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Compensation of skeletal Class III malocclusion by isolated extraction of mandibular teeth

Part 2: Skeletal, dentoalveolar and soft tissue parameters in comparison with nonextraction Class III therapies

Kompensation der skelettalen Klasse III mit isolierten Unterkieferextraktionen

Teil 2: Skelettale, dentoalveoläre und Weichgewebeparameter im Vergleich mit Klasse-III-Behandlung ohne Extraktion

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

Abstract

Objectives

To retrospectively compare two compensatory approaches taken in skeletal Class III patients during the main treatment stage, including a study group of multiband treatment plus isolated extraction of mandibular teeth and a control group of multiband treatment without extraction of teeth.

Patients and methods

The extraction group included 22 (12 female, 10 male) patients receiving compensatory multiband treatment for a mean of 3.47 ± 1.14 years and 16.22 ± 1.92 years old at debonding. The nonextraction group included 24 (14 female, 10 male) patients undergoing multiband treatment for 2.76 ± 1.28 years and 15.38 ± 1.46 years old at debonding. Lateral cephalograms obtained at baseline and upon completion of active treatment were traced for skeletal, dentoalveolar, and soft tissue parameters. Welch and Wilcoxon tests were used to analyze intergroup differences (initial values, final values, initial-to-final changes) and within-group differences (p < 0.05).

Results

Upon completion of active treatment, the only significant intergroup differences were noted for U1NA and L1ML. Significant within-group changes over the courses of treatment were seen for SNB, MLNL, U1NA, U1NL, L1NB, L1ML, H-angle, ULipEL, and LLipEL (extraction group) or for SNB, ANB, individual ANB, Wits appraisal, U1NA, U1NL, H-angle, Naslab-a, ULipEL, and LLipEL (nonextraction group). Parameters that changed by significantly different amounts in both groups included Wits appraisal, L1NB, L1ML, and LLipEL.

Conclusion

The added value of isolated extraction therapy basically lies in increasing the potential for retruding the lower incisor inclinations, so that compensatory treatment becomes an option even in selected patients presenting with adverse occlusal situations that would otherwise require orthognathic surgery. Given the successful outcomes in both groups, which had been established by Peer Assessment Rating (PAR) scores, it was possible to define the skeletal, dentoalveolar, and soft tissue characteristics of successful treatment more precisely than before.

Zusammenfassung

Ziele

In der vorliegenden Arbeit sollten zwei kompensatorische Ansätze für die Hauptbehandlungszeit skelettaler Klasse-III-Patienten verglichen werden. Dazu dienten eine Gruppe mit Multibandbehandlung plus isolierter Unterkieferzahnextraktion und eine Kontrollgruppe, bei der eine Multiband-Behandlung ohne Extraktion zum Einsatz kam.

Patienten und Methoden

Die Extraktionsgruppe bestand aus 22 Patienten (12 weiblich, w, 10 männlich, m), die über im Mittel 3,47 ± 1,14 Jahre eine kompensatorische Multiband-Behandlung erhielten und zum Zeitpunkt des Debondings im Mittel 16,22 ± 1,92 Jahre alt waren. Die Gruppe ohne Extraktion bestand aus 24 (14 w, 10 m) Patienten, die sich für im Mittel 2,76 ± 1,28 Jahre einer Multiband-Behandlung unterzogen und bei Debonding im Mittel bzw. 15,38 ± 1,46 Jahre alt waren. Die vor Behandlungsbeginn und nach Beendigung der aktiven Behandlungsphase erstellten Fernröntgenseitbilder wurden zur Erhebung von skelettalen, dentoalveolären und Weichgewebeparametern durchgezeichnet. Zur Analyse von Inter- (Werte vor Beginn und nach Beendigung der aktiven Behandlung, Veränderungen im Intervall) und Intragruppenunterschieden (p < 0,05) dienten der Welch- und der Wilcoxon-Test.

Ergebnisse

Nach Beendigung der aktiven Behandlungsphase wurden signifikante Unterschiede zwischen den Gruppen lediglich für U1NA und L1ML beobachtet. Signifikante Intragruppenveränderungen im Laufe der Behandlung zeigten sich für SNB, MLNL, U1NA, U1NL, L1NB, L1ML, H-Winkel, ULipEL und LLipEL (Extraktionsgruppe) bzw. für SNB, ANB, individuelle ANB, Wits-Appraisal, U1NA, U1NL, H-Winkel, Naslab-a, ULipEL und LLipEL (Nichtextraktionsgruppe). Zu den Parametern, die sich in beiden Gruppen in signifikant unterschiedlichem Ausmaß veränderten, zählten Wits-Appraisal, L1NB, L1ML und LLipEL.

Schlussfolgerungen

Der zusätzliche Wert einer isolierten Extraktionsbehandlung liegt darin begründet, dass sie das Potenzial für die Bewegung der Schneidezahninklination nach lingual erhöht. Damit kann eine kompensatorische Behandlung auch für ausgewählte Patienten mit einer ungünstigen Okklusionslage, bei denen andernfalls eine chirurgische orthognathe Intervention erforderlich wäre, zu einer Therapieoption werden. Angesichts der mittels PAR (Peer Assessment Rating)-Indizes als erfolgreich eingestuften Therapie-Outcomes in beiden Gruppen war es möglich, skelettale, dentoalveoläre und Weichgewebeparameter einer erfolgreichen Behandlung genauer als bisher zu definieren.

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Authors and Affiliations

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

    Bernd Zimmer

  2. Department of Orthodontics, Georg-August University, Göttingen, Germany

    Sarah Gaida & Henning Dathe

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  1. Bernd Zimmer
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  2. Sarah Gaida
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Correspondence to Bernd Zimmer.

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Bernd Zimmer, Sarah Gaida, and Henning Dathe state that there are no conflicts of interest.

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Zimmer, B., Gaida, S. & Dathe, H. Compensation of skeletal Class III malocclusion by isolated extraction of mandibular teeth. J Orofac Orthop 77, 119–128 (2016). https://doi.org/10.1007/s00056-016-0016-6

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