Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore.

CEPH!"#E$R%C E&!U$%"' "( "&ERB%$E ') &ER$%C!

CH'GES ("!!"*%'G (%RS$ PRE#"!R E+$RC$%"' %' H%GH
'G!E CSES , RE$R"SPEC$%&E S$U)-
By
)r. R#ESH G.C.
Dissertation Submitted to the
Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore.
In Partial fulfillment
of the requirements for the degree of
#S$ER "( )E'$! SURGER-
In Speciality of
"R$H")"'$%CS ') )E'$"(C%! "R$H"PE)%CS
Under the Guidance of
)r. RU'KU#R G.
Associate Professor
)e.art/ent of "rthodontics and )entofacial "rtho.edics
College of )ental Sciences,
)avangere.
01123 0114
II
I
II
III
IV
CK'"*!E)GE#E'$
This Dissertation represents the assistance and efforts of many individuals, the
contributions of whom I acnowled!e and to whom I !ive my thans"
I bow my head to the supreme force $HE !#%GH$-, drivin! me to my
destinations, I than them for havin! blessed me with his choicest blessin!s and
openin! the doors of opportunity to this adobe of nowled!e and havin! blessed me
with most lovin! family and teachers"
#ords are inade$uate to e%press my indebtedness and infinite respect for my
&G5r5' and G5ide, )R RU' KU#R G. Associate Professor, Department of
(rthodontics, )olle!e of Dental *ciences, Davan!ere. +is unfailin! willin!ness to
render help and lovin! !uidance, coupled with his rich nowled!e and een interest
have been a constant source of inspiration and bacbone of this study" ,ucy are the
few who are privile!ed to wor under him and imbibe priceless insi!hts into life" I
find myself deeply indebted to him for teachin! me the true values of life, imbibin! in
me his virtues of hard wor, truthfulness and love towards fellow human bein!s"
It is with utmost sincerity that I than my beloved Professor and +ead,
)r.G Shiva.rakash" A mere word of thans is not sufficient to e%press his solid
support, inspiration and unswervin! !uidance, durin! my post !raduation and in the
preparation of this dissertation" As his post !raduate student, I have not only
inculcated nowled!e in the art and science of orthodontics but also other human
$ualities of life" +is discipline, principles, scientific approach and lo!ical e%planation
to this art of orthodontics shall always be my !uidin! star"
V
It is with utmost sincerity that I than my beloved former Professor and +ead,
)r.n/ol S.Kalha" A mere word of thans is not sufficient to e%press his solid
support, inspiration and unswervin! !uidance, durin! my post !raduation and in the
preparation of this dissertation" To be his post !raduate student definitely !ives me
immense pleasure and honour"
The unflinchin! support and !uidance I received from all the faculty members
durin! my post-!raduate course leaves me with an overwhelmin! sense of profound
humbleness"
,et me at this .uncture, pen down my deepest appreciation towards my
teachers, )r.6#rs7 #ala Ra/ #anohar, Professor, )r. 'aveen Sha/n5r,
Associate Professor, )r.Pra8h5raj, Associate Professor, )r.U/ashankar, /eader,
)r. Shashi K5/ar, Asst" Professor, )r. nvar !atif, Asst" Professor, )olle!e of
Dental *ciences, Davan!ere for bein! my wheel of support and encoura!ement over
the last three years" It is with sincerest !ratitude that I than )r. !itesh Singla 9
)r. $ho/as, Assistant Professors, for !ivin! valuable insi!hts durin! the study and
durin! my post !raduation course"
At this .uncture my deepest !ratitude !oes to Sri. Sha/an5r
Shivashankara..a 0+on" *ecretary1, and )r.&.&. S588a Reddy 0Principal1, for
providin! me the ind of atmosphere, fully e$uipped with the near latest technolo!ies"
This acnowled!ement would be incomplete if I fail to mention
my 2ather Sri. CH''&EERPP, 3other S/t. G%R%:, Brother in-laws,
)R .R H'U#'$HPP and .G '$R: G"*), and *isters
S/t. SU)H and S/t. REKH and my 2amily 3embers" It is their love, prayers,
VI
many sacrifices and encoura!ement both morally and emotionally made it possible to
me ;hat % a/ today.
It would be unfair on my part if I do not mention my batch mates,
)r.ravind, )r. 'aveen, )r. #5rt5<a, )r. nk5sh and )r. )ivya, without them
this dissertation would have not been successful"
I would lie to than all my friends and especially j5niors for their whole
hearted support in completion of my post !raduate course"
#ith out the help of #r. Sanga/, our esteemed biostatistician, my wor
would have !one unappreciated"
I also than #r.S5rendra, Dyna )omputers for or!ani4in! and neatly typin!
this manuscript and r5na Printers, for their services rendered"
A special word of thans to the non teachin! staff, especially sister :esline,
:agdish, Santosh and 'eela..a, Geetha and #anj5la for the help rendered
whenever re$uired from them"

Place = )avangere.
)ate = )r. R#ESH G.C
VII
!%S$ "( BBRE&%$%"'S USE)
A5* Anterior nasal spine
B,6 Bodily movement of the mandibular incisors
2+ 2ranfort hori4ontal
Gn Gnathion
Go Gonion
+* +i!hly si!nificant
I P3 first premolar
II P3 *econd premolar
,6 3andibular )entral Incisor
,7 3andibular first molar
,A2+ ,ower anterior face hei!ht
35*8 3andibular seletal chan!e
3PA 3andibular plane an!le
39*8 3a%illary seletal chan!e
5 5asion
5* 5ot si!nificant
(P (cclusal plane
P:A Pre ad.usted ed!ewise appliance
P2+ Posterior face hei!ht
Po!v Po!onion vertical
* *ella
* *i!nificant
*v *ella vertical
TA2+ Total anterior face hei!ht
T,6 Tippin! movement of the mandibular incisors
TU6 Tippin! movement of the ma%illary incisors
U6 3a%illary )entral Incisor
U7 3a%illary first molar
UA2+ Upper anterior face hei!ht
BS$RC$
VIII
Back gro5nd 9 o8jectives = (rthodontists !enerally a!ree that non-e%traction
treatment is associated with downward and bacward rotation of the mandible and an
increase in the ,A2+" They also a!ree that e%traction line of treatment is associated
with upward and forward rotation of the mandible and decrease in the ,A2+" The
intent of this cephalometric investi!ation was to e%amine the popular hypothesis,
0wed!e hypothesis1 that the vertical dimension collapses after first bicuspid
e%traction" The present study was undertaen to evaluate the cephalometric overbite
and vertical chan!es followin! first premolar e%traction in hi!h an!le cases"
#ethods = A total of ;< adult patients havin! hi!h mandibular plane an!le i"e" Go!n =
*5 more than or e$ual to >; de!rees havin! class I molar and canine relation were
included" Pre and post treatment lateral cephalo!rams were measured and compared
to analy4e the cephalometric chan!es"
Res5lts = There was a si!nificant increase in the 3PA" There was no si!nificant
chan!e in the pre and post treatment overbite, total anterior face hei!ht, lower anterior
face hei!ht and posterior face hei!ht"
%nter.retation 9 Concl5sion = The study concluded that, There was no increase in
the vertical facial dimension and overbite and no clinically si!nificant increase in the
mandibular plane an!le" +owever it should be interpreted with caution, !iven the
small sample si4e" The facial comple% does increase in si4e with !rowth, but
mandibular plane while movin! inferiorly, remain essentially parallel to its
pretreatment position, due to residual !rowth and treatment"
Key ;ords? I premolar e%traction@ +i!h an!le@ #ed!e hypothesis@ ,ateral
cephalo!rams@ Adult"
I9
$B!E "( C"'$E'$S
PGE '".
>. %'$R")UC$%"' 1>
0. "B:EC$%&ES 1?
?. RE&%E* "( !%$ER$URE 1@
@. #E$H")"!"G- 0@
A. RESU!$S ?B
2. )%SCUSS%"' @@
C. C"'C!US%"' A1
B. SU##R- A>
4. B%B!%"GRPH- A0
>1. ''E+URES AB
9
!%S$ "( $B!ES
S!.'". $%$!E PGE '".
Table 6
D:2I5ITI(5 (2 ):P+A,(3:T/I)
,A5D3A/8* A5D 3:A*U/:3:5T* U*:D
I5 T+: *TUDA
;<
Table ;
P/: A5D P(*T T/:AT3:5T )(3PA/I*(5
(2 A5GU,A/ 3:A*U/:3:5T*
>B
Table >
P/: A5D P(*T T/:AT3:5T )(3PA/I*(5
(2 ,I5:A/ 3:A*U/:3:5T*
CD
Table C
P/: A5D P(*T T/:AT3:5T )(3PA/I*(5
(2 (V:/BIT: 3:A*U/:3:5T*
C6
9I
!%S$ "( (%GURES
S!.'". $%$!E
PGE
'".
2i!" 6
A/3A3:5TA/IU3 U*:D 2(/ T/A)I5G
/ADI(G/AP+*
;7
2i!" ; (V:/BIT: 3:A*U/:3:5T* U*:D I5 T+: *TUDA ;E
2i!" > A5GU,A/ 3:A*U/:3:5T* U*:D I5 T+: *TUDA ;B
2i!" C ,I5:A/ 3:A*U/:3:5T U*:D I5 T+: *TUDA >D
2i!" <
,A5D 3A/8* U*:D T( :VA,UAT: 3(,A/
)+A5G:*
>6
2i!" 7 P/: = T/:AT3:5T :9T/A (/A, P+(T(G/AP+* >>
2i!" F P/: = T/:AT3:5T I5T/A (/A, P+(T(G/AP+* >>
2i!" E P/: = T/:AT3:5T ,AT:/A, ):P+A,(G/A3 >C
2i!" B 3ID = T/:AT3:5T I5T/A (/A, P+(T(G/AP+* ><
2i!" 6D P(*T = T/:AT3:5T :9T/A (/A, P+(T(G/AP+* >7
2i!" 66 P(*T = T/:AT3:5T I5T/A (/A, P+(T(G/AP+* >7
2i!" 6; P(*T = T/:AT3:5T ,AT:/A, ):P+A,(G/A3 >F
9II
!%S$ "( GRPHS
S!.'". $%$!E PGE '".
Graph I
P/: = P(*T *IG5I2I)A5T A5GU,A/
3:A*U/:3:5T*
C;
Graph II
P/: = P(*T I5*IG5I2I)A5T A5GU,A/
3:A*U/:3:5T*
C;
Graph III
P/: = P(*T I5*IG5I2I)A5T ,I5:A/
3:A*U/:3:5T*
C;
Graph IV P/: = P(*T A5T:/I(/ T((T+ 3(V:3:5T* C>
Graph V P/: = P(*T 3(,A/ 3(V:3:5T* C>
9III
''E+URES
S!.'". $%$!E PGE '".
3aster )hart 6
P/: = P(*T A5GU,A/ ):P+A,(3:T/I)
3:A*U/:3:5T*
<F
3aster )hart ;
P/: = P(*T ,I5:A/ ):P+A,(3:T/I)
3:A*U/:3:5T*
<E
3aster )hart >
P/: = P(*T (V:/BIT: ):P+A,(3:T/I)
3:A*U/:3:5T*
<B
9IV
Introduction
%'$R")UC$%"'
The e%traction of permanent teeth has been a controversial topic throu!hout
(rthodontic history, be!innin! with the !reat e%traction debate between An!le and
)alvin case
6
and continuin! throu!h GohnstonHs comparison of e%traction and non-
e%traction outcomes in borderline cases"
;
The &no e%tractions under any
circumstances', An!le forces had been defeated by &e%tractions when necessary',
)ase forces on the stren!th of ar!ument supported by the overwhelmin!
preponderance of countervailin! scientific and clinical evidence"
>

