betreuers vor.

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Authors and Affiliations

  1. Orthodontic Specialist Practice, Teichstr. 24, 34130, Kassel, Germany

    B. Zimmer

  2. Klinik für Kieferorthopädie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Kassel, Deutschland

    S. Schenk-Kazan

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  1. B. Zimmer
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  2. S. Schenk-Kazan
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Correspondence to B. Zimmer.

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Zimmer, B., Schenk-Kazan, S. Dental compensation for skeletal Class III malocclusion by isolated extraction of mandibular teeth. J Orofac Orthop 76, 251–264 (2015). https://doi.org/10.1007/s00056-015-0287-3

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  • DOI: https://doi.org/10.1007/s00056-015-0287-3

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