kat|ona|e for Lxtract|ons of 1eeth |n Crthodont|c 1reatment

1he exLracLlon versus nonexLracLlon debaLe has raged over many years 8esearch can be found
supporLlng or refuLlng Lhe beneflLs of exLracLlon and lL ls Lhls unpredlcLablllLy and uncerLalnLy wlLh
whlch lndlvldual pracLlLloners musL quesLlon when decldlng upon Lhe usefulness of exLracLlons as
parL of Lhelr Lallored LreaLmenL plan 1he followlng presenLs Lhe raLlonale for exLracLlon of LeeLh ln
orLhodonLlc LreaLmenL and assoclaLed sLudles supporLlng Lhls approach ConLralndlcaLlons Lo LooLh
exLracLlon wlll noL be generally consldered Lhus lL ls lmporLanL Lo keep ln mlnd LhaL alLhough
exLracLlons may be warranLed ln some slLuaLlons nonexLracLlon LreaLmenL ls conslderably more
effecLlve ln oLhers
n|stor|ca| trends |n extract|on treatment
1he exLracLlon of LeeLh for orLhodonLlc LreaLmenL prlor Lo 1900 was a prevalenL buL lndlscrlmlnaLe
process (10) lrom Lhe Lurn of Lhe cenLury Lo Lhe mldLhlrLles Angle moved Lhe speclalLy away from
exLracLlons Lo a relaLlvely rlgld nonexLracLlon LreaLmenL phllosophy (10)
Angle's phllosophy cenLred upon every lndlvldual as havlng Lhe poLenLlal for an ldeal relaLlonshlp of
all 32 naLural LeeLh and Lherefore exLracLlon for orLhodonLlc purposes was never needed (30) Pe
came Lo belleve LhaL skeleLal sLrucLures were so adapLable LhaL [usL rubber bands connecLlng Lhe
upper Lo Lhe lower LeeLh could overcome lmproper [aw relaLlonshlps as dlfferenL paLLerns of
pressure assoclaLed wlLh LreaLmenL could change growLh Lo overcome Class ll and Class lll problems
lor Angle proper orLhodonLlc LreaLmenL for every paLlenL lnvolved expanslon of Lhe denLal arches
and rubber bands as needed Lo brlng Lhe LeeLh lnLo occluslon and exLracLlon was noL necessary for
sLablllLy of resulL or aesLheLlcs
ulssaLlsfled wlLh relapslng Class ll cases recurrence and aggravaLlon of crowdlng and whaL he felL
were blmaxlllary full faces 1weed and oLhers clrca 1933 redlrecLed Lhe professlon back Lo
exLracLlons wlLh a more dlsclpllned approach Lo LreaLmenL by Lhe removal of four flrsL premolars
(10) 8eLreaLmenL of paLlenLs who had experlenced relapse produced beLLer faclal aesLheLlcs and a
more sLable occluslon afLer LreaLmenL was compleLed (30) Slnce Lhe accepLed concepL was LhaL
orLhodonLlc LreaLmenL could noL affecL faclal growLh exLracLlon was consldered necessary Lo
accommodaLe Lhe LeeLh Lo dlscrepancles ln [aw poslLlon as well as Lo overcome crowdlng caused by
LooLh[aw dlscrepancles and was done for elLher or boLh purposes (30)
rof||e changes |n extract|on treatment
1hose who favour nonexLracLlon have ofLen presumed LhaL exLracLlon LreaLmenL Lends Lo dlsh ln
Lhe face Lhose who favour exLracLlon on Lhe oLher hand ofLen presume Lhe llps Lend Lo be blown
ouL" by excesslve lnclsor flarlng (12) 1he varlablllLy ln research resulLs has led Lo Lhls lmpasse ln
Lerms of proflle effecLs of exLracLlon LreaLmenL varlable changes durlng LreaLmenL posLLreaLmenL
and ln Lhe longLerm also lend Lo Lhe confuslon as Lo lf and when exLracLlons sh ould be consldered
lrequenLly subsLanLlal lmprovemenLs ln proflle wlLh premolar exLracLlons [usLlfy Lhe exLracLlon of
Lhese LeeLh (2434) wlLh a slgnlflcanLly greaLer reducLlon ln hard and sofL Llssue proLruslon
compared Lo nonexLracLlon groups (46) 1hus four flrsL premolar exLracLlons may produce Lhe
deslred reLruslve LreaLmenL ouLcome ln Lhe case of a proLruslve paLlenL
Wllllams and Poslla (24) compared Lhe efflcacy of molars Lo premolars and found Lhe exLracLlon of
four flrsL molars resulLed ln less lnclsor reLracLlon Lhan cases LreaLed wlLh exLracLlon of four flrsL
premolars or maxlllary flrsL premolars and mandlbular second premolars LxLracLlon of premolars