*chudy
C-7
described facial types as &hypodiver!ent and hyperdiver!ent' and
recommended a none%traction approach in treatment of hypodiver!ent facial types
and an e%traction in hyperdiver!ent facial types &to close down the bite'" *assouni
and 5anda
F
concurred with this treatment sophy" Althou!h it is difficult to ar!ue
a!ainst e%traction and non-e%traction treatment, e%traction of permanent teeth is still a
valuable arrow in the orthodontists $uiver of options"
6

The primary reason for e%traction of permanent teeth are to correct the
discrepancy between tooth si4e and arch len!th to reduce bima%illary protrusion" The
first clinical concern i"e" lac of contact between the anterior teeth, or openbite,
several authors have su!!ested that removin! of permanent teeth from posterior
buccal se!ment with subse$uent protraction to close the spaces corrects the open bite
by anti-clocwise rotation of mandible" This rationale for e%traction is referred to as
&wed!e hypothesis'"
E

#hat role of e%traction play in the cause or cure of T3G disorders has been
actively debated in the dental literature" 2irst premolar e%tractions are considered by
many to be an etiolo!ic factor in T3G disorders" These persons believe that e%traction
6
Introduction
of premolars permits the posterior teeth to move forward resultin! in a decrease in the
vertical dimension of occlusion" The mandible is then allowed to overclose, and the
muscles of mastication become foreshortened, as a result T3G problems are liely to
occur" Althou!h this theory is popular, no controlled study has published results
supportin! this hypothesis" Another theory that has been proposed is that first
premolar e%tractions lead to over-retraction of anterior teeth, particularly the
ma%illary anteriors" This over relocation of anterior teeth is thou!ht to displace the
mandible and the condyle posteriorly resultin! in T3G disorders"
B

*ome disa!reement e%ists concernin! the effect of bicuspid e%tractions on the
vertical dimension" It has been su!!ested that orthodontic forward movement of the
posterior teeth after bicuspid e%tractions leads to a reduction in vertical dimension and
overclosure of the musculature" This is said to cause muscles to wor inefficiently
and to result in pain and fati!ue"
6D
*everal authors su!!ests that it re$uires special
effort in addition to bicuspid e%tractions, to reduce the vertical dimension in hi!h
mandibular plane an!le 03PA1 Grasis Pearson showed a mean decrease of >"B
o
in
3PA followin! first bicuspid e%traction, with vertical chin cups used before and
durin! orthodontic treatment"
66

;
Objectives
"B:EC$%&ES
&The ob.ective of the study is to evaluate vertical chan!es followin! first
premolar e%traction in hi!h an!le cases'"
>
Review of Literature
RE&%E* "( !%$ER$URE
An attempt has been made to analy4e tooth movements occurrin! in cases
treated by the removal of four second and four first premolars" Also, to outline
primarily the indications for the use of second premolar e%tractions" There does not
appear to be any dominatin! evidence from which conclusions can be drawn@
however, a few !enerali4ations may be permitted"
6" There seems to be an indication for mesial movement of molar teeth in certain
e%traction cases if commonly accepted ob.ectives are to be met consistently"
;" 3ore mesial movement of molars 0maintainin! !ood inclinations1 may be
accomplished throu!h second bicuspid e%traction than first bicuspid e%traction
when that is the ob.ective and the appliance is desi!ned accordin!ly"
>" #hen arch len!th discrepancy is F"< millimeters or less and there is no
indication for incisor retraction, it may be advisable to consider second rather
than first premolars if e%tractions are to be performed"
C" There apparently is variability that e%ists in mesial movement and mesial drift
of molars in different individuals" *ome factors involved may be?
a" *ta!e of dental development"
b" 5umber of unerupted molars"
c" (cclusion"
d" De!ree of arch crowdin!"
e" 3uscle balance"
Authors su!!est, once e%traction has been decided upon a further analysis as
to which teeth to remove should be considered, instead of acceptin! some may believe
to the only choice, namely, first premolars"
6;
C
Review of Literature
A study was conducted to evaluate over.et and overbite after orthodontic
treatment" Pretreatment, posttreatment and post- retention study models from fifty-
three orthodontically treated cases were e%amined at the *tate of 5ew Aor
Department of +ealth, Bureau of Dental +ealth" (verbite and over.et data were
assembled, statistically analy4ed, and tabulated for each of the different classes of
malocclusion leadin! to the followin! conclusions?
6" #hen total overbite correction and relapse were e%amined, the sample as a
whole showed continued posttreatment decrease in overbite" Both )lass I and
)lass III malocclusions e%hibited this same pattern while )lass II, Division 6
and Division ; malocclusions showed, respectively, >D per cent and 67 per
cent posttreatment increases in overbite"
;" The total over.et relapse in )lass I cases was five per cent and in )lass II,
Division 6 cases it was ten per cent" The whole sample showed a post-
treatment relapse in over.et of ei!ht per cent"
>" The avera!e relapse of those cases that did relapse was, at all times, less than
;"D mm in all parameters measured"
C" The ability to predict relapse potential needs to be assessed further accordin!
to more refined classifications of malocclusion, the types of treatment and the
characteristics of the patient"
6>

A study was carried out by utili4in! standard dia!nostic procedures in an
office, decisions were made on a number of e%traction cases, selectin! four first
premolars or four second premolars as the preferable teeth to remove" An effort was
made to determine whether there were some ob.ective variables which were
si!nificantly different for first premolar e%traction cases and second premolar
<
Review of Literature
e%traction cases" C> patients were studied with an avera!e a!e of 6; years, 0ran!e E">-
;;"E years1 which includes ;> !irls and ;D boys" Various measurements were used to
evaluate the chan!es in hard and soft tissue chan!es"
Authors concluded that, for the cephalometric indices used in this study and
the tooth-arch si4e discrepancy, there were no parameters which were si!nificantly
different" #hen soft-tissue measurements were included however, and a discriminant
computer analysis completed, it was discovered that the nose tip, the chin, the
mandibular plane and the relation of the lips to the :-line were statistically si!nificant
in determinin! whether the case was a first or second premolar e%traction case" The
combination of lips to :-line and lower left central to AP! 0an!le only1 was helpful in
classifyin! second premolar cases" It must be emphasi4ed that these parameters were
for the results of this sample only" 2urther, this entire study assumed that the
dia!nostician has already decided that the case bein! evaluated is indeed a case
re$uirin! sacrifice of dental units in both ma%illary and mandibular arches, and that
the e%traction site should be in the premolar area" In applyin! these formulae to a
specific patient they may serve as an aid to their dia!nosis" The additional utili4ation
of the nose len!th, chin len!th and mandibular plane an!le all used sin!ly, help to
identify where the patient varies from the above standard formula, when the formula
does not seem clinically applicable"
6C
A study conducted by means of corrected tomo!raphy, the positions of the
condyles in patients who had under!one four-premolar e%traction treatment 0;D
ed!ewise and F Be!!1 were compared with the condylar positions of patients who had
not yet received orthodontic treatment" 5o si!nificant between-!roup differences in
condylar position were noted" In addition, the relationship between bite depth and
condylar position was e%amined and no si!nificant correlation was found" Thus, as
7
Review of Literature
performed in this study, authors concluded that condylar position was unrelated to
e%traction treatment and to bite depth"
6<
A cephalometric study investi!ates that the chan!es in the facial seleton and
dento-alveolar structures which occur durin! orthodontic treatment of class II division
I malocclusion by e%traction of four first premolars followed by fi%ed appliances" The
Be!! and ed!ewise appliances are compared, and both are contrasted with a !roup of
untreated class II div I sub.ects" The main effects of treatment were in the dento-
alveolar structures, the chan!e in the in the overall facial pattern small and lar!ely due
to e%trusion of molars durin! overbite reduction" 3olar e%trusion tended to interrupt
forward !rowth rotation of the mandible, temporarily main! it more bacwards in
direction and increasin! lower anterior face hei!ht" An increase in the posterior lower
face hei!ht was also noted in the ed!ewise !roup" #hilst *5A, and therefore A5B,
reduced si!nificantly durin! treatment, this was probably the result of palatal root
tor$ue to the upper incisors" The Be!! appliance was more successful than ed!ewise
in this respect"
67
In a study, the effect of over.et and overbite correction in non-e%traction and
e%traction therapy in a class II malocclusion treated with ed!ewise appliance was
compared" The sub.ects were ;D children treated without e%traction and ;D children
treated with e%traction of four first premolars" Durin! the post-treatment period
relapse of over.et and overbite occurred in both !roups, however there was a
beneficial net effect of over.et and overbite correction in both !roups with no
si!nificant difference between the two !roups" A study showed that mandibular
intercanine width space conditions in the lower .aw and mandibular incisor position
were important factors in treatment plannin!"
6F

F
Review of Literature
The orthodontist has been both accused of causin! and complimented for
curin! temporomandibular dysfunction" To better understand the ori!ins of these
conflictin! opinions, a review of the orthodontic and temporomandibular .oint
.ournals was performed for articles published since 6B77" A total of B6 publications
that discussed the relationship between orthodontics and temporomandibular disorders
was found, and these articles were divided in three cate!ories? viewpoint publications,
case reports, and sample studies" Amon! the areas scrutini4ed in each cate!ory was
the method that has led to the diversity of viewpoints" 2rom this analysis, the
followin! conclusions were drawn? 061 viewpoint publications and case reports were
e%cessively represented in comparison with the number of sample studies@ 0;1
viewpoint publications and case reports described a wide variety of conflictin!
opinions on the relationship between orthodontics and temporomandibular disorders@
0>1 unlie sample studies, viewpoint publications and case reports have little or no
value in assessment of the relationship between orthodontics and temporomandibular
disorders@ 0C1 sample studies indicate that orthodontic treatment is not responsible for
creatin! temporomandibular disorders, re!ardless of the orthodontic techni$ue@ and
0<1 sample studies indicate that orthodontic treatment is not specific or necessary to
cure si!ns and symptoms of temporomandibular dysfunction"
C

A study was conducted to evaluate the condylar position followin! ma%illary
first premolars e%traction" )ondylar position in 6F patients whose )lass II treatment
06C with ed!ewise appliances and > with Be!! appliances1 included e%traction of the
ma%illary first premolars and in 6F control patients was compared by means of
corrected tomo!raphy" The condyles in both !roups were in an anterior position, and
there were no statistical differences between the !roups" In addition, no statistical
correlation was found when the posttreatment bite depth, interincisal an!le, and
E
Review of Literature
ma%illary incisor inclination were correlated with condylar position" Thus, as
determined in this study, condylar position was unrelated to treatment, bite depth,
interincisal an!le, and ma%illary incisor inclination"
6B
It has been ar!ued by a vocal coterie of disaffected dentists that premolar
e%traction, incisor retraction, and Ibacward-pullin!I mechanics conspire to
Idistali4eI the condyles and, pari passu, to produce craniomandibular dysfunction" C;
Ied!ewiseI patients with )lass II, Division 6 malocclusions, treated in con.unction
with the e%traction of two ma%illary first premolars" /e!ional and anterior cranial-
base cephalometric superimpositions were used to $uantify the individual components
of the molar and over.et corrections, to measure both at the chin and condyles the
mandibular displacement seen durin! treatment, and to e%amine the e%tent to which
this displacement is related to the correction of ma%illary incisor protrusion" Althou!h
the present patients underwent mared upper incisor retraction 0on avera!e, about <
mm1, lip retraction was much less pronounced, and FDJ of the sample showed a net
forward displacement of mandibular basal bone" *i!nificantly, chan!es in condylar
position were not correlated with incisor retraction, as the Ifunctional orthodontistsI
would have it, but rather with the chan!es in the buccal occlusion and the !rowth of
the ma%illa" Thus, >DJ of the patients who showed evidence of distal displacement
were !enerally non!rowin! patients who underwent more than avera!e anchora!e loss
in the mandible and less than avera!e loss in the ma%illa" /e!ardless of the direction
of basal displacement, however, condylar remodelin! apparently served to

stabili4e
the spatial position of surface landmars 0e"!", condylion1, an observation that
underscores the faulty of usin! any type of serial radio!raph to assess chan!es in
condylar position in the !rowin!, unimplanted patient"
;D

