Effects of Unilateral Maxillary Premolar Extraction on Smile Aesthetics: A Retrospective Study

Authors

  • Seyed Moahammad Reza Safavi Department of Orthodontics, Dentofacial Deformities Research Center, Research Institute for Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • Anahita Dehghani Soltani Department of Orthodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • Saeed Reza Motamedian Department of Orthodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • Alireza Akbarzadeh Baghban Proteomics Research Center, Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
  • Samin Ghaffari Department of Orthodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Keywords:

Unilateral Premolar Extraction; Dental Midline Deviation; Smile Arc; Aesthetic

Abstract

Background: Unilateral maxillary premolar extraction (UMPE) has been recommended for the orthodontic treatment of specific dental asymmetries. This study has aimed to compare the extraction side and non-extraction side within the same patient to assess the impact of UMPE on specific dental and aesthetic outcomes. Materials and Methods: In this retrospective investigation at department of orthodontics, school of Dentistry, Shahid Beheshti University of Medical Sciences (SBMU), post treatment documents of 40 patients, who underwent UMPE in their completed orthodontic treatments, were selected. Upper dental midline, smile arc and number of visible teeth in final smile photographs was assessed. Evaluations were analyzed using SPSS 18. Results: Analyses showed a positional deviation of upper dental midline in 90% of patients by average of 1.0±0.5 mm, the angular deviation of dental midline in 87.5% of patients toward the extraction side by average of 0.83°±0.27° and an elevated smile arc for 0.43 mm in extraction side. Moreover, the evaluations showed a mean of 5 and 4.52 visible teeth in the non-extraction and the extraction sides, respectively. Conclusion: The current study showed that in the treatment with UMPE the smile indices can be end very close to absolute symmetry and the asymmetries that still exists are negligible and will not affect the aesthetic results of the treatment.

References

RodenJohnson D, Gallerano R, English J. The effects of buccal corridor spaces and arch form on smile esthetics. Am J Orthod Dentofacial Orthop. 2005;127(3):34350.

https://doi.org/10.1016/j.ajodo.2004.02.013

PMid:15775949

Castiblanco Gómez A, Criado Pacheco C, López Burgos C. Determinación de parámetros para evaluar la sonrisa en ortodoncia y su aplicación a beldades colombianas. Rev Latinoam Ortod. 1996;2(3):7186.

Van der Geld P, et al. Smile attractiveness: selfperception and influence on personality. Angle Orthod. 2007;77(5):75965.

https://doi.org/10.2319/082606-349

PMid:17685777

Londoño Bolívar MÁ, Botero Mariaca P. The smile and its dimensions. Rev Fac Odontol Univ Antioquia. 2012;23(2):25365.

Machado AW. 10 commandments of smile esthetics. Dental Press J Orthod. 2014;19(4):13657.

https://doi.org/10.1590/2176-9451.19.4.136-157.sar

PMid:25279532 PMCid:PMC4296640

Struhs TW. Effects of unilateral. extraction treatment on arch: symmetry and occlusion; 2005.

Janson GR, et al. Threedimensional evaluation of skeletal and dental asymmetries in Class II subdivision malocclusions. Am J Orthod Dentofacial Orthop. 2001;119(4):40618.

https://doi.org/10.1067/mod.2001.113267

PMid:11298314

Rose JM, et al. Mandibular skeletal and dental asymmetry in Class II subdivision malocclusions. Am J Orthod Dentofacial Orthop. 1994;105(5):48995.

https://doi.org/10.1016/S0889-5406(94)70010-9

PMid:8166099

Shroff B, Lindauer SJ, Burstone CJ. Class II subdivision treatment with tipback moments. Eur J Orthod. 1997;19(1):93101.

https://doi.org/10.1093/ejo/19.1.93

PMid:9071050

Robb SI, et al. Effectiveness and duration of orthodontic treatment in adults and adolescents. Am J Orthod Dentofacial Orthop. 1998;114(4):3836.

https://doi.org/10.1016/S0889-5406(98)70182-9

PMid:9790321

Vig PS, et al. The duration of orthodontic treatment with and without extractions: a pilot study of five selected practices. Am J Orthod Dentofacial Orthop. 1990;97(1):4551.

https://doi.org/10.1016/S0889-5406(05)81708-1

PMid:2296943

Shetty S, Kumar A. Unusual extraction combinations in orthodontics - A literature review. Int J Oral Health Dent. 2020;6:1936.

https://doi.org/10.18231/j.ijohd.2020.040

Kılıç EP, Gümüş EB. Evaluation of the Effects of Asymmetric Premolar Extraction Treatment on Arch Form and Symmetry. Akdeniz Diş Hekimliği Dergisi. 2023;2(3):1209.

BeGole EA, Fox DL, Sadowsky C. Analysis of change in arch form with premolar expansion. Am J Orthod Dentofacial Orthop. 1998;113(3):30715.

https://doi.org/10.1016/S0889-5406(98)70302-6

PMid:9517723

Torsello F, et al. Relationships between facial features in the perception of profile attractiveness. Prog Orthod. 2010;11(2):927.

https://doi.org/10.1016/j.pio.2010.04.002

PMid:20974445

Kim E, Gianelly AA. Extraction vs nonextraction: arch widths and smile esthetics. Angle Orthod. 2003;73(4):3548.

Wertz RA. Diagnosis and treatment planning of unilateral Class II malocclusions. Prog Orthod. 1975;45(2):8594.