and use of Lhls space Lo reLracL proLruslve lnclsors appears Lo be Lhe mosL effecLlve exLracLlon
sequence 1he sLlcklng polnL ls subsLanLlal daLa exlsLs showlng mlnlmal posLLreaLmenL proflle
dlfferences beLween exLracLlon and nonexLracLlon paLlenLs (121417) CephalomeLrlc evaluaLlons
generally show slgnlflcanL sofL Llssue proflle changes from posLLreaLmenL Lo long Lerm buL Lhe
changes are noL slgnlflcanLly dlfferenL beLween exLracLlon and nonexLracLlon groups (131617)
Luppanapornlarp eL al (46) found boLh exLracLlon and nonexLracLlon groups underwenL essenLlally
Lhe same change durlng Lhe posLLreaLmenL perlod decreased proflle convexlLy and a paLLern of
denLal change/relapse LhaL was correlaLed wlLh anLeroposLerlor mandlbular dlsplacemenL 1hese
resulLs suggesL LhaL alLhough exLracLlon may be warranLed Lo decrease severe proLruslon long
Lerm dlfferences ln proflle ls noL greaLly lmproved by one LreaLmenL meLhod over Lhe oLher 1hls ls
supporLed by aqueLLe eL al (13) who found LhaL Lhe declslon for 33 exLracLlon and 30 non
exLracLlon sub[ecLs had been parLly based on dlfferences ln denLal proLruslon Saelens and SmlLs
second premolar exLracLlon group began wlLh a more proLruslve denLlLlon Lhan Lhe nonexLracLlon
group also lndlcaLlng Lhe degree of proLruslon could have been declslve as Lo wheLher or noL
exLracLlons were performed no exLracLlons were performed ln paLlenLs wlLh moderaLe crowdlng
and no proLruslve denLal poslLlons (23)
AnoLher lssue ls wheLher Lhe dlfferences can be percelved lL has been shown LhaL exLracLlon faces
are flaLLer dlrecLly afLer LreaLmenL and are preferred over nonexLracLlon faces by denLlsLs and
laypeople wlLh Lhe denLlsLs preferrlng flaLLer faces more Lhan laypersons (16) 1reaLmenL of Class ll
ulvlslon l maloccluslons (18) also showed preference for changes ln Lhe exLracLlon group
AL oLher Llmes premolar exLracLlon can lead Lo whaL ls someLlmes called Lhe orLhodonLlc look or
dlshedln proflle (2434) 1hls unaesLheLlc ouLcome ls more llkely due Lo poor case selecLlon
however Lhan lllprlnclples ln Lhe use of exLracLlon Lechnlques 1here ls also greaL lndlvldual
varlablllLy ln Lhe response Lo LreaLmenL 8esearchers such as urobocky eL al (34) and
Luppanapornlarp eL al (46) have shown LhaL Lhe common bellef LhaL premolar exLracLlon frequenLly
causes dlshed ln proflles dlsLallsed mandlbles and ulLlmaLely cranlomandlbular dysfuncLlon
cannoL be supporLed 1he posLLreaLmenL forward mandlbular movemenL offers llLLle supporL for
Lhe noLlon LhaL exLracLlon produces dlsLal condylar dlsplacemenL and LhaL Lhls dlsplacemenL
produces 1Mu (46)
As Lhere has been no clear relaLlon beLween LreaLmenL modallLy and Lhe proflle preferences of
orLhodonLlsLs and laypeople lL cannoL be concluded LhaL 1 Lype of LreaLmenL produces beLLer or
worse longLerm proflles Lhan Lhe oLher WheLher L eeLh were exLracLed had no bearlng on wheLher
Lhe proflles goL beLLer or worse (12) WlLhln Lhe approprlaLe lndlcaLlons however exLracLlon Lherapy
has been shown Lo produce good occlusal resulLs wlLhouL unfavourable changes ln Lhe faclal proflle
(23)

er|a| Lxtract|on
Serlal exLracLlon ls based on Lhe premlse LhaL ln Lhe mlxed denLlLlon sLage lL ls posslble Lo predlcL
wheLher Lhe lncrease ln arch slze and lnLercanlne wldLh wlll noL be sufflclenL Lo accommodaLe all Lhe
permanenL LeeLh ln regular allgnmenL (27) 1hls pracLlce was lnlLlally advocaLed Lo reduce or
ellmlnaLe subsequenL appllance Lherapy buL now ls looked upon as a way of reduclng Lhe severlLy of
a developlng maloccluslon an ad[uncL Lo laLer LreaLmenL and a means Lo make comprehenslve
LreaLmenL easler and ofLen qulcker (30)
ln cases of severe crowdlng LhaL requlres exLracLlon serlal exLracLlon sLarLlng from Lhe mlxed
denLlLlon sLage ls a valld meLhod of LreaLmenL (26) ?oshlhara eL al (26) found Lhe proporLlon of