B
Review of Literature
A study was carried out evaluate the orthodontic ris factors for temporo-
mandibular disorders" There is )oncern about claims that premolar e%tractions may
put patients at ris for temporomandibular disorders 0T3D1" They have reported first
findin!s from a lon!itudinal study of orthodontic patients be!un in 6BE>" By usin! the
methods of +elimo, T3D data before initiation of orthodontic treatment, between D
and 6; months after debandin!, and 6; to ;C months after debandin!" Analyses
related +elimo scores with premolar e%tractions in 7< patients for whom orthodontic
treatment had been completed" Twenty-si% patients were treated without premolar
e%tractions, ;< had four premolars e%tracted, and 6C had two upper premolars
e%tracted" Tests for si!nificance of differences between mean +elimo scores were
conducted for the none%traction !roup compared with the e%traction !roups, and
between pretreatment and posttreatment +elimo scores for each !roup" /esults
included? 061 no si!nificant inter!roup differences between mean pretreatment or
posttreatment scores, and 0;1 small but statistically si!nificant 0p K D"D<1 differences
0in the direction of improvement1 between mean pretreatment and posttreatment
scores for both the none%traction !roup and for the four premolar e%traction !roup"
;6

Authors conducted a study to evaluate the effects of e%traction and
none%traction orthodontic treatment mechanics on patients with dolichofacial and
brachyfacial !rowth patterns between one and two standard deviations were studied"
Groups underwent treatment of either none%traction or e%traction of four premolars
with the appropriate mechanics for the facial type" )han!es in the facial a%is and
correlation between ma%illary molar movement and facial a%is chan!e were
measured" A positive correlation was found between the amount of anteroposterior
movement of the upper molar and chan!e in the facial a%is in brachyfacial and
dolichofacial patients under!oin! none%traction treatment" A wea correlation was
6D
Review of Literature
found in the e%traction treatment !roups" 5o statistically si!nificant difference was
found in the facial a%is chan!e amon! any of the !roups studied, re!ardless of facial
type or plan of treatment" There were indications of a more severe openin! of the
facial a%is 0Ba-5a plane to constructed !nathion1 with !reater de!rees of ma%illary
molar distal movement in both facial patterns studied"
;;
A study was carried out evaluate the effects of e%traction versus non-
e%traction orthodontic treatment on the !rowth of lower anterior face hei!ht" The
effect of (rthodontic treatment on the lower anterior face hei!ht 0A5* = 3e1 is of
fundamental importance to (rthodontist" +owever, the choice between the two
methods of treatment, e%traction versus non-e%traction, is not clear cut" It is believed
that the e%traction method decreases A5* = 3e, whereas non- e%traction method
results in increase in A5*-3e" This study e%amined both the methods on 6FC sub.ects
which were e$ually divided into class I and class II malocclusions" In addition to
!rowth and treatment duration, other factors lie the effects of treatment choice and
treatment mechanics were considered" The results showed that non-e%traction
treatment in class I and class II sub.ects is associated with si!nificant increase in
lower anterior face hei!ht" +owever e%traction treatment is not associated with any
si!nificant chan!e in A5*-3e"
;>

A lon! term study was done to compare the outcomes in clear cut e%traction
and non-e%traction class II patients" Discriminant analysis was used to assess the
anatomical basis of the e%tractionLnone%traction decision in ;>E former *aint ,ouis
University )lass II ed!ewise patients" The resultin! discriminant scores 0based on si%
measures of protrusion and crowdin!1 were used to divide this parent sample into
three pro!nostic sub!roups? clear-cut e%traction, clear-cut none%traction, and a
borderline stratum containin! both e%traction and none%traction patients" The Iclear-
66
Review of Literature
cutI patientsMthose at the tails of the distributionMwere then contacted and ased to
return for follow-up records 0cephalo!rams, models, clinical e%amination1@ in the end,
7; 0>> e%traction and ;B none%traction1 were recalled" The avera!e post-treatment
interval was about 6< years" Premolar e%traction produced a si!nificantly !reater
reduction in hard-and soft-tissue protrusion" Durin! the post-treatment period,
however, both !roups underwent essentially the same chan!e? decreased profile
conve%ity and a pattern of dental chan!eLrelapse that was correlated with antero-
posterior mandibular displacement" Because of their !reater initial crowdin! and
protrusion, the various effects summed to mae the e%traction patients si!nificantly
more protrusive at recall" Both treatment produced mesial mandibular displacement,
e%traction si!nificantly !reater than non-e%traction, however at recall both !roups did
not differ with respect to the si!ns and symptoms of dysfunction" Authors concluded
that, this study fail to support the common influential belief that premolar e%traction
fre$uently causes &dished in' profiles, &distali4ed' mandibles, and ultimately
craniomandibular dysfunction"
;C
A study was conducted to evaluate the effects of first bicuspid e%tractions on
facial hei!ht in hi!h an!le cases" 3esial molar movement is e%pected in first bicuspid
e%traction cases and accounts for the belief that facial hei!ht should decrease" This
study e%amined 67 boys and ;6 !irls, with an avera!e a!e of 66 years 6D months, at
the outset of treatment" /esults showed that >"; mm of upper molar e%trusion and ;";
mm of lower molar e%trusion" As much as 6"B mm of vertical movement of molar and
6"7 mm of that mandibular molar can be attributed to !rowth" This study indicate that
the occlusal movement of the posterior teeth tends to eep the occlusal movement of
the posterior teeth tends to eep pace with the increase in anterior face hei!ht, thus
maintainin! the 3PA and nullifyin! the bite closin! effect of posterior protraction"
6;
Review of Literature
The facial comple% does increase in si4e with !rowth, but the Go!n plane, while
movin! inferiorly, remains essentially parallel to its pretreatment position, due to both
the !rowth and treatment"
6D

A study was conducted to determine the vertical chan!es followin! first
premolar e%traction" (rthodontic treatment involvin! the e%traction of first premolars
has been implicated in the dental literature as an etiolo!ic factor in the development of
T3G disorders" Authors have proposed that the e%traction of first premolars causes a
decrease in the vertical dimension of occlusion" The purpose of this study was to
investi!ate the validity of this claim" /ecords of C< class I, non-e%traction cases and
>E class I, first premolar e%traction cases were obtained" The pre-treatment and post-
treatment cephalo!rams were di!iti4ed, and several cephalometric variables were
e%amined to evaluate the vertical chan!es occurrin! as a result of orthodontic
treatment" *tatistical analysis of the data revealed no si!nificant differences between
the vertical chan!es occurrin! in the e%traction and non-e%traction !roups" (n
avera!e, orthodontic treatment in both !roups produced an increase in the
cephalometric vertical dimensions that were e%amined"
B

:%traction has been a controversial sub.ect for as lon! as the specialty of
orthodontics has e%isted" *ome authors believe that the e%traction of premolars leads
to temporomandibular disorders" This occurs, they say, because the vertical dimension
collapses" )oncomitantly, over-retraction and retroclination of the incisors cause the
facial profile to flatten, brin! about premature anterior contacts, and distally displace
the mandible and mandibular condyle" 5umerous correlation studies in the dental
literature do not support this contention" There appears to be no hi!her incidence of
temporomandibular disorders in patients treated with the e%traction of premolars than
in nontreated patients or those treated without e%tractions" Analysis of premolar
6>
Review of Literature
e%traction cases reveals that there is no collapse of the vertical dimension@ on the
contrary, the vertical dimension is either maintained or sli!htly opened" *imilarly,
there is no evidence that premolar e%traction causes undesirable flattenin! of the
facial profile" The facial profile established durin! treatment is primarily the result of
dia!nosis and treatment mechanics" :%cessive anterior interferences resultin! in
possible posterior condyle displacement are the result of treatment mechanics" #hen
arches are leveled properly and space closure and over.et reduction are ade$uately
controlled, there is no reason that such interferences should occur" Thus study reveals
little support for the claim that premolar e%traction treatment leads to
temporomandibular disorders"
;<

A study was done to evaluate the effects of different growth pattern and treatment
type factors on craniofacial structures in cases treated with different fixed mechanics and
premolar extractions. A total of 41 cases with a mean chronologic age of 14 years 7 months
and skeletal age of 14 years 6 months was included in the study. These cases were treated
with fixed edgewise mechanics and with extraction of four first premolars. The growth pattern
factor was assessed in two levels as mesiodivergent and hyperdivergent, and the treatment
factor was assessed as with and without headgear. The results in the assessment of
differences etween the two types of growth patterns at the end of treatment, the changes in
!"A!# and !"$e were found to e statistically significant. %nteraction was found to e non"
significant for all measurements. %t was oserved that treatment with fixed appliances and
premolar extractions does not change significantly the growth pattern.
&6
The study was conducted by authors to evaluate the vertical chan!es
occurrin! in )lass I patients treated orthodontically with first premolar e%traction and
to compare these chan!es with those occurrin! in )lass I patients treated
orthodontically without e%tractions" /ecords of CD )lass I none%traction cases 0;C
!irls, 67 boys1 and CD )lass I ma%illary and mandibular first premolar e%traction cases
0;> !irls, 6F boys1 were obtained" The pretreatment and posttreatment cephalo!rams
6C
Review of Literature
were di!iti4ed, and 7 linear and E an!ular cephalometric measurements were selected
to evaluate vertical chan!es" :valuation of the treatment results of the e%traction and
none%traction cases showed that the vertical chan!es occurrin! after the e%traction of
ma%illary and mandibular first premolars were not different than those occurrin! in
the none%traction cases" Authors concluded that this study disproves the hypothesis
that the e%traction of premolars leads to a loss of vertical dimension which in turn
leads to T3G disorders"
;F

Authors conducted a cephalometric study to evaluate an early none%traction
treatment approach for patients with severe vertical seletal dysplasia and ma%illary
transverse constriction" Thirty-ei!ht patients, E"; years 0N 6"; years1 of a!e, were
treated for 6"> years 0N D"> years1 with lip seal e%ercises, a bonded palatal e%pander
appliance, and a banded lower )ro4atLlip bumper" The bonded palatal e%pander
functioned as a posterior bite-bloc and was fi%ed in place throu!hout treatment"
Patients with poor masticatory muscle force 0FBJ1 wore a hi!h-pull chincup 6; to 6C
hours per day" A control !roup was matched for a!e, se%, and mandibular plane an!le"
Treatment chan!es for chincup and other patients were not si!nificantly different"
(verall, treatment si!nificantly enhanced condylar !rowth, altered it to a more
anterosuperior direction, and produced ItrueI forward mandibular rotation ;F times
!reater than control values" Posterior facial hei!ht increased si!nificantly more in
patients than in controls, and the ma%illary molars showed relative intrusion" In
treated patients, articular an!le increased, !onial an!le decreased, and the chin moved
anteriorly twice as much as in controls" Treatment also led to increased overbite and
decreased over.et" 3a%illary and mandibular e%pansion did not cause the mandibular
plane an!le to increase" The 67 patients with openbite malocciusions e%hibited a ;"F
mm increase in overbite and inhibition of !rowth in anterior lower facial hei!ht" The
6<
Review of Literature
a!!re!ate of individual chan!es demonstrates a net improvement, indicatin! this
treatment approach may be suited for hyperdiver!ent patients with seletal
discrepancies in all > planes of space"
;E

