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Short-term effects of systematic premolar extraction on lip profile, vertical dimension and cephalometric parameters in borderline patients for extraction therapy—a retrospective cohort study

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Abstract

Objectives

The belief of many orthodontists that premolar extraction therapy leads to a loss of vertical dimension and an aggravated facial profile often predetermines a non-extraction approach. We investigated the short-term effects of systematic premolar extraction in borderline cases for extraction therapy on dentofacial parameters, especially vertical dimension and facial profile.

Materials and methods

Of 50 juvenile borderline cases for extraction treatment with a distinct sagittal overjet of 6–9 mm and dental crowding of >6 mm, 25 had all first premolars extracted, whereas the 25 control patients received non-extraction orthodontic treatment with corresponding fixed and removable appliances. Patient selection by multivariate cluster analysis ensured homogeneity at baseline regarding dentoskeletal parameters. Parameter changes were determined with radiographic cephalograms and compared between the extraction and non-extraction group.

Results

The systematic extraction of premolars in borderline patients with a distinct sagittal overjet and crowding did not significantly influence sagittal or vertical skeletal dimension, while leading to a slightly more concave lip profile due to incisor retraction compared to the non-extraction control group.

Conclusions

The influence of premolar extractions on facial profile is often overestimated, since only slight changes in lip profile are to be expected. In integrated treatment planning, the extraction decision should not be primarily based on concerns about the aggravation of facial profile and loss of vertical dimension.

Clinicial relevance

The decision, whether to extract healthy premolars in borderline patients for extraction therapy, is difficult to make. Our study clarifies the repercussions on cephalometric dentofacial parameters, facilitating future orthodontic extraction decisions.

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Conflict of interest

The authors declare that they have no competing interests.

Compliance with ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Human and animal rights and informed consent

This article does not contain any studies with animals performed by any of the authors. Informed consent was obtained from all individual participants included in the study.

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Authors and Affiliations

  1. Department of Orthodontics, University Medical Centre of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany

    Christian Kirschneck, Peter Proff & Claudia Reicheneder

  2. Department of Orthodontics, University of Muenster, Waldeyerstraße 30, 48149, Muenster, Germany

    Carsten Lippold

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  1. Christian Kirschneck
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  2. Peter Proff
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Correspondence to Christian Kirschneck.

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Kirschneck, C., Proff, P., Reicheneder, C. et al. Short-term effects of systematic premolar extraction on lip profile, vertical dimension and cephalometric parameters in borderline patients for extraction therapy—a retrospective cohort study. Clin Oral Invest 20, 865–874 (2016). https://doi.org/10.1007/s00784-015-1574-5

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