severe anLerlor crowdlng decreased slgnlflcanLly as serlal exLracLlon proceeded Powever Lhere was
a sponLaneous lmprovemenL wlLh age afLer Lhe LreaLmenL flnlshed no aggravaLlon of Lhe average
crowdlng level was found durlng Lhe observaLlon perlod 1hls sLudy quanLlLaLlvely suggesLs LhaL
serlal exLracLlon ls useful for Lhe purpose of correcLlng or reduclng crowdlng ln mosL Class l cases
(26)
ln uewel's analysls of Lhe raLlonale for serlal exLracLlon Lherapy he sald (31) cllnlcally exLracLlon ls
noL a radlcal soluLlon ln Lhese exLreme arch reducLlon lrregularlLles lnsLead lL can be consldered a
conservaLlve LreaLmenL measure lf relapse and fallure are Lo be avolded
Serlal exLracLlon reduces Lhe lengLh of Llme of acLlve appllances AcLlve orLhodonLlc LreaLmenL ls
normally used ln mosL cases Lo lmprove overblLe Lorque space and angulaLlon whlch resulLs from
serlal exLracLlon Lherapy (26) LlLLle eL al (29) found average LreaLmenL Llmes for serlal exLracLlon
cases was 12 monLhs compared Lo nearly Lwlce LhaL flgure for Lhe laLe exLracLlonLreaLed cases
AlLhough serlal exLracLlon may requlre more observaLlon vlslLs fewer monLhs of acLlve Lherapy are
requlred As Craber sald (32) Such mechanoLherapy (comprehenslve LreaLmenL followlng serlal
exLracLlon) ls usually of slgnlflcanLly shorLer duraLlon lL ls llkely Lo produce less damage and Lhe
resulLs are more sLable"
ersson eL al (28) found sponLaneous changes wlLhln Lhe denLlLlon afLer serlal flrsL premolar
exLracLlons reduced Lhe maloccluslon level MosL cases were found aL followup Lo demonsLraLe a
redevelopmenL of crowdlng however alLhough less pronounced Lhan before LlLLle eL al (29)
concluded arch lengLh and wldLh decrease along wlLh lncreased crowdlng was Lhe Lyplcal posL
reLenLlon flndlng ln Lhelr flrsL premolar serlal exLracLlon cases 1hese sLudles refuLe clalms serlal
exLracLlon cases would produce more sLable resulLs lnconcluslve evldence on longLerm sLablllLy
however does not appear to [ust|fy om|tt|ng ser|a| extract|on techn|ques |f they are |nd|cated
Longterm tab|||ty
ConLroversy exlsLs as Lo wheLher exLracLlon or nonexLracLlon LreaLmenL wlll evenLually lead Lo
orLhodonLlc sLablllLy 8ossouw eL al (9) found no slgnlflcanL dlfferences beLween exLracLlon and
nonexLracLlon LreaLmenLs concludlng LhaL Lhe correcL lnlLlal LreaLmenL cholce wlll noL only lead Lo
correcLlon of Lhe maloccluslon buL wlll also ensure cllnlcally accepLable sLablllLy
Lven when dlfferences where noLed confllcLlng resulLs once agaln muddle Lhe declslon Lo exLracL
SLudles have found LhaL premolar exLracLlon does noL necessarlly guaranLee posLLreaLmenL sLablllLy
of lower anLerlor allgnmenL (3343) ln conLrasL posLreLenLlon mandlbular lnclsor sLablllLy afLer
premolar exLracLlon has been reporLed by several researchers (4344) Cne could argue LhaL lf Lhe
resulLs are noL very sLable elLher way Lhere ls no reason Lo sacrlflce LeeLh lL can also be argued LhaL
lf exLracLlon cases ofLen are unsLable nonexLracLlon would be worse (36)
LongLerm archlengLh reducLlons of 23mm LhaL ls apparenLly lndependenL of LreaLmenL sLraLegy
or Lype of class ll has been documenLed (1348) 1hls suggesLs exLracLlon paLlenLs are beLLer able Lo
accommodaLe Lhls posLLreaLmenL change compared Lo nonexLracLlon cases As a resulL Lhe
exLracLlon paLlenLs were shown Lo lmprove whereas Lhe nonexLracLlon paLlenLs worsened (46)
Lower Anter|or Crowd|ng
1he exLracLlon of prlmary canlnes has been suggesLed as a meLhod ln reduclng anLerlor lrregularlLy
(30) reLreaLmenL evaluaLlon of Saelen's flrsL premolar exLracLlon group found an arch lengLh
dlscrepancy nearly Lwlce as large as Lhe oLher groups 1hls hlgh mean value for crowdlng could Lhus