A study was carried out to evaluate the vertical facial chan!es in adult
orthodontic patients and to evaluate the stability of these chan!es" Thirty three
patients 0E males and ;< females1 were e%amined" The patients had been treated fi%ed
ed!ewise appliance mechanics and e%hibited atleast 6"DO of clocwise rotation of the
mandible durin! treatment" 3andibular rotation was determined by the an!ular
chan!e in the A-a%is to the 2ranfort hori4ontal plane" Twelve an!ular and 6C linear
seletal and dental measurements and three seletal ratios were derived from
pretreatment 0T61, posttreatment 0T;1, and postretention 0T>1 cephalometric
radio!raphs" Twenty-five percent of the openin! rotation of the mandible recovered
durin! the posttreatment period", resultin! in a si!nificant overall rotation that was
maintained" Both treatment and posttreatment chan!es in the A-a%is an!le" *tepwise
re!ression analysis of pretreatment variables and treatment chan!es failed to predict
the behavior of the A-a%is an!le chan!e"
;B
A study was carried out to evaluate the effects of orthodontic treatment on the
soft tissue facial profile of patients with lon! and short facial types" (rthodontic
treatment records of BB white lon!-faced and short-faced patients were analy4ed to
determine the effects of ed!ewise orthodontic treatment over an avera!e period of
;"67 N D">; years" The avera!e a!es at the initiation and conclusion of treatment were
6>"CD N P CD years and 6<"76 N D";B years, respectively" A si!nificant findin! in this
study was the lar!e variability in set tissue response to tooth movement" This
variability was due to a wide dispersion of individual results between upper and lower
lip chan!e to ma%illary and mandibular incisor movement anteriorly or posteriorly"
67
Review of Literature
Because of this soft tissue variability amon! individuals, definite differences between
the lon!-faced and short-faced types could not be identified, nor was it possible to
establish definite ratios for chan!e in lip response to incisor movements"
>D
The study was conducted usin! lateral cephalometric radio!raphs taen before
and after treatment" fifteen patients who had an anterior open bite 0A(B1 only were
treated with first premolar e%tractions 0Group :C1" *eventeen patients with an A(B
e%tendin! to the posterior teeth were !rouped accordin! to the e%tractions? e%traction
of second premolars 0Group :<1 and first molar 0Group :71" )ephalometric data were
analysed accordin! to the Qtwo factor e%periment with a repeated measure on one
factorQ model" The treatment !roup factor had three levels, :C, :<, and :7, and the
time factor two levels, pre- and post-treatment" The differences between the pre- and
post-treatment periods were statistically si!nificant for all the cephalometric variables
0PK D"DD6, P< D"DDD61, e%cept for A5*-3eL 5a-3e, The time and !roup interaction
were found to be statistically si!nificant for the variables where the time factor is
important, such as *5-GoGn an!le, *Gn-5Ba an!le, A5*-3e dimension, 5a 3e
dimension, forward movement of the ma%illary and mandibular molars, and the
distance to the mandibular plane of the lower molars" The severity of vertical
dysplasia did not chan!e in !roup :C" Generally, however, within the appropriate
indications, e%traction of the second premolars or the first molars led to a closin!
rotation of the mandible in sub.ects with a seletal A(B e%tendin! to the posterior
teeth"
>6

A study was carried out to evaluate the effects of bilateral upper premolar
e%traction on mandibular !rowth" Twenty-si% sub.ects 0E males and 6E females1 in
ma%imum pubertal !rowth with an an!le class II molar relationship, normal to mild
over.et increase, mild or lower arch len!th discrepancy and no severe seletal
6F
Review of Literature
discrepancy were divided into two !roups e$ual in number and !ender, as e%traction
and control !roups" The median chronolo!ical a!e was 66"; years in the e%traction
!roup 6;"7 years in controls" The sub.ects were observed for a median period 6"6
years in the e%traction !roup after bilateral e%traction of the upper premolars and 6";
years in the controls until termination of pubertal !rowth 0DP>u1 without any
orthodontic treatment" Twenty nine linear and an!ular measurements were made on
<; lateral cephalo!rams and hand-wrist radio!raphs taen before and after the study
period" The increase in *5B measured on the total superimposition was si!nificantly
!reater in the controls than in the e%traction !roup" In addition, anterior mandibular
counterclocwise rotation was si!nificantly in the control !roup" Thus, it mi!ht be
su!!ested that bilateral upper premolar e%tractions mi!ht affect the mandibular
rotation tendency"
>;
A study was conducted to evaluate the effects on vertical dimension followin!
first or second premolar e%traction" (b.ective of the study is, mesial movement of the
molars to reduce the &wed!e effect' and decrease facial vertical dimension valid" This
study compares the mesial movement of 3olars and chan!es in the 2VD between P6
and P; !roups in class I malocclusion with hyperdiver!ent facial pattern" ;F cases
0P6-!roup61 with ma%illary and mandibular first premolar e%traction and ;F cases
0P;-!roup ;1 with second premolar e%tractions were compared" /esults showed that
!roup ; showed more mesial movement of the ma%illary and mandibular molars and
less retraction of ma%illary and mandibular incisors than !roup 6" Both the !roups
showed increased anterior facial hei!ht, but there were no statistically si!nificant
differences in an!ular and proportional measurements between pre and post treatment"
There were no si!nificant differences in the amount of 2VD between !roup 6 and ;
e%cept in the ma%illomandibular plane an!le and *5 to palatal plane an!le" These
6E
Review of Literature
results su!!est that there is no decrease in 2VD re!ardless of the ma%illary and
mandibular first or second premolar e%traction" Therefore authors conclude, the
hypothesis that second premolar e%traction in hyperdiver!ent facial types will result
in mesial molar movement and decrease 2VD by reducin! &wed!e effect' is invalid"
>>
A retrospective, lon!itudinal, cephalometric study was carried out to
investi!ate the influence of e%traction and non-e%traction orthodontic treatment on the
facial hei!ht of Gapanese = Bra4ilians with class I and class II division I malocclusion"
*ample included <B mesocephalic patients distributed into C !roups" Group 6? class I
patients treated with C first premolar e%tractions, Group ;? class I patients treated with
non-e%traction" Group >? class II division I patients treated with C first premolar
e%tractions, Group C? class II division I patients treated with non-e%traction" The
overall initial mean a!e of the !roups was 6;"6C years, and all cases were treated with
standard ed!ewise appliances for a mean period of ;"CB years" The pre-treatment and
post-treatment sta!e comparison and the inter!roup comparison of the treatment
chan!es were conducted between e%traction and non-e%traction !roups in the class I
and class II malocclusions" /esults showed that chan!es in the absolute ma!nitude of
posterior and anterior facial hei!hts and in the ratios of lower posterior facial hei!htsL
lower anterior face hei!ht and lower anterior face hei!htLtotal anterior face hei!ht
were similar in e%traction and non-e%traction treatment in both class I and class II
malocclusions" Authors concluded that facial hei!ht were similar between e%traction
and non-e%traction treatment in both class I and class II malocclusios
>C
A study was carried out to evaluate the outcome of standard ed!ewise
orthodontic treatment with e%traction of C first molars 07%T !roup1 or Tweed
ed!ewise treatment with e%traction of C first premolars 0C%T !roup1" A cephalometric
analysis that isolated tippin! and bodily movements of the ma%illary and mandibular
6B
Review of Literature
incisors and measured vertical chan!es in the anterior re!ion of the ma%illa and
mandible used" Thirty sub.ects treated 6D practioners comprised the 7%T !roup,
whereas >6 sub.ects treated in the case western university orthodontic clinic were
used in the C%T !roup" )ontrol !roups 07%)1 and C%)1 were selected from untreated
sub.ects enrolled in the Bolton-Brush !rowth study and were matched on a!e and
!ender" Data were collected before 0T61 and after 0T;1 treatment" /esults showed no
statistically si!nificant chan!es between 7%T and 7%) for any of the variables studied"
An increase in overbite of ;"6 mm in the 7%T !roup was small but clinically
si!nificant chan!es in both tippin! and e%trusion of ma%illary and mandibular
incisors" In the C%T !roup, statistically and clinically si!nificant chan!es were
observed for intrusion of the ma%illary and mandibular incisors, resultin! in a C"6 mm
decrease in overbite" Importantly, both the 7%T and C%T !roups showed no increase in
mandibular vertical hei!ht durin! treatment" Authors concluded that both treatment
strate!ies showed !ood control of vertical mandibular !rowth" Bodily intrusion of
the anterior teeth was the main contributor to correction of deep overbite in the Tweed
ed!ewise sample"
6
A study was conducted to evaluate the vertical chan!es in class II division 6
malocclusion after premolar e%tractions" ;7 cases each in two !roups with 67 boys
and 6D !irls, !roup 6 treated with mandibular first premolar e%tractions 0a!e? 6>"; N
6"<years1 and !roup ; treated with mandibular second premolar e%traction" The two
!roups were matched by se%, a!e, 0with in si% months1 and facial diver!ence
measured by ma%illary-mandibular plane an!le and ratio of posterior face hei!ht to
total anterior face hei!ht" /esults showed, second premolar e%traction was associated
with more mesial movement of the mandibular molars, but there was no si!nificant
difference in vertical facial !rowth between the two !roups" There was no si!nificant
;D
Review of Literature
chan!e in mandibular plane an!le and 33 an!le in both the !roups" Authors
concluded that this study do not support the hypothesis, that mandibular premolar
e%traction is associated with mandibular overclosure or reduction in the vertical
dimension, or both, in sub.ects with class II division I malocclusion"
><
Authors conducted a cephalometric study was to investi!ate vertical
dentoalveolar compensation in untreated adults with e%cessive 0lon!-face1 and
deficient 0short-face1 lower anterior face hei!hts" Vertical and sa!ittal base
relationships, vertical dentoalveolar dimension in the anterior re!ion of the .aws,
incisor inclination, overbite, and over.et were assessed in 66; short-face and B< lon!-
face sub.ects" The contribution of seletal and dentoalveolar components to achieve a
normal overbite was assessed by means of re!ression analysis" 2or the ; most
important independent variables of the re!ression e$uation, the values were calculated
that would render an overbite of ; mm" It was subse$uently investi!ated whether the
calculated value fell within the ran!e of the sample" The results showed that, in lon!-
face sub.ects, overbite was mainly related to lower anterior face hei!ht@ in short-face
sub.ects, it was mainly related to mandibular anterior alveolar and basal hei!hts"
Dentoalveolar compensation occurred in both !roups mainly by adaptations in
mandibular incisor alveolar and basal hei!hts" 3olar hei!ht was unrelated to overbite"
)utoff values for achievin! a positive overbite were calculated for lower face hei!ht
and mandibular incisor alveolar and basal hei!hts" Authors concluded that, the lower
face hei!ht mainly determines the overbite in lon!-face sub.ects, while in short-face
sub.ects, lower dentoalveolar morpholo!y influences overbite" ,ower dentoalveolar
compensation can maintain a normal overbite in lon!-face sub.ects to a limited
e%tent"
>7
;6
Review of Literature
A study was carried out by authors to determine, if appliance induced increase
in the in the hei!hts of upper and lower molars in !irls with class II division I
malocclusion, and the conse$uential increase the hei!ht of the face are maintained"
Ten an!les and ten linear measurements were measured on lateral cephalo!rams of 66
year old !irls 0E"<-6C years1 with treated 05 RB1 and untreated 05RE1 class II division
I malocclusion" The intervals between initial and recall records were, on avera!e, 6;
years 0F"7-6<"< years1 for the !irls in the treatment !roup, and E years 0C-6> years1 for
the !irls untreatedLcontrol !roup" In the treatment !roup E !irls were treated with
Be!! appliance and class II elastics" /esults showed that upper and lower molar
hei!hts in both the !roups increased si!nificantly, between the initial and recall visits"
There were no si!nificant differences between the molar hei!hts in the !roups at the
start or recall visits" A2+ also increased si!nificantly in both !roups between initial
and recall visits" At recall, A2+ in the treatment !roup was si!nificantly !reater than
A2+ in the control !roup" This findin! is attributed to similar si4ed differences
between the !roups at the start, to the lon!er period between the initial and lon!er
period in the treatment !roup and to lesser variation in the both !roups at recall" In
both !roups, posterior face hei!ht increased si!nificantly between the initial and recall
sta!es" At the conclusion of the study there were no statistically si!nificant
differences between the treated and control !roups in either over.et or the inclination
of upper incisors" /elapse of upper incisors in the treatment !roup and retroclination
of upper incisors in the control !roup reduced the initial differences between the
!roups" These chan!es are attributed to altered lip posture and increased lip pressure
in adolescence" At recall, an!les *5A and *5B were si!nificantly smaller in the
treatment !roup" Authors concluded that hei!hts of the upper and lower molars and
the face increased in both !roups" (rthodontic treatment effect have no lastin! effect
;;
Review of Literature
on either the hei!ht of the face or the hei!hts of the molars in !irls with class II
division I malocclusion"
>F