Janson G, et al. Smile attractiveness in patients with Class II division 1 subdivision malocclusions treated with different tooth extraction protocols. Eur J Orthod. 2014;36(1):18.

https://doi.org/10.1093/ejo/cjr079

PMid:21771805

Janson G, et al. Influence of orthodontic treatment, midline position, buccal corridor and smile arc on smile attractiveness: A systematic review. Angle Orthod. 2011;81(1):15361.

https://doi.org/10.2319/040710-195.1

PMid:20936969 PMCid:PMC8926359

Johnson DK, Smith RJ. Smile estheties after orthodontic treatment with and without extraction of four first premolars. Am J Orthod Dentofacial Orthop. 1995;108(2):1627.

https://doi.org/10.1016/S0889-5406(95)70079-X

PMid:7625391

Kokich Jr V, Kiyak H, Shapiro P. Comparing the perception of dentists and lay people to altered dental esthetics (reprint). Adv Esthetics Interdisciplin Dent. 2005;1(1):2033.

Kokich Jr VO, Kiyak HA, Shapiro PA. Comparing the perception of dentists and lay people to altered dental esthetics. J Esthet Restor Dent. 1999;11(6):31124.

https://doi.org/10.1111/j.1708-8240.1999.tb00414.x

PMid:10825866

Graber LW, et al. Orthodonticsebook. current principles and techniques: Elsevier Health Sciences; 2016.

Rosner B, Tworoger S, Qiu W. Correcting AUC for measurement error. J Biom Biostat. 2015;6(5):270.

https://doi.org/10.4172/2155-6180.1000270

PMid:28458954 PMCid:PMC5409172

Janson G, et al. Class II subdivision treatment success rate with symmetric and asymmetric extraction protocols. Am J Orthod Dentofacial Orthop. 2003;124(3):25764.

https://doi.org/10.1016/S0889-5406(03)00406-2

PMid:12970659

Pinho S, et al. Impact of dental asymmetries on the perception of smile esthetics. Am J Orthod Dentofacial Orthop. 2007;132(6):74853.

https://doi.org/10.1016/j.ajodo.2006.01.039

PMid:18068592

Johnston CD, Burden DJ, Stevenson MR. The influence of dental to facial midline discrepancies on dental attractiveness ratings. Eur J Orthod. 1999;21(5):51722.

https://doi.org/10.1093/ejo/21.5.517

PMid:10565092

Burstone CJ. Diagnosis and treatment planning of patients with asymmetries. Semin Orthod: Elsevier; 1998.

https://doi.org/10.1016/S1073-8746(98)80017-0

PMid:9807152

Shroff B, Siegel SM. Treatment of patients with asymmetries using asymmetric mechanics. Semin Orthod: Elsevier; 1998.

https://doi.org/10.1016/S1073-8746(98)80018-2

PMid:9807153

Choma NM, Madiba TK, Sethusa P. Buccal corridor changes in orthodontically treated extraction and nonextraction Class 1 patients. S Afr Dent J. 2022;77(5):25863.

https://doi.org/10.17159/2519-0105/2022/v77no5a1

Chiche GJ, Pinault A. Esthetics of anterior fixed prosthodontics. Vol 1: Quintessence Publishing Company; 1994.

Ashish K, et al. Decision in Class II Subdivision Malocclusions Treatment: Three Case Reports with Contrasting Strategies. J Contemp Orthod. 2020;4:610.

Fiorentino G, Melsen B. Asymmetric mandibular space closure. J Clin Orthod. 1996;30(9):519.

Gianelly AA, et al. Asymmetric space closure. Am J Orthod Dentofacial Orthop. 1986;90(4):33541.

https://doi.org/10.1016/0889-5406(86)90090-9

PMid:3464195

Jones O, Ortiz C, Schlein RJ. Orthodontic management of a patient with Class I malocclusion and severe crowding. Am J Orthod Dentofacial Orthop. 1990;98(3):18996.

https://doi.org/10.1016/S0889-5406(05)81595-1

PMid:2206039

Lima MH, Oliveira JH, Tanaka OM. Extraçöes assimétricas de dentes permanentes na correçäo da linha mediana. J Bras Ortodon Ortop Facial. 2002;7(37):7886.

Whitley JB Jr. A Class II, Division 1 malocclusion: a malocclusion with a significant mandibular arch length deficiency. Am J Orthod Dentofacial Orthop. 1996;110(6):68893.

https://doi.org/10.1016/S0889-5406(96)80049-7

PMid:8972818

Rebellato J. Asymmetric extractions used in the treatment of patients with asymmetries. Semin Orthod: Elsevier; 1998.

https://doi.org/10.1016/S1073-8746(98)80019-4

PMid:9807154

Melgaço CA, Araújo MT. Asymmetric extractions in orthodontics. Dental Press J Orthod. 2012;17(2):1516.

https://doi.org/10.1590/S2176-94512012000200025

Anistoroaei D, et al. The prevalence of facial asymmetry in preorthodontic treatment. Int J Med Dent. 2014;4:21015.

Dahiya G, et al. Effects of unilateral premolar extraction treatment on the dental arch forms of Class II subdivision malocclusions. Am J Orthod Dentofacial Orthop. 2017;152(2):23241.

https://doi.org/10.1016/j.ajodo.2017.04.013

PMid:28760285

Downloads

Published

2025-12-15

How to Cite

Safavi, S. M. R., Dehghani Soltani, A., Motamedian, S. R., Akbarzadeh Baghban, A., & Ghaffari, S. (2025). Effects of Unilateral Maxillary Premolar Extraction on Smile Aesthetics: A Retrospective Study. Galen Medical Journal, 14(SP1), 4002. Retrieved from https://journals.salviapub.com/index.php/gmj/article/view/4002