be a facLor ln Lhls exLracLlon declslon (23) 8ecenL sLudles have shown LhaL unaccepLable lower
anLerlor crowdlng occurs ln 90 per cenL of wellLreaLed exLracLlon cases 1he lmpllcaLlon ls LhaL non
exLracLlon cases should be 90 per cenL or hlgher (10) uesplLe llLLle research Lo daLe demonsLraLlng
Lhls Lo be Lrue Lhe greaLer space requlred ln nonexLracLlon cases for wellallgned lnclsors ln Lheory
suggesLs exLracLlon Lherapy may be lndlcaLed for Lhe severely crowded paLlenL
1h|rd Mo|ar Lxtract|on
Ceneral consensus has been reached on exLracLlng mandlbular Lhlrd molars when Lhey are lnvolved
ln paLhologlc processes Powever early exLracLlon ls advlsable ln cases of erupLlon dlsLurbances of
Lhe mandlbular second molar before or durlng orLhodonLlc LreaLmenL ln Lhese cases elLher Lhe
presence of Lhe Lhlrd molar presenLed an obsLacle ln Lhe erupLlon paLh of Lhe second or Lhlrd molar
germ removal was consldered beneflclal Lo Lhe course of orLhodonLlc LreaLmenL Larly exLracLlon of
Lhe mandlbular Lhlrd molar faclllLaLes Lhe erupLlon of Lhe second molar especlally ln cases where
evldence of crowdlng and lack of space ln Lhe posLerlor mandlbular reglon exlsL (11)
ln 1979 a llsL of crlLerla for Lhlrd molar removal was developed focuslng prlmarlly on paLhologlc
condlLlons as a sLrong lndlcaLlon for removal of Lhlrd molars (40) 1hls was laLer expanded Lo lnclude
'prevenLlve or prophylacLlc removal Lo faclllLaLe orLhodonLlc LooLh movemenL and promoLe denLal
sLablllLy Lhe presence of orLhodonLlc abnormallLles (eg arch lengLh/LooLh slze dlscrepancles) a
LooLh lnLerferlng wlLh orLhognaLhlc surgery and lnsufflclenL space Lo accommodaLe Lhe erupLlng
LooLh or LeeLh (41) 1here are several LreaLmenL ob[ecLlves (42) whlch are noL llkely Lo be achleved
unless Lhlrd molars are exLracLed as parL of Lhe orLhodonLlc LreaLmenL plan (39)
Several orLhodonLlc advanLages exlsL ln removlng Lhlrd molars as parL of flxed appllance Lherapy
1he mosL obvlous ls ln cases ln whlch severe crowdlng exlsLs and flrsL premolar exLracLlons are parL
of Lhe plan Larly exLracLlon wlll faclllLaLe Lhe dlsLal movemenL of Lhe flrsL and second molars whlch
may be parL of Lhe mechanlcs plan SlmulLaneous exLracLlon of premolars and Lhlrd molars ln
younger paLlenLs may afford conslderable blologlcal and economlc beneflL Lo Lhe paLlenL (39) 1hlrd
molars should also be removed before or durlng LreaLmenL ln paLlenLs requlrlng orLhognaLhlc
surgery 1hese LeeLh have Lhe poLenLlal Lo lnLerfere wlLh Lhe surglcal procedure and ln parLlcular
can dlsrupL mandlbular osLeoLomles lf noL removed several monLhs before surgery (39)
Cne of Lhe mosL conLroverslal lssues regardlng mandlbular Lhlrd molars has been Lhelr lnfluence on
crowdlng of mandlbular lnclsors especlally afLer orLhodonLlc LreaLmenL Several sLudles have
supporLed boLh sldes of Lhe conLroversy (49) A recenL arLlcle suggesLs LhaL exLracLlon of lmpacLed
Lhlrd molars should be consldered ln paLlenLs undergolng nonexLracLlon orLhodonLlc LreaLmenL for
crowded mandlbular lnclsors or who wlll have a LlghL anLerlor occluslon afLer orLhodonLlc
LreaLmenL (49)
|max|||ary rotrus|on
1an (2) sLudled orLhodonLlc correcLlon of blmaxlllary proLruslon ln Chlnese adulL paLlenLs and found
favourable sofL Llssue and denLal changes afLer Lhe exLracLlon of four premolars Lew (3) also
reporLed slgnlflcanL lmprovemenL ln upper and lower lnclsor proLruslon nasolablal angle upper and
lower llp lengLh and upper and lower llp proLruslon ln an Aslan populaLlon A sLudy lnvolvlng a more
eLhnlcally dlverse group (1) showed Lhe exLracLlon of four premolars Lo be exLremely successful ln
Lhe reLracLlon and reLrocllnaLlon of boLh maxlllary and mandlbular lnclsors resulLlng ln a reducLlon
of denLal and sofL Llssue procumbency and convexlLy ln paLlenLs wlLh blmaxlllary proLruslon