There is disa!reement concernin! the effect of premolar e%tractions on the
dentofacial vertical dimension" It has been su!!ested that orthodontic forward
movement of the posterior teeth after first premolar e%traction leads to reduction in
vertical dimension" The purpose of this study was to e%amine cephalometrically the
dentofacial vertical chan!es in )lass I Indian sub.ects treated with and without
e%tractions" The e%traction !roup included >6 normodiver!ent patients 0;7 female, <
male@ pretreatment a!e, 6F"6B N >"EB years1 with ma%illary and mandibular first
premolar e%tractions" The none%traction !roup included ;B patients 06E female" 66
male@ pretreatment a!e, 6E"CE to >"76 years1" A coordinate system with the 2ranfort
hori4ontal plane and a mandibular fiduciary line was used for the cephalometric
calibration" To determine vertical dimension chan!es due to treatment and to compare
differences between the ; !roups, paired and unpaired t tests were performed,
respectively" /esults showed that both !roups had increases in linear vertical
dimensions 0P KD"D<1, but the chan!e was comparatively !reater in the e%traction
!roup (P KD"D<1" 3esial movement of the ma%illary and mandibular posterior teeth
was coincidental with the e%trusion to such an e%tent that it increased the vertical
dimension, althou!h the mandibular plane an!le remained unchan!ed durin!
treatment" Authors concluded that e%traction of teeth only to increase the overbite or
decrease the mandibular plane an!le mi!ht not be .ustified"
>E
;>
Methodology
#E$H")"!"G-
#aterials and #ethod =
The present retrospective study was desi!ned to evaluate the overbite and
vertical chan!es followin! first premolar e%traction in hi!h an!le cases, who have
been orthodontically treated with pre-ad.usted :d!ewise appliances 0D"D;; slot, 3BT1
in the Department of (rthodontics and Dentofacial (rthopaedics, )olle!e of Dental
*ciences, Davan!ere"
Sa/.le Si<e =
Twenty five adult patients were randomly selected from the pool of completed
cases with pre and post treatment records in the Department of (rthodontics and
Dentofacial (rthopedics" All ;< cases were treated with consistent biomechanical
principles, transpalatal arch L 5ance palatal arch were used for anchora!e" *ample
included 6; boys, of a!e ran!in! from 6F"> years to ;6"7 years 0Avera!e 6E"B years1
and 6> !irls of a!e ran!in! from 6F"6 years to ;D"7 years 0Avera!e 6E"7 years1"
*ample *election ?
The sample eli!ible for the study was selected on the basis of the followin!
criteria"
%ncl5sion Criteria =
)ases havin! hi!h mandibular plane an!le, that is GoGn-*n !reater than or
e$ual to >;
o
0*teiners analysis1"
)ases treated with P:A with all first bicuspids e%tractions
)ases havin! )lass I molar relation bilaterally"
EDcl5sion Criteria =
)ases with )lass II and )lass III molar relationship"
;C
Methodology
)ases treated with sur!ical orthodontics"
r/a/entari5/ Used in the St5dy 6(ig.>7=
D"> mm pencil
D">mm lead acetate tracin! sheets
*et of proctractors
9 = ray View bo%
:raser
$B!E , > = )E(%'%$%"'S "( CEPH!"#E$R%C !')#RKS
39*8
The distance between the intersection of the vertical hori4ontal
reference liens to A5*"
BU6 The distance between A5* and )/U6"
T,6 The distance between )/U6 and I:U6"
B,6 The distance between )/,I and I:,6
35*8 Distance between )/,I and 3e"
3PA It is the an!le formed between Go!n - *5
UA2+ It is the linear distance from 5 to A5*"
TA2+ It is the linear distance t from 5 to 3e
,A2+ It is the linear distance from A5* to 3e
P2+ It is the linear distance from * to Go
*v Perpendicular to 2+ plane from sella
Po!v Perpendicular to 2+ plane from po!onion
Go!n = 2+ It is the an!ular measurement between Go!n = 2+
Go!n = PP It is the an!ular measurement between Go!n = PP
Go - (P It is the an!ular measurement between Go!n = (P
*5 - PP It is the an!ular measurement between *5 = PP
*5 - (P It is the an!ular measurement between *5 = (P
;<
Methodology
;7
Methodology
The analysis compares radio!raphs with .udicial hori4ontal and vertical
reference lines, at the T
6
tracin! hori4ontal drawn parallel to the 2+ and a
perpendicular line was drawn to establish the vertical reference used" The T
;
tracin!
was superimposed on the T
6
tracin! by usin! cranial base landmars and both the
hori4ontal and vertical fudicial lines were carried throu!h the T
;
tracin!" *i%
landmars, Anterior 5asal *pine 0A5*1, )entre of /otation of the ma%illary and
mandibular central incisors 0)/U6 and )/,61, incisal ed!es of the ma%illary and
mandibular central incisors 0I:UI1 and 0I:,I1 and menton 03e1 were identified on
each cephalo!ram and pro.ected on to the vertical reference line, eepin! the
landmar location parallel to the hori4ontal reference line" This procedure resulted in
si% linear variables"
61 #aDillary skeletal change 6#+SK7? - The distance between the intersection
of the vertical hori4ontal reference lines to A5*"
;1 Bodily /ove/ent of the /aDillary incisors 6BU>7= 3 the distance between
A5* and )/U6"
>1 $i..ing /ove/ent of the /aDillary incisors 6$U>7= = the distance between
)/U6 and I:U6"
C1 $i..ing /ove/ent of the /andi85lar incisors 6$!>7= = the distance
between )/,I and I:,6"
<1 Bodily /ove/ent of the /andi85lar incisors 6B!>7= = distance between
)/,I and 3e"
71 #andi85lar skeletal change 6#'SK7= 3 the distance between A5* and 3e
pro.ected onto the vertical reference line"
;F
Methodology
2i!" ; ? *chematic Dia!ram showin! (verbite chan!es
The net chan!e in these variables were used to compute chan!es in the
dependent variables = SoverbiteH by usin! the followin! e$uation"
6

A(B R T 35*8 U T BUI U T TUI U T B,I U T T,I
#here T - 5et chan!e
Tracin! ; minus tracin! 6, !ives the post treatment chan!es in overbite"
2ollowin!, an!ular and linear measurements were selected to evaluate
vertical dimensional chan!es"
F

;E
Methodology
ng5lar #eas5re/ents =
61 Go Gn to *5
;1 Go Gn to 2+
>1 Go Gn to PP
C1 Go Gn to (cclusal plane
<1 *5 to PP
71 *5 to 2+
F1 U6 to *5
E1 ,6 to Go Gn
B1 I3PA
6D1 A-A%is
Po
"r
S
Cd
A
'S
#e
'
Pg
Gn
Go
2i!" > ? *chematic dia!ram showin! an!ular land mars used in the study
;B
Methodology
!inear #eas5re/ents =
61 UA2+ = 5 to A5*
;1 Post 2+ = *e to Go
>1 A2+ = 5 to A5*
C1 ,A2+ = A5* to 3e
<1 Anteroposterior face hei!ht ratio R
AFH
FH Post"
9 6DD R V V V J
71 *v = U7
F1 Po! = ,7
E1 2+ = U7
B1 2+ = ,7

2i!" C ? *chematic dia!ram showin! linear land mars used in the study
Po
"r
S
Cd
#e
'S
A
Go
'
>D
2i!" < ? *chematic dia!ram showin! land mars used to evaluate molar chan!es
in the study
Po
"r
S
Cd
A
'S
#e
'
Pg
Gn
Go
S$$%S$%C! '!-S%S =
/esults are e%pressed as mean *D paired t-test was used to analyse post-
treatment chan!es in cephalometric evaluation"
The results were also ascertained by non-parameteric #ilco%onHs test
whenever the measurements were presumed to be non-normally distributed" All the
analysis were done usin! *P** *oftware 0Version 6>1, U*A"
P-value of D"D< or less was considered for statistical si!nificance"
(or/5lae Used for nalysis=
W %i
#ean, % R ------- i R 6, ;X n
n
W 0%i = %1
;

