Extraer o no extraer dientes en los tratamientos ortodóncicos. Influencia de las extracciones dentarias sobre el perfil facial

Résumé

Introduction: One of the most transcendental problems in orthodontics (with, perhaps, the exception of deciding whether to treat a case or not) is to decide to perform a treatment with or without extraction of teeth, as well as to avoid the negative consequences of such a decision upon the esthetics of the facial profile. Patients and methods: A study was made of 31 patients with dental malocclusions of the Angle class I and class II types, with a mean overjet greater than 5.5 mm. All of them were treated with fixed appliances and edgewise technique. Fifteen patients did not undergo extraction of teeth (group without extractions), while sixteen underwent extractions of four premolars (group with extractions). Data was obtained from the corresponding lateral radiographs of the head taken both before and after orthodontic treatment. The main aim of our study was to compare the response of the soft and hard tissues of the facial profile in class I and class II malocclusions treated with the extraction of four premolars and the response of borderline cases presenting with similar malocclusions but not subjected to extraction. In this latter group reasonable doubt existed as to whether or not to remove teeth to solve the occlusal and aesthetic problems. Results: Significant differences between groups at the end of treatment were few. At the Ievel of hard tissues they were limited to a more retruded position of the incisors (only observed with the Ricketts analysis, but not with the Steiner analysis) and a lesser overbite amongst those patients subjected to extraction. On the other hand, the main soft tissue differences between the groups at the end of treatment were a more retruded lower lip and a more pronounced lower labial sulcus in those patients subjected to extraction. Conclusions: A conservative strategy when planning treatment in borderline cases, where there is a reasonable doubt over whether or not to extract teeth, allows to minimize the risk of making irreversible mistakes and can greatly enhance the efficacy of treatment.