AlLhough kurz (4) also demonsLraLed greaLly lmproved faclal proflles ln exLracLlon cases several
oLher sLudles on Lhe amounL of proflle lmprovemenL ln paLlenLs LreaLed wlLh four premolar
exLracLlon have shown resulLs LhaL have varled greaLly (37) Cverall Lhe currenL research provldes a
sLronger evldencebased raLlonale for Lhls LreaLmenL modallLy
Anky|os|s
Ankylosed prlmary LeeLh wlLh permanenL successors are a poLenLlal allgnmenL problem for Lhe
permanenL LeeLh 1hls can delay Lhe erupLlng permanenL LooLh or deflecL lL from Lhe normal
erupLlon paLh ManagemenL conslsLs of exLracLlon and space managemenL lf requlred (30)
Ankylosed LeeLh wlLh no successor should be exLracLed before a large verLlcal occlusal dlscrepancy
develops Lo avold longLerm perlodonLal problems (37)
Anter|or Crossb|te
lf a developlng anLerlor crossblLe ls dlscovered before erupLlon ls compleLe and overblLe has noL
been esLabllshed Lhe ad[acenL prlmary LeeLh can be exLracLed Lo provlde Lhe necessary space Lo
correcL Lhe problem Lven afLer lnclsal erupLlon and overblLe has been esLabllshed exLracLlon of Lhe
ad[acenL LeeLh ls sLlll an opLlon Lo ensure adequaLe space for LooLh movemenL (30)
Contemporary v|ew to extract|on treatment
ln orLhodonLlcs Lhere are Lwo ma[or reasons Lo exLracL LeeLh (1) Lo provlde space Lo allgn Lhe
remalnlng LeeLh ln Lhe presence of severe crowdlng and (2) Lo allow LeeLh Lo be moved (usually
lnclsors Lo be reLracLed) so proLruslon can be reduced or so skeleLal Class ll or Class lll problems can
be camouflaged (30) WlLh exLracLlon of LeeLh Lo provlde space for Lhe necessary LooLh movemenL
ofLen lL ls posslble Lo obLaln correcL molar and lnclsor relaLlonshlps desplLe an underlylng skeleLal
Class ll or Class lll [aw relaLlonshlp (30)
1he cholce beLween exLracLlon and nonexLracLlon ls a crlLlcal aesLheLlc declslon for some paLlenLs
who are Loward Lhe exLremes of lnclsor proLruslon or reLruslon SLablllLy ls also a crlLlcal facLor for
Lhese paLlenLs (30) LxLracLlon declslons have Lo be made noL only by conslderlng Lhe amounL of
crowdlng buL also Lhe evenLual lnfluence of orLhodonLlc LooLh dlsplacemenL on Lhe sofL Llssue
surface of Lhe face (23) 1he cholce of LreaLmenL sLraLegles (exLracLlon or nonexLracLlon) appears Lo
be of llLLle longLerm funcLlonal slgnlflcance (4647) Lach Lends Lo produce a characLerlsLlc
reperLolre of addlLlve effecLs and Lherefore each would be an approprlaLe answer Lo a dlfferenL
Lype of maloccluslon 1he facL LhaL premolar exLracLlon has produced no obvlous funcLlonal or
aesLheLlc penalLles lmplles LhaL Lhere ls no presslng blologlcal need Lo search for alLernaLlves Lo
exLracLlon when lL ls lndlcaLed (46)
C|ass I II and III |nd|cat|ons
ConLemporary guldellnes for orLhodonLlc exLracLlon ln class l crowdlng and/or proLruslon can be
summarlsed as follows (30)
Severe lnclsor proLruslon or ln a few lnsLances a severe verLlcal dlscrepancy when Lhere ls
less Lhan 4mm arch lengLh dlscrepancy
Arch lengLh dlscrepancy 39mm exLracLlon depends on hard and sofL Llssue characLerlsLlcs
of Lhe paLlenL and how Lhe flnal poslLlon of Lhe lnclsors wlll be conLrolled
Arch lengLh dlscrepancy 10mm or more exLracLlon almosL always requlred Lo obLaln enough
space 1he cholce ls four flrsL premolars or perhaps upper flrsL premolars and mandlbular
laLeral lnclsors second premolar or molar exLracLlon ls rarely saLlsfacLory
Lxtract|on of spec|f|c teeth
lmpocteJ teetb lf LeeLh are lmpacLed or ecLoplc exLracLlon of an erupLed LooLh can gulde Lhe paLh
of erupLlon and avold Lhe need for surgery LxLracLlon of a LooLh under local anaesLheLlc ls less
LraumaLlc Lhan removal of an lmpacLed LooLh
5ecooJ molots rellef of mlld premolar crowdlng ln Lhe early permanenL denLlLlon LrupLlon of Lhe