Standard deviation, *D R -------------
n = 6

*D
*tandard :rror, *: R ---------
n
3ean of the differences
Paired t test, t R -------------------------------------------
*tandard error of the differences
d
R -------------
sd L n
*ilcoDonEs Signed Rank $est 6lternative to Paired t3test7
Pre-post differences are found for each case and rans are assi!ned to the
differences" *um of the ne!ative and positive rans are found separately"
,east of these two sums 0-ve Uve1 is compared with table value for
si!nificance"
Results
RESU!$S
There was statistically si!nificant chan!e in the 3PA 0Go!n-*51 but the mean
difference in the chan!e -D"< mm 0Table I1 su!!ests that the chan!e is clinically
insi!nificant"
There was statistically si!nificant chan!e in the U6 to *5, ,6 to Go!n, BUI
and B,I 0Table II and Table IV1 su!!estin! that, the e%traction space was closed by
retraction of the anteriors" The mean chan!e in the U6 to *5 and ,I to Go!n is 6D"E
and F"B de!rees respectively" The mean chan!e in the BU6 and B,6 is -;"C and ;">
mm respectively"
There was si!nificant chan!e in the sella vertical to mesiobuccal cusp tip of
ma%illary first molar and po!onion vertical to mesiobuccal cusp tip of mandibular
first molar 0Table IV1 su!!ests that there was mesial movement of the upper and
lower molars" The avera!e mesial movements of ma%illary and mandibular molars is
-;"> and -;"; respectively"
There was a statistically si!nificant chan!e in the 2+ plane to mesiobuccal
cusp tip of ma%illary first molar and 2+ plane to mesiobuccal cusp tip of mandibular
first molar, su!!estin! that there was e%trusion of molars in ma%illary by -;"; mm and
in mandible by 6"; mm"
There was a sli!ht chan!es in the certain parameters shown in the Table II III
V IV" Althou!h there was a sli!ht chan!e, the difference in the chan!es were very
less and statistically insi!nificant"
Results
$B!E , %%
PRE ') P"S$ $RE$#E'$ 'GU!R #ESURE#E'$S
Para/eters Pre Post )ifference t3&al5e .3&al5e
Go!n-*5
3ean >>"E >C"> -D"<
;"> D"D>, *
*D 6"; 6"> 6
Go!n-2+
3ean ;F"DC ;F"DC D
D 6"DD, 5*
*D ; 6"6 ;"C
Go!n-PP
3ean ;<"C ;<"F -D">
-6"FF D"DB, 5*
*D 6"7 6"6 D"E
Go!n-(P
3ean 67 67"DC D"DC
-6 D"B;, 5*
*D D"B 6"7 ;"6
*5-PP
3ean 6D 6D"> -D">
-6"67 D";7, 5*
*D 6"6 6"C 6";
*5-2+
3ean B"E B"E D
D 6"DD, 5*
*D D"E D"B D"F
UI-*5
3ean 667"E 6D<"B 6D"E
;B"DE
KD"DD6,
+*
*D ;"> 6"; 6"B
,I-Go!n
3ean 6D; BC F"B
;7"BC
KD"DD6,
+*
*D > ;"< 6"<
U-Gonial
3ean <>"7 <>"7 D
-D"CC D"77, 5*
*D 6 6 D"<
,-Gonial
3ean F7"; F7"> -D"DC
-D"DB D"B>, 5*
*D 6"B ; ;">
A-A5*
3ean 7F"; 7F"C -D";
-6"DC D">6, 5*
*D 6"> 6"7 6
Results
$B!E , %%%
PRE ') P"S$ $RE$#E'$ &!UES "( !%'ER #ESURE#E'$S
Parameters Pre Post Difference t-value p-value
5-3e
3ean 6;<"6 6;7 -D"6;
D">F D"F;, 5*
*D >"6 ;"E 6"7
5-A5*
3ean <; <;"6 -D"6
-D"7; D"<C, 5*
*D 6"7 6"< D"7
A5*-3e
3ean FD"6 F6"6 -D"DC
-D"6F D"EF, 5*
*D >"7 >"> 6";
*e-Go
3ean F;"C F;"; D";
6"C6 D"6F, 5*
*D >"> >"> D"F
AP2 +t
/atio
3ean <B"7C <B"F6 D"D;
D"; D"EC, 5*
*D D"7 D"E D"7
Results
$B!E , %&
"&ERB%$E ') &ER$%C! CH'GES "( )E'$%$%"'
Parameters Pre Post Difference t-value p-value
39*I*
3ean ;>"C ;>"B -D"<
-6"E6 D"DE, 5*
*D 6"F 6"7 6">
BU6
3ean 67"6< 6E"B -;"C
-66"<; KD"DD6, +*
*D 6 6 6
TU6
3ean 6B"C ;D"7 -6";
-<"FB KD"D<, *
*D 6"6 6"6 6
B,6
3ean ;<"F ;>"C ;">
F"FF KD"DD6, +*
*D 6"F 6"6 6"<
T,6
3ean 6>"7 6;"7 6"6
C";; KD"D<, *
*D 6"; 6"6 6">
35*6s
3ean F>"B F>"E D"6
D";< D"ED, 5*
*D 6"; 6"; 6"7
(B
3ean 6<D"< 6<D"; D";
D"FB D"CC, 5*
*D ;"C 6"E 6"<
*v-U7
3ean CD C;"> -;">
-;<"; KD"D<, *
*D D"B D"B D"<
Po!-,7
3ean -;D -6F"E -;";
-6B"<E KD"D<, *
*D 6 6 D"7
2+-U7
3ean C7"C CE"7 -;";
-;C">B KD"D<, *
*D 6"F 6"< D"<
2+-,7
3ean CF"< C7"> 6";
C"FF KD"D<, *
*D 6"7 6"7 6">
Results
Gra.h % = Pre3Post Significant ng5lar #eas5re/ents
D
;D
CD
7D
ED
6DD
6;D
)
e
g
r
e
e
s
Go!n-*5 U6-*5 ,6-Go!n
ng5lar Para/eters
Pre Post
Gra.h , %% = Pre3Post %nsignificant ng5lar #eas5re/ents
D
6D
;D
>D
CD
<D
7D
FD
ED
D
e
!
r
e
e
s
Go!n-2+ Go!n-PP Go!n-(P U"Gonial ,"Gonial
An!ular Parameters
Pre Post
Gra.h %%% = Pre3Post %nsignificant !inear #eas5re/ents
D
;D
CD
7D
ED
6DD
6;D
6CD
67D
m
m
5-3e A5*-3e *e-Go (B
,inear Parameters
Pre Post
Results
Gra.h %& = Pre3Post nterior $ooth #ove/ent
D
<
6D
6<
;D
;<
>D
m
m
BU6 TU6 B,6 T,6
,inear Parameters
Pre Post
Gra.h & = Pre3Post #olar #ove/ents
-;D
-6D
D
6D
;D
>D
CD
<D
m
m
*V-U7 Po!-,7 2+-U7 2+-,7
,inear Parameter
Pre Post
Discussion
)%SCUSS%"'
2or evaluation of treatment results it is important to consider facial types"
,on! faced individuals e%hibit lon! anterior face hei!ht, e%cessive bacward rotation
of the mandible, and hi!h 3PA"
>B,CD
*imilarly short anterior face hei!ht, e%cessive
forward rotation of the mandible and low mandibular plane an!le has been reported
for short faced individuals"
CD,C6

*chudy advocated e%traction of teeth &to close the bite', in hyperdiver!ent
facial type"
C-7
*assouni and 5anda concurred with a such a treatment phylosophys"
F
(rthodontists !enerally a!ree that non-e%traction treatment is associated with
downward and bacward rotation of the mandible and an increase in the ,A2+" They
also a!ree that e%traction line of treatment is associated with upward and forward
rotation of the mandible and decrease in the ,A2+"
;>

Previously published literatures
B,6D,;>,;F
showed that there is no si!nificant
chan!es in the vertical facial dimension followin! first premolar e%traction treatment"
The present study aimed to study the comparison of overbite and vertical facial
chan!es followin! first premolar e%traction in hi!h an!le adult patients"
Twenty five adult patients havin! hi!h mandibular plane an!le i"e" GoGn-*5
!reater than or e$ual to >;
o
were compared with pre and post treatment cephalometric
results" Pre and post treatment lateral cephalo!rams of all the adult ;< patients were
taen, obtained with patient positioned in the natural head position
C;,C>
and evaluated
for pre and post treatment overbite and vertical facial dimensions" 2ranfort
hori4ontal plane 0porion to orbitale1 was taen as a hori4ontal reference plane and a
perpendicular to this 2+ plane !ives a .udicial vertical plane, which was used to
evaluate the overbite chan!es"
6

Discussion
To evaluate the mandibular plane an!le, Go!n - *5 plane was used, as !iven
by the *teinerHs analysis"
CC
5-3e and A5*-3e were used as landmars and evaluate
the A2+ and ,A2+ respectively" As *e point is stable, vertical line drawn
perpendicular to 2+ from sella was used to evaluate the mesial movement of
ma%illary first molar and Po! vertical was drawn from Po! perpendicular to 2+ in
order to overcome the errors by mandibular rotation" Perpendicular line was drawn
from 2+ to mesiobuccal cusps of the ma%illary and mandibular first molars to analy4e
the e%trusion of molars after treatment"
>E

The absolute measurements of vertical face hei!ht, the ratio of A2+ L P2+,
3PA and incisor vertical hei!hts did not show si!nificant difference between the pre
and post treatment chan!es, followin! first premolar e%traction in hi!h an!le cases"
This su!!ests that the treatment approach followin! first premolar e%traction in hi!h
an!le cases does not affect the vertical proportions of the face"
/esults in this study su!!ests that, there were no statistically si!nificant
difference in the amount of chan!e in the variables for TA2+ and ,A2+" This is
because of the e%trusion of molars, which would compensate for the mesial mi!ration
of the molars which would accounts for anchora!e loss"
8ocadereli
;F
and *ta!!ers
B
showed that there was no statistically si!nificant
difference in vertical dimension chan!es between first premolar e%traction and non-
e%traction !roups, and orthodontic treatment produced increase in the cephalometric
vertical dimensions in both e%traction and non-e%traction !roups" )hua et al
;>
e%amined the effects of e%traction and non e%traction on ,A2+ and reported a
si!nificant increase in the non-e%traction !roup and no si!nificant chan!e in the
Discussion
e%traction !roup" )usimano, 3c,au!hlin et al
6D
found no difference in facial hei!ht
of hyperdiver!ent patients with first premolar e%traction treatment"
Garlin!ton and ,o!an studied vertical chan!es in hi!h mandibular plane cases
followin! enucleation of second premolars and observed si!nificant chan!e in the
lower anterior face hei!ht due to forward rotation of the mandible, but there were no
si!nificant chan!es in the total anterior face hei!ht" This su!!ests that there were
compensatory chan!es in the ma%illary vertical !rowth"
C<
This study corroborates our
study, could be due to enucleation of second premolar mi!ht reduce the arch len!th
resultin! seletal chan!es, #hereas in this study there was no si!nificant seletal
chan!es, rather more of dental chan!es have occurred"
Baumrind
C<
reported that the mean increase in anterior lateral face hei!ht was
si!nificantly !reater in the )lass II e%traction sub!roup than in )lass II non e%traction
!roup This does not a!ree with our results, probably due lac of class II mechanics as
the samples included in the study were )lass I molar and canine relation" 8im et al
>>
tested the occlusal wed!e hypothesis by comparin! the mesial molar movement and
the chan!es in vertical dimension between first premolar and second premolar
e%traction !roups and concluded that there was no decrease in facial vertical
dimension re!ardless of ma%illary and mandibular first premolar and second premolar
e%traction"
The present study did not show the si!nificant chan!es in A2+ and P2+" This
is due to, thou!h there is mesial movement of the molars and tend to reduce the bite,
e%trusion of the molars tend to increase the downward and bacward rotation of the
mandible and maintain the vertical reduction of the facial hei!ht" (ur results !oes in
favour of +ayasai et al
>C
reported that the chan!es in the absolute ma!nitude of
anterior and posterior facial hei!hts between e%traction and non-e%traction treatments
Discussion
in both )lass I and )lass II malocclusion patients" Their results conclude that facial
!rowth pattern in the vertical and anteroposterior position of the ma%illary and
mandibular molars, in the absolute ma!nitude of anterior and posterior face hei!hts, in
the ratios of lower posterior face hei!htLlower anterior face hei!ht lower anterior face
hei!htLtotal anterior face hei!ht are similar between e%traction and non e%traction
treatment, either in class I or class II malocclusions"
Al-5imri
><
compared the chan!es in facial vertical dimension in patients with
)lass II division I malocclusion after e%traction of either the mandibular first
premolar or second premolar" The forward movement of the mandibular molars was
!reater in second pre molar e%traction !roup and this is attributed to the lar!er
residual space in the lower arch after ali!nment in this !roup and difference in the
distribution of the anchora!e values in the lower arch with in e%traction !roup and
concluded that the mandibular premolar e%traction, whether first or second was not
associated with mandibular over closure or reduction in facial vertical dimension,
despite more forward movement of the mandibular molars in second premolar
e%traction !roup"
The analysis of the variables at pre-treatment and post-treatment in table III
su!!ests that there was some e%trusion of ma%illary and mandibular molars, which
were statistically si!nificant" This could have been conse$uent to the
mechanotherapy
B,6D,C7
or residual !rowth"
>>
Growth is nearly complete at 6C years in
!irls and at 67 years in boys"
>E
The avera!e a!e of the sample was 6F">B >"BB years"
*o we can mention little about the influence of residual !rowth as it is limited at these
a!es" The present study su!!ests that some residual !rowth as well as treatment
mechanics too place" This findin! is similar to the studies of 8im et al
>>
and +arris
et al
CF
with sub.ect in the late teens"
Discussion
The ma%illary and mandibular molars showed mesial movement in relation to
S*H vertical and Pe! vertical respectively, which were statistically si!nificant 0Table
III1" This movement may be conse$uent to mechanotherapy or residual !rowth" This
findin! is similar to the studies of Gardner et al,
CE
#est and 3c5amara
CB
in late teens
and Gesimano et al,
6D
Gardner et al
CE
reported that the hori4ontal distance of the
ma%illary first molar measured in relation to ptery!oma%illary vertical, continued to
increase mesial movement on an avera!e of ;"7 mm from post treatment at the a!e of
67"7 years to the first recall e%amination at the a!e of ;6"7 years"
CE
#est and
3c5amara reported the same with the molars in males and females with mean a!es of
6F years ; months and 6F years 7 months, respectively, erupted and moved mesially
durin! adulthood"
CB
In addition to this, the normal mesial displacement of the
ma%illary and mandibular molars, mesial movement in the e%traction !roup mi!ht be
allowed, dependin! on the severity of the anterior discrepancies"
B,<D

