A LONG-TERM COMPARISON OF NONEXTRACTION AND PREMOLAR EXTRACTION EDGEWISE THERAPY IN BORDERLINE CLASS-II PATIENTS

The long-term effects of extraction and nonextraction edgewise treatments were compared in 63 patients with Class II, Division 1 malocclusions who were identified by discriminant analysis as being equally susceptible to the two strategies. A lateral cephalogram, study models, and a self-evaluation of the esthetic impact of treatment were obtained from each of the 33 extraction and 30 nonextraction subjects. The average posttreatment interval was 14.5 years. Although the two strategies produced significant, long-lived differences in the convexity of the profile and the protrusion of the dentition (the nonextraction patients were about 2 mm "fuller"), half of the nonextraction patients and three fourths of the extraction patients ultimately presented with less than 3.5 mm of lower incisor irregularity. The two groups showed an essentially identical pattern of Posttreatment relapse/settling that was related more to the differential growth of the jaws than to the posttreatment position and orientation of the denture. Because in the end the various tooth movements tended to cancel one another, excess mandibular growth was also the most important net contributor to the molar and overjet corrections. In the process, both groups showed a marked forward displacement of the mandible, both at the chin and at the condyle. Finally, although it is probable that most of the present sample would today be treated by expansion, the 30 patients who actually received this presumably correct treatment rated their appearance no more highly than did the extraction subjects. On balance, our data provide little support for the popular concept of a single stable incisor angulation and for the troublesome claims that premolar extraction-as opposed to expansion and bite-jumping-must of necessity produce distal mandibular displacement and, in the process, flatten the profile enough to "ruin the face."