Lhlrd molar requlres revlew and laLer orLhodonLlc LreaLmenL may be needed (30)
Conc|us|on
When examlnlng research behlnd Lhe raLlonale for exLracLlons of LeeLh ln orLhodonLlc LreaLmenL Lhe
ouLcomes are aL besL mlxed no deflnlLlve evldence supporLs Lhe concepL of excluslve use of
exLracLlon Lherapy llkewlse no research deflnes nonexLracLlon LreaLmenL as Lhe answer 8oLh have
advanLages and llmlLaLlons ln Lhelr ablllLy Lo achleve a saLlsfacLory resulL 1he lnconcluslveness of
exLracLlons as an evldencebased pracLlce reflecLs LhaL lLs use musL be lndlvldually consldered when
formlng a LreaLmenL plan Careful Llmlng of exLracLlons can resulL ln sponLaneous correcLlon of a
maloccluslon




8eferences

1 8llls uA Pandelman CS 8eCole LA 8lmaxlllary uenLoalveolar roLruslon 1ralLs and CrLhodonLlc CorrecLlon Angle CrLhod
2003 73 (3) 333339
2 1an 1! roflle changes followlng orLhodonLlc correcLlon of blmaxlllary proLruslon wlLh a pread[usLed edgewlse appllance
lnL ! AdulL CrLhod CrLhognaLh Surg 1996 11 239231
3 Lew k roflle changes followlng orLhodonLlc LreaLmenL of blmaxlllary proLruslon ln adulLs wlLh Lhe 8egg appllance Lur !
CrLhod 1989 11 373381 ClLed by 8llls uA Pandelman CS 8eCole LA Angle CrLhod 2003 73 (3) 333339
4 kurz C 1he use of llngual appllances for correcLlon of blmaxlllary proLruslon Am ! CrLhod uenLofaclal CrLhop 1997 112
337363
3 ulels 8M kalra v ueLoach n owers M nelson SS Changes ln sofL Llssue proflle of AfrlcanAmerlcans followlng exLracLlon
LreaLmenL Angle CrLhod 1993 63 283292
6 1alass Ml 1alass L 8aker 8C SofLLlssue proflle changes resulLlng from reLracLlon of maxlllary lnclsors Am ! CrLhod
uenLofaclal CrLhop 1987 91 383394
7 Chlasson 8C SofL 1lssue Changes ln 8lack CrLhodonLlc aLlenLs masLers Lhesls Chlcago lll unlverslLy of llllnols aL
Chlcago 1996 ClLed by 8llls uA Pandelman CS 8eCole LA Angle CrLhod 73 (3) 333339
8 McCaul Lk !enklns WMM kay L! 1he reasons for Lhe exLracLlon of varlous LooLh Lypes ln ScoLland a 13year follow up !
uenL 2001 29(6) 401407
9 8ossouw L resLon C8 Lombard C A longlLudlnal evaluaLlon of exLracLlon versus nonexLracLlon LreaLmenL wlLh speclal
reference Lo Lhe posLLreaLmenL lrregularlLy of Lhe lower lnclsors Semlnars ln CrLhodonLlcs 1999 3(3) 160170
10 8ramanLe MA ConLroversles ln orLhodonLlcs 8evlew uenLal Cllnlcs of norLh Amerlca 1990 34(1) 91102
11 kavadla S AnLonlades k kaklamanos L eL al Larly exLracLlon of Lhe mandlbular Lhlrd molar ln case of erupLlon dlsLurbances
of Lhe second molar ! uenL Chlld (Chlc) 2003 70(1) 2932
12 SLephens Ck 8oley !C 8ehrenLs 8C Alexander 8C 8uschang P LongLerm proflle changes ln exLracLlon and
nonexLracLlon paLlenLs Am ! CrLhod uenLofaclal CrLhop 2003 128(4) 430437
13 aqueLLe uL 8eaLLle !8 !ohnsLon LL A longLerm comparlson of nonexLracLlon and premolar exLracLlon edgewlse Lherapy
ln borderllne" Class ll paLlenLs Am ! CrLhod uenLofaclal CrLhop 1992 102 114
14 8lshara SL Cummlns uM !akobsen !8 Zaher A8 uenLofaclal and sofL Llssue changes ln Class ll ulvlslon 1 cases LreaLed
wlLh and wlLhouL exLracLlons Am ! CrLhod uenLofaclal CrLhop 1993 107 2837
13 8lshara SL Cummlns uM Zaher A8 1reaLmenL and posLLreaLmenL changes ln paLlenLs wlLh Class ll ulvlslon 1 maloccluslon
afLer exLracLlon and nonexLracLlon LreaLmenL Am ! CrLhod uenLofaclal CrLhop 1997 111 1827
16 8owman S! !ohnsLon LL 1he esLheLlc lmpacL of exLracLlon and nonexLracLlon LreaLmenL on Caucaslan paLlenLs Angle
CrLhod 2000 70 310
17 ZlerhuL LC !oondeph u8 rLun ! LlLLle 8M LongLerm proflle changes assoclaLed wlLh successfully LreaLed exLracLlon and
nonexLracLlon Class ll ulvlslon 1 maloccluslons Angle CrLhod 2000 70 208219
18 8lshara SL !akobsen !8 roflle changes ln paLlenLs LreaLed wlLh and wlLhouL exLracLlons assessmenLs by lay people Am !
