Korean J Orthod.  2018 Jul;48(4):224-235. 10.4041/kjod.2018.48.4.224.

Comparison of treatment effects between four premolar extraction and total arch distalization using the modified C-palatal plate

• Jo SY
• Bayome M
• Park J
• Lim HJ
• Kook YA
• Han SH

• KMID: 2417964
• DOI: http://doi.org/10.4041/kjod.2018.48.4.224

Abstract

OBJECTIVE
The purpose of this study was to compare the skeletal, dental, and soft-tissue treatment effects of nonextraction therapy using the modified C-palatal plate (MCPP) to those of premolar extraction (PE) treatment in adult patients with Class II malocclusion.
METHODS
Pretreatment and posttreatment lateral cephalographs of 40 adult patients with Class II malocclusion were retrospectively analyzed. The MCPP group comprised 20 patients treated with total arch distalization of the maxillary arch while the PE group comprised 20 patients treated with four PE. Fifty-eight linear and angular measurements were analyzed to assess the changes before and after treatment. Descriptive statistics, paired t-test, and multivariate analysis of variance were performed to evaluate the treatment effects within and between the two groups.
RESULTS
The MCPP group presented 3.4 mm of retraction, 1.0 mm of extrusion, and 7.3° lingual inclination of the maxillary central incisor. In comparison, the PE group displayed greater amount of maxillary central incisor retraction and retroclination, mandibular incisor retraction, and upper lip retraction (5.3 mm, 14.8°, 5.1 mm, and 2.0 mm, respectively; p < 0.001 for all). In addition, the MCPP group showed 4.0 mm of distalization and 1.3 mm of intrusion with 2.9° distal tipping of the maxillary first molars.
CONCLUSIONS
These findings suggest the MCPP is an effective distalization appliance in the maxillary arch. The amount of incisor retraction, however, was significantly higher in the PE group. Therefore, four PE may be recommended when greater improvement of incisor position and soft-tissue profile is required.

Keyword

Orthodontic implant; Adult treatment; Extraction vs. nonextraction; Modified C-palatal plate

MeSH Terms

Adult
Bicuspid*
Humans
Incisor
Lip
Malocclusion
Molar
Multivariate Analysis
Retrospective Studies

Figure

• 

  Figure 1 Linear cephalometric variables used for analyzing the effects of four premolar extraction or the modified C-palatal plate. Pt, Pterygoid; Or, orbitale; U, upper; L, lower; UL, upper lip; LL, lower lip; FH, Frankfort horizontal plane; HRL, horizontal reference line; VRL, vertical reference line; TVL, true vertical line; MeGo, menton to gonion line; Perp to MeGo, perpendicular line to MeGo passing the pogonion; 1, U1 crown to HRL; 2, U1 crown to VRL; 3, U1 apex to HRL; 4, U1 apex to VRL; 5, U6 crown to HRL; 6, U6 crown to VRL; 7, U6 apex to HRL; 8, U6 apex to VRL; 9, U7 crown to HRL; 10, U7 crown to VRL; 11, U7 apex to HRL; 12, U7 apex to VRL; 13, L1 crown to HRL; 14, L1 crown to VRL; 15, L1 apex to HRL; 16, L1 apex to VRL; 17, L6 crown to HRL; 18, L6 crown to VRL; 19, L6 apex to HRL; 20, L6 apex to VRL; 21, L7 crown to HRL; 22, L7 crown to VRL; 23, L7 apex to HRL; 24, L7 apex to VRL; 25, overjet; 26, overbite; 27, UL to TVL; 28, LL to TVL; 29, soft tissue A point to VRL; 30, soft tissue B point to VRL.

• 

  Figure 2 Angular cephalometric variables used for analyzing the effects of four premolar extraction or the modified C-palatal plate. SN, Sella-nasion; FH, Frankfort horizontal plane; Go, gonion; Me, menton; U, upper; L, lower; 1, SNA; 2, ANB; 3, occlusal plane angle; 4, SN to mandibular plane angle; 5, U1 to FH angle; 6, U6 to FH angle; 7, U7 to FH angle; 8, L1 to FH angle; 9, L6 to FH angle; 10, L7 to FH angle; 11, nasolabial angle; 12, mentolabial angle.

• 

  Figure 3 Linear and angular cephalometric variables in reference to the mandible for analyzing the effects of four premolar extraction or the modified C-palatal plate. Go, Gonion; Me, menton; mVRL, mandibular vertical reference line; Perp to, perpendicular to; L, lower; 1, L1 crown to mVRL; 2, L1 crown to GoMe; 3, L1 apex to mVRL; 4, L1 apex to GoMe; 5, L6 crown to mVRL; 6, L1 crown to GoMe; 7, L6 apex to mVRL; 8, L6 apex to GoMe; 9, L7 crown to mVRL; 10, L7 crown to GoMe; 11, L7 apex to mVRL; 12, L7 apex to GoMe; 13, L1 to GoMe angle; 14, L6 to GoMe angle; 15, L7 to GoMe angle.

• 

  Figure 4 Mid-treatment oral photographs in the premolar extraction and nonextraction (modified C-palatal plate) groups. A, Extraction treatment; B, Nonextraction treatment.

• 

  Figure 5 Representative changes in the lower third of the face based on the pretreatment (left) and posttreatment (right) lateral cephalographs in the premolar extraction and nonextraction groups. A, Extraction treatment; B, Nonextraction treatment.

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