3andibular plane an!le showed statistically si!nificant increase from pre-
treatment to post-treatment 0Table 61" This is due to the e%trusion of molars in both
ma%illa and mandible" It could also be due to of residual !rowth as as e%plained
earlier" Another criteria for sample selection was hi!h mandibular plane an!le,
su!!ests that vertical .aw pattern" This findin! supports the study done by 3c
,au!hlin, )usimano et al on effects of first premolar e%traction on facial hei!hts in
hi!h an!le cases" where as a study
>E
done by Arunachalam and Ashima Valiathan on
cephalometric assessment of dentofacial vertical chan!es in class I sub.ects
corroborates our findin!s" But the difference in the chan!es from pre-treatment 0-D"<1
to post-treatment 06"D1 is ne!li!ible" *o we can say that thou!h it is statistically
si!nificant, it is clinically insi!nificant" This statistical chan!e may be due to small
sample si4e"
Discussion
(verbite did not show any si!nificant chan!es in this study" Probably due to
more of bodily movement of the incisors"
There was a statistically hi!hly si!nificant chan!e in the U6-*5, ,6-GoGn
0Table II1 and BUI and B,I 0Table >1 su!!ests that the most of the e%traction space
was closed by upper and lower anterior retraction"
There was si!nificant chan!e in the tippin! movement of upper and lower
anteriors 0TUI and T,I1 0Table III1 su!!estin! that there was bite closure by tippin!
movement of anteriors both in ma%illa and mandible" There was no si!nificant
chan!es in the pre and post treatment comparison of ma%illary and mandibular
seletal measurements 0Table III1 rather relative positions of the ma%illary and
mandibular incisors were affected by treatment" These results !oes in favor with the
study done by 3ar G" +ans et al"
6