CrLhod uenLofaclal CrLhop 1997 112 639644
19 nanda 8S Meng P kaplla S Coorhuls ! CrowLh changes ln Lhe sofL Llssue faclal proflle Angle CrLhod 1990 60 177190
ClLed by SLephens Ck 8oley !C 8ehrenLs 8C Alexander 8C 8uschang P Am ! CrLhod uenLofaclal CrLhop 2003 128(4)
430437
20 llnnoy ! WlsLh ! 8oe CL Changes ln sofL Llssue proflle durlng and afLer orLhodonLlc LreaLmenL Lur ! CrLhod 1987 9
6878 ClLed by SLephens Ck 8oley !C 8ehrenLs 8C Alexander 8C 8uschang P Am ! CrLhod uenLofaclal CrLhop 2003
128(4) 430437
21 SLrombonl ? laclal aesLheLlcs ln orLhodonLlc LreaLmenL wlLh and wlLhouL exLracLlons Lur ! CrLhod 1979 1(3) 201206
22 vlg S WelnLraub !A 8rown C kowalskl C! 1he duraLlon of orLhodonLlc LreaLmenL wlLh and wlLhouL exLracLlons a plloL
sLudy of flve selecLed pracLlces Am ! CrLhod uenLofaclal CrLhop 1990 97(1) 4331
23 Saelens nA ue SmlL AA 1herapeuLlc changes ln exLracLlon versus nonexLracLlon orLhodonLlc LreaLmenL Lur ! CrLhod
1998 20 223236
24 Wllllams 8 Poslla 1he effecL of dlfferenL exLracLlon slLes upon lnclsor reLracLlon Am ! CrLhod 1976 69 388410 ClLed by
Saelens nA ue SmlL AA Lur ! CrLhod 1998 20 223236
23 ue CasLro n Second premolar exLracLlon ln cllnlcal pracLlce Am ! CrLhod 1974 63 113137 ClLed by Saelens nA ue SmlL
AA Lur ! CrLhod 1998 20 223236
26 ?oshlhara 1 MaLsumoLo ? Suzukl ! SaLo n Cguchl P LffecL of serlal exLracLlon alone on crowdlng 8elaLlonshlps beLween
LooLh wldLh arch lengLh and crowdlng Am ! CrLhod uenLofaclal CrLhop 1999 116(6) 691696
27 uewel 8l Serlal exLracLlon ln orLhodonLlcs lndlcaLlons ob[ecLlves and LreaLmenL procedures Am ! CrLhod 1934 40 906
926 ClLed by ?oshlhara 1 MaLsumoLo ? Suzukl ! SaLo n Cguchl P Am ! CrLhod uenLofaclal CrLhop 1999 116(6) 691
696
28 ersson M ersson LC Skaglus S LongLerm sponLaneous changes followlng removal of all flrsL premolars ln Class l cases
wlLh crowdlng Lur ! CrLhod 1989 11 271282 ClLed by ?oshlhara 1 MaLsumoLo ? Suzukl ! SaLo n Cguchl P Am ! CrLhod
uenLofaclal CrLhop 1999 116(6) 691696
29 LlLLle 8M 8ledel 8A LngsL Lu Serlal exLracLlon of flrsL premolars posLreLenLlon evaluaLlon of sLablllLy and relapse Angle
CrLhod 1990 60(4) 233262
30 rofflL W8 ConLemporary CrLhodonLlcs 3rd ed SL Louls Mosby 2000
31 uewel 8l A crlLlcal analysls of serlal exLracLlon ln orLhodonLlc LreaLmenL Am ! CrLhod 1939 43 424433 ClLed by LlLLle
8M 8ledel 8A LngsL Lu Angle CrLhod 1990 60(4) 233262
32 Craber 1M Serlal exLracLlon a conLlnuous dlagnosLlc and declslonal process Am ! CrLhod 1971 60 341373 ClLed by
LlLLle 8M 8ledel 8A LngsL Lu Angle CrLhod 1990 60(4) 233262
33 LlLLle 8M 8ledel 8A ArLun ! An evaluaLlon of changes ln mandlbular anLerlor allgnmenL from 10 Lo 20 years posLreLenLlon
Am ! CrLhod uenLofalclal CrLhop 1988 93 423428
34 urobocky C8 SmlLh 8! Changes ln faclal proflle durlng orLhodonLlc LreaLmenL wlLh exLracLlon of four flrsL premolars Am !
CrLhod uenLofac CrLhop 1989 93 220230
33 Mc8eynolds uC LlLLle 8M Mandlbular second premolar exLracLlon posLreLenLlon evaluaLlon of sLablllLy and relapse
Angle CrLhod 1991 61 133144 ClLed by rofflL W8 ConLemporary CrLhodonLlcs 3rd ed
36 8urke S Sllvelra AM ColdsmlLh L! eL al A meLaanalysls of mandlbular lnLercanlne wldLh ln LreaLmenL and posLreLenLlon
Angle CrLhod 1998 68 3360 ClLed by rofflL W8 ConLemporary CrLhodonLlcs 3rd ed
37 kurol ! 1hllander 8 lnfraoccluslon of prlmary molars wlLh aplasla of Lhe permanenL successor a longlLudlnal sLudy Angle
CrLhod 1984 34 283294 ClLed by rofflL W8 ConLemporary CrLhodonLlcs 3rd ed
38 8asdra Lk SLellzlg A komposch C LxLracLlon of maxlllary second molars ln Lhe LreaLmenL of Class ll maloccluslon Angle
CrLhod 1996 66 287292 ClLed by rofflL W8 ConLemporary CrLhodonLlcs 3rd ed
39 8eeman CS 1hlrd Molar ManagemenL A Case for 8ouLlne 8emoval ln AdolescenL and ?oung AdulL CrLhodonLlc aLlenLs !
Cral Maxlllofac Surg 1999 37 824830
40 naLlonal lnsLlLuLes of PealLh Consensus uevelopmenL Conference 8emoval of 1hlrd Molars WashlngLon uC naLlonal
lnsLlLuLes of PealLh 1979 ClLed by 8eeman CS ! Cral Maxlllofac Surg 1999 37 824830
41 arameLers of Care for Cral and Maxlllofaclal Surgery A Culde for racLlce MonlLorlng and LvaluaLlon (AACMS
arameLers of Care93) ! Cral Maxlllofac Surg 1993 33 1 (suppl 3) ClLed by 8eeman CS ! Cral Maxlllofac Surg 1999 37
824830
42 Amerlcan 8oard of CrLhodonLlcs lnformaLlon for CandldaLes 1997 ClLed by 8eeman CS ! Cral Maxlllofac Surg 1999 37
824830
43 Sadowsky C Sakols L LongLerm assessmenL of orLhodonLlc relapse Am ! CrLhod 1982 82 436 ClLed by 8eeman CS ! Cral
Maxlllofac Surg 1999 37 824830
44 uhde M Sadowsky C 8egole L LongLerm sLablllLy of denLal relaLlonshlps afLer orLhodonLlc LreaLmenL Angle CrLhod
1983 33 240 ClLed by 8eeman CS ! Cral Maxlllofac Surg 1999 37 824830
43 Shlelds 1L LlLLle 8M Chapko Mk SLablllLy and relapse of mandlbular anLerlor allgnmenL A cephalomeLrlc appralsal of flrsL
premolarexLracLlon cases LreaLed by LradlLlonal edgewlse orLhodonLlcs Am ! CrLhod 1983 87(1) 2738
46 Luppanapornlarp S !ohnsLon LL 1he effecLs of premolar exLracLlon A longLerm comparlson of ouLcomes ln 'clearcuL
exLracLlon and nonexLracLlon Class ll paLlenLs Angle CrLhod 1993 63(4) 237272
47 8eaLLle !8 aqueLLe uL !ohnsLon LL 1he funcLlonal lmpacL of exLracLlon and nonexLracLlon LreaLmenLs A longLerm
comparlson ln paLlenLs wlLh 'borderllne equallysuscepLlble Class ll maloccluslons Am ! CrLhod uenLofac CrLhop 1993
ClLed by Luppanapornlarp S !ohnsLon LL Angle CrLhod 1993 63(4) 237272
48 LlLLle 8M Wallen 18 8ledel 8A SLablllLy and relapse of mandlbular anLerlor allgnmenL llrsL premolar exLracLlon cases
LreaLed by LradlLlonal edgewlse orLhodonLlcs Am ! CrLhod 1981 80 349363 ClLed by Luppanapornlarp S !ohnsLon LL
Angle CrLhod 1993 63(4) 237272
49 eLerson L! 8aLlonale for 8emovlng lmpacLed 1eeLh When Lo exLracL or noL Lo exLracL ! Am uenL 1992 123 198204
30 1ravess P 8oberLsParry u Sandy ! CrLhodonLlcs arL 8 LxLracLlons ln orLhodonLlcs 8rlL uenL ! 2004 196(4) 193203