There was a sli!ht chan!es in the certain parameters shown in the Table I, II
and III" Althou!h there was a sli!ht chan!e, the difference in the chan!es were very
less and statistically insi!nificant" This could be probably due to limitations of the
study which could be due to small sample si4e" Another limitation of the study is we
could not analy4e in depth the response differences of different patients" 2or e%ample,
in our study nine patients showed vertical reduction, but statistical evaluation mased
these findin!s" *o it is better to assess an in-depth evaluation of vertical dimension
chan!es in each sta!e of treatment of the samples, and treatment results should be
contemplated with concomitant evaluation of the biomechanics of the
temporomandibular .oint, since they do not function as simple hin!es" *o further
studies are re$uired on the biolo!ical response to treatment effects as well as
compensatory mechanisms, particularly affectin! vertical dimensions"
Conclusion
C"'C!US%"'
The intent of this investi!ation was to e%amine the popular &wed!e
hypothesis' that the vertical dimension collapses followin! first bicuspid e%traction
line of orthodontic treatment"
The results of this study leads to the followin! conclusion,
6" There was no linear chan!e in the vertical facial dimension
;" There was no si!nificant increase in the overbite
>" There was no clinically si!nificant increase in the mandibular plane
an!le
This study indicate that occlusal movement of the posterior teeth tend to eep
pace with the increase in anterior face hei!ht, thus maintainin! the mandibular plane
an!le and nullifyin! the bite closin! effect of posterior protraction" The facial
comple% does increase in si4e with !rowth, but Go!n = *5 plane while movin!
inferiorly, remain essentially parallel to its pretreatment position, due to residual
!rowth and treatment mechanics"
Summary
SU##R-
The stimulus for this investi!ation was assertion that e%traction treatment is
tantamount to reduction in facial vertical dimension and subse$uent increase in depth
of the bite" In clinical practice most of the orthodontists believed the theory that
reducin! tooth mass will lead to bite closure by acceleratin! the normal forward
!rowth rotation of the mandible" *uch rotation, would, in theory, reduce the anterior
facial hei!ht and carry the chin forward" 3ost of the previous literature showed that
there was no si!nificant chan!e in the facial vertical dimensions followin! e%traction
line of treatment"
The present study was desi!ned to evaluate cephalometric overbite and
vertical hei!ht chan!es followin! first bicuspid e%traction in hi!h an!le cases" i"e"
Go!n = *5 Y >; de!rees"
A total of ;< adult patients havin! hi!h mandibular plane an!le 0GoGn-*5 Y
>;
o
1 treated in the Department of (rthodontics, )olle!e of Dental *ciences,
Davan!ere, with all first bicuspid e%traction over a period of 6E to ;C months, usin!
consistent biomechanical principles" In order to evaluate the overbite chan!es all pre
and post cephalo!rams were traced and measured in relation to the vertical fuducial
line drawn perpendicular to 2+ plane" *imilarly various linear and an!ular
measurements were measured to evaluate the facial vertical dimensions"
/esults showed that e%traction line of treatment with all first bicuspids did
not show si!nificant chan!es in overbite and vertical facial hei!ht after treatment"
There was a sli!ht increase in the mandibular plane an!le, but it was clinically
insi!nificant" +owever it should be interpreted with caution, !iven the small sample
si4e" The results in this study concludes that there is no vertical reduction in the facial
hei!ht followin! first bicuspid e%traction, thus e%traction of teeth solely to increase
the overbite or decrease the mandibular plane an!le mi!ht not be .ustified"
Bibliograhy
B%B!%"GRPH-
6" +ans 3G, Groisser G, (amon ), Amberman D, 5elson *, Palomo 3"
)ephalometric chan!es in overbite and vertical facial hei!ht after removal of C
first molar or first premolars" Am G (rthod Dentofacial (rthop ;DD7@6>D0;1?
6E>-E"
;" Behrents /G, #hite /A" T3G /esearch" /esponsibility and ris" Am G (rthod
Dentofacial (rthop 6BB;@6D;061?6-6C"
>" Bernstein ," :dward +" An!le versus )alvin *" )ase ? :%traction vLs 5on-
e%traction" Part I +istorical /evisionism" Am G (rthod Dentofacial (rthop
6BB;@6D;0<1?C7C-FD"
C" *chudy 22" Vertical !rowth versus anteroposterior !rowth as related function
and treatment" An!le (rthod 6B7C@>C0;1?F<-B>"*chudy 22" An!le (rthod
6B7C@>C0;1?F<-B>"
<" *chudy 22" The rotation of the mandible resultin! from !rowth @ its implication
in orthodontic treatment" An!le (rthod 6B7<@><061?>7-<D"
7" *chudy 22" The control of vertical overbite in clinical orthodontics" An!le
(rthod 6B7E@>E061?6B->B"
F" *assouni and 5anda" Dentofacial vertical proportions" Am G (rthod
6B7C@<D0661?ED6-E;>"
E" Issacson G/, Issacson /G, *peidel T3, #orms 2#" :%treme variations in
vertical facial !rowth and associated variation in seletal and dental relations"
An!le (rthod 6BF6@C60>1?;6B-;B"
B" *tra!!ers GA" Vertical chan!es followin! first premolar e%tractions" Am G
(rthod Dentofacial (rthop 6BBC@6D<061?6B-;C"
Bibliograhy
6D" )usimano ), 3c,au!hlin /P, Zerni G+ :ffects of first bicuspid e%tractions on
facial hei!ht in hi!h-an!le cases" G )lin (rthod 6BB>@;F0661?;BC-BE"
66" Pearson ,:" Vertical control throu!h use of mandibular posterior intrusive
forces" An!le (rthod 6BF>@C>0;1?6BC-;DD"
6;" *choppe /G" An analysis of second premolar e%traction procedures" An!le
(rthod 6B7C@>C0C1?;E;->D;"
6>" Brensonis #,, Grewe G3" Treatment and post treatment chan!es in orthodontic
cases ? (verbite and (ver.et" An!le (rthod 6BFC@CC0C1?;B<-BB"
6C" 8etterha!en D+" 2irst premolar or second premolar e%tractions ? 2ormula or
)linical Gud!ement" An!le (rthod 6BFB@CB0>1?6BD-BE"
6<" Gianelly AA, +u!hes +3, #ohl!emuth P, Gielden G" )ondylar position and
e%traction treatment" Am G (rthod Dentofacial (rthop 6BEE@B>0>1?;D6-<"
67" )arter 5:" 2irst premolar e%traction and fi%ed appliance in )lass II division I
malocclusion" British Gournal of (rthodontics 6BEE@6<0;1?6-6D"
6F" +elleant 3, ,au!estrom ,, Gleerup A" (verbite and over.et correction in
)lass II Division 6 sample treated with :d!ewise therapy" :uropean Gournal of
(rthodontics 6BEB@6601?B6-6D7"
6E" /eyanders /3" (rthodontics and temporomandibular disorders = A review of
,iterature 06B77-6BEE1" Am G (rthod Dentofacial (rthop 6BBD@BF071?C7>-F6"
6B" Gianelly AA, )o44ani 3, Boffa T" )ondylar position and ma%illary first
premolar e%traction" Am G (rthod Dentofacial (rthop 6BB6@BB0<1?CF>-7"
;D" ,uece P:, Gohnston ,:" The effects of ma%illary first premolar e%traction and
incisor retraction on mandibular position" Testin! the central elo!ma of
Sfunctional orthodonticsH" Am G (rthod Dentofacial (rthop 6BB;@6D6061?C-6;"
Bibliograhy
;6" 8remena )/, 8irser DD, +arman +A, 3enard )), Gaobsen G/" (rthodontic
ris factors for temporomandibular disorders 0T3D1 ? I premolar e%traction"
Am G (rthod Dentofacial (rthop 6BB;@6D6 061?6>-;D"
;;" 8lapper ,, 5avarro *, Bowman D, Pawlonesi B" The influence of e%traction
of non-e%traction orthodontic treatment on bronchofacial and dolichofacial
!rowth patterns" Am G (rthod Dentofacial (rthop 6BB;@6D6 0<1?C;<->D"
;>" )haw A,, ,im GA*, ,ubit :)" The effects of e%traction versus non-e%traction
orthodontic treatment on !rowth of the lower anterior face hei!ht" Am G (rthod
Dentofacial (rthop 6BB>@6DC0C1?>76-E"
;C" ,uppanapornlarp *, Gohnston ,:" The effects of premolar e%traction ? A lon!-
term comparison of outcomes in Sclear-cutH e%traction and non-e%traction class
II patients" An!le (rthod 6BB>@7>0C1?;<F-FD"
;<" 3c,aun!hlin /P, Bennett G)" The e%traction = non-e%traction dilemma as it
realist T3D" An!le (rthod 6BB<@7<0>1?6F<-E7"
;7" *avisay ,T, Darendelier 5" The influence of e%traction orthodontic treatment
on craniofacial structures" :valuation accordin! to two factors" Am G (rthod
Dentofacial (rthop6BBB@66<0<1?<DE-6C"
;F" 8ocadereli I" The effects of first premolar e%traction on vertical dimension"
Am G (rthod Dentofacial (rthop 6BBB@667061?C6-<"
;E" *ansey #,, Buschan! P+, :n!lish I, (wen A+" :arly treatment of vertical
seletal dysplasia ? The hyperdiver!ent phenotype" Am G (rthod Dentofacial
(rthop ;DDD@66E0B1?>6F-;F"
;B" Ahn GG, *chneider BG" )epahlometric appraisal of posttreatment vertical
chan!es in adult orthodontic patients" Am G (rthod Dentofacial (rthop
;DDD@66E0C1?>FE-EC"
Bibliograhy
>D" ,ai G, Ghosh G, 5anda /*" :ffects of orthodontic therapy on facial profile in
lon! and short vertical facial pattern" Am G (rthod Dentofacial (rthop
;DDD@66E0<1?<D<-6>"
>6" Avous A" Vertical chan!es followin! orthodontic e%traction treatment in
seletal openbite sub.ects" :ur G (rthod ;DD;@;C0C1?CDF-67"
>;" 3erel (, Iscan +5, (ay ), Giirsoy A" :ffects of bilateral upper first
premolar e%traction on the mandible" :ur G (rthod ;DDC@;C0>1?;;>-;>6"
>>" 8im T8, 8im GT, 3ah G, Aan! #*, Bac *+" 2irst or second premolar
e%traction effects on facial vertical dimension" An!le (rthod ;DD<@F<0;1?6FF-
6E;"
>C" +ayasai *3, +enri$ues G2), Ganson G, )reitas 3/d" Influence of e%traction
and non-e%traction orthodontic treatment in Gapanese-Bra4ilians with )lass I
and )lass II Division 6 malocclusion" Am G (rthod Dentofacial (rthop
;DD<@6;F061?>D-7"
><" Al-5imi 8*" Vertical chan!es in class II division 6 malocclusion after
premolar e%tractions" An!le (rthod F7061?<;-<E"
>7" 8uitert /, Becmann *, ,oenen 3V, Tain4in! B, Zentner A" Dentoalveolar
compensation in sub.ects with vertical seletal dysplasia" Am G (rthod
Dentofacial (rthop ;DD7@6;B0<1?7CB-<F"
>F" *harp ), +arners 3, +erbison P" Vertical chan!es in treated and untreated
class II division I malocclusion" Aust (rtho G ;DDF@;>0;1?66C-6;D"
>E" *ivaumar A, Valiathan A" )ephalometric assessment of dentofacial vertical
chan!es in )lass I sub.ects treated with and without e%traction" Am G (rthod
Dentofacial (rthop ;DDE@6>>071?E7B-F<"
Bibliograhy
>B" *urendra 8" 5anda" Growth patterns in sub.ects with lon! and short faces" Am
G (rthod Dentofacial (rthop 6BBD@BE0<1?;CF-<E"
CD" (pdebeec +, Bell #+ = The short face syndrome" Am G (rthod Dentofacial
(rthop 6BFE@F>0<1?CBB-<66"
C6" 3oorrees )2A, 8ean 3/" 5atural head position, a basic consideration in the
interpretation of cephalometric radio!raphs" Am G Phy Anthropol
6B<E@670>1?;6>->C"
C;" )ooe 3* #ei *tephen +A" The reproducibility of natural head posture ? A
methodolo!ical study" Am G (rthod Dentofacial (rthop 6BEE@B>0C1?;ED-E"
C>" *teiners ))" )ephalometric chan!es in clinical practice" Am G (rthod
6B<B@;B061?E-;B"
CC" Garlicu!lenmound ,o!an ,/" Vertical chan!es in hi!h mandibular plane cases
followin! enucleation of second premolars" An!le (rthod 6BBD@7D0>1?;7>-;7F"
C<" Baumrind *" Unbiased $uantitative testin! of conventional orthodontic beliefs"
*em (rthod 6BBE@C?>-67"
C7" Pearson ,:" Vertical control throu!h use of mandibular posterior intrusive
forces" An!le (rthod 6BF>@6BC-;DD"
CF" +arris :+, Gardner /,, Vander G," A lon!itudinal cephalometric study of
post-orthodontic craniofacial chan!es" Am G (rthod Dentofacial (rthop
6BBB@66<061?FF-E;"
CE" Gardner /Z, +arris :+, Vanden G," Postorthodontic dental chan!es" A lon!
study" Am G (rthod Dentofacial (rthop 6BBE@66C0<1?<E6-7"
Bibliograhy
CB" #est 8*, 3c5amara GA" )han!es in the craniofacial comple% from
adolescence to midadulthood ? A ceph *tudy" Am G (rthod Dentofacial (rthop
6BBB@66<0<1?<;6->;"
<D" *tas!ers GA" A comparison of results of II molar and I premolar e%traction
treatment" Am G (rthod Dentofacial (rthop 6BBD@BE0<1?C>D-7"
!nne"ures
#S$ER CHR$ 3 > = PRE , P"S$ 'GU!R CEPH!"#E$R%C #ESURE#E'$S 6%' )EGREES7
*l"
5o"
5ame
A
!
e
0
A
r
s
1
*
e
%
Go!n - *5 Go!n - 2+ Go!n - PP Go!n-(P *5-PP *5 - 2+ U6 - *5 ,6 - Go!n U"Gonial ,"Gonial A - A%is
P
/
:
P
(
*
T
P
/
:
P
(
*
T
P
/
:
P
(
*
T
P
/
:
P
(
*
T
P
/
:
P
(
*
T
P
/
:
P
(
*
T
P
/
:
P
(
*
T
P
/
:
P
(
*
T
P
/
:
P
(
*
T
P
/
:
P
(
*
T
P
/
:
P
(
*
T
6 Veeranna ;6 3 >< >C ;7 ;< ;B ;E 6F 6> E 66 B B 66< 6D< 6D< B7 <C << F< F< 7B FD
; 3an.unath 3 G ;D 3 >7 >7 ;7 ;7 ;F ;F 67 6< B E B B 66E 6D7 6D> BC <C << F< FE FD 7E
> *antosh 6B 3 >C >C ;F ;F ;7 ;7 67 67 B B E E 66C 6D7 6D6 B> <; <; F; F> 7F 7E
C 5abi 6E"7 3 >> >C ;F ;B ;< ;< 6< 67 6D 6; 6D B 66; 6DC 6DD B; <; <; F7 FF 77 77
< ,oesh 6E 3 >> >C ;F ;E ;< ;7 6F 6C 6D 66 6D 6D 66< 6D< 6DC B< <; <; F7 F7 7F 7F
7 Pradeep 6F"7 3 >> >> ;7 ;7 ;< ;< 6< 6F 66 66 B B 66C 6D7 6D6 B> <> <C F7 FE 7F 7E
F Basavalin!appa ;D 3 >< >7 ;E ;E ;7 ;7 6< 6E 66 6; 6D 66 66E 6D< 6D> B< << <C FE ED 7E 7B
E Pradeep ;D 3 >> >< ;F ;E ;C ;7 67 6F 6D 6D 6D 6D 6;D 6DF 6D7 BE <> <> F< FF 7F 7E
B *aneth 6E 3 >; >> ;7 ;F ;C ;C 6F 6F 66 6D 66 66 66E 6D7 BB BD <C <C F7 F> 7< 7<
6D Girish U T ;6 3 >C >> ;F ;F ;C ;< 67 6F 66 6D 6D 6D 6;D 6DE 6DC BF << << FB F< 7F 7<
66 Praveen G 3 6E 3 >; >> ;7 ;F ;C ;C 6F 6F 6D B 6D 6D 66F 6DF BE BD <C <C F7 F< 77 77
6; Basavara. ;D 2 >< >7 ;7 ;7 ;7 ;7 6< 6C E F 6D B 66B 6DF 6D> B< <C <C FE FE 7B 7B
6> Tabussam 6B 2 >< >< ;F ;E ;C ;< 67 6F 6D 6D 66 6D 667 6DC B; BD <> <> F< FF 7F 7E
6C *wathi ;6 2 >C >> ;F ;F ;C ;< 67 6F 66 6D 6D 6D 6;D 6DE 6DC BF << << FB F7 77 7F
6< Aasmeen 6E"7 2 >7 >7 ;E ;F ;F ;7 6< 67 B B B E 66C 6D7 6D6 B> <; <; F; FE 7F 7E
67 Gowri 6B 2 >C >C ;7 ;7 ;< ;< 6< 6F 66 66 B B 66C 6DF 6D6 B< <> <> FE FE 7E 7E
6F /oopa ;D 2 >C >F ;E ;B ;7 ;F 6< 6E 66 6; 6D 66 66E 6D< 6D> B< << <C FE ED 7E 7B
6E /eena ;6 2 >C >> >7 ;< ;B ;E 6F 6> E 66 B 66 66< 6D< 6D< B7 <C <C F< F< 7B FD
6B *harada ;D 2 >; >> ;7 ;F ;C ;C 6F 6F 66 66 66 6D 66E 6D7 BB BD <C <C F7 F> 7< 7<
;D Ashwini 6E 2 >> >< ;F ;E ;< ;7 6F 6C 6D 66 6D 6D 66< 6D< 6DC B7 <> <> F< F< 7F 7F
;6 *hobha 6B 2 >< >7 ;7 ;F ;E ;F 6< 6< B E B B 66E 6D7 6D> BC <C <C FE FE 7E 7E
;; Bha!ya 6B 2 >> >> ;7 ;7 ;< ;7 6< 6E 66 6; 6D 66 66E 6D< 6D> B< <> <> FF FF 7F 7E
;> Vineeta ;D 2 >> >C ;F ;F ;C ;< 67 6F 66 6D 6D 6D 6;D 6DE 6DC BF << << FB F7 7F 7<
;C Deepa 6B"7 2 >> >C ;F ;E ;< ;7 6F 6C 6D 66 6D 6D 66< 6D< 6DC B< <; <; F7 F7 7F 7F
;< +alamma ;D 2 >C >> ;7 ;F ;C ;C 6F 6F 66 6; 66 66 66E 6D7 BB BD <C <C F7 F> 7< 7<
!nne"ures
#S$ER CHR$ , 0 = PRE , P"S$ !%'ER CEPH!"#E$R%C #ESURE#E'$S 6%' ##7
*l"
5o" 5ame
A!e
0Ars1
*e
%
5 = 3e *e = Go 5 = A5* A5*-3e AP2 ht /t *V - U7 Po!-,7 2+ - U7 2+ - ,7
P
/
:
P
(
*
T
P
/
:
P
(
*
T
P
/
:
P
(
*
T
P
/
:
P
(
*
T
P
/
:
P
(
*
T
P
/
:
P
(
*
T
P
/
:
P
(
*
T
P
/
:
P
(
*
T
P
/
:
P
(
*
T
6 Veeranna ;6 3 6;B 6;E FE FE << << FC F> 7D"C 7D"B CD C; -;D -6E CF CB CE CF
; 3an.unath 3 G ;D 3 6;E 6>D FE FB << << F< F> 7D"F 7D"6 C6 C> -;6 -6B C7 CE"< CF C<"<
> *antosh 6B 3 6;F 6;E FF F7 <C << F> F> <B"B 7D"> >B C; -6B -67 CB <; <D CE
C 5abi 6E"7 3 6;< 6;F F7 F< <C <> F> FC 7D"E <B"6 CD C> -;D"< -6F"< CF CE"< CE CF
< ,oesh 6E 3 6;C 6;C FC F> <6 <6 F> F< <B"7 <B"C CD C; -;D -6E CE <D CB CF
7 Pradeep 6F"7 3 6;C 6;C F; F; <> <> F6 F6 <E"7 <E"6 >B C; -6B -67 CE <D <D CE
F Basavalin!appa ;D 3 6;F 6;< F< F> <C <C F> F6 <B"6 <B >B C6 -6B -6F C7 CE"< CF C<
E Pradeep ;D 3 6;E 6;F F7 FF <; <; F7 F< <B"> 7D >B C; -;D -6F CE CB"< CB CF"<
B *aneth 6E 3 6;C 6;> F> F; <6 <6 FC F> <E"E <E"< CD C; -6B -6E C< CE C7 CE
6D Girish U T ;6 3 6;< 6;> FC FC <; <; F> F6 <B"; 7D"6 CD C; -;D -6E C7 CE CF CB
66 Praveen G 3 6E 3 6;D 6;6 F> F> <D <D FD F6 7D"< 76 C6 C> -;6 -6B CC C7"< C< CF
6; Basavara. ;D 2 66B 6;D F; F; <; <; 7F 7E <B"7 7D"> CD C; -;D -6E C> C7 CF C<"<
6> Tabussam 6B 2 66E 66E 7E 7E <D <6 77 7F <B"> <B"> >B C6 -6B -6F CF CB CE C7"<
6C *wathi ;6 2 6;B 6;E F6 F; <; <> 7F 7E 7D 7D"6 C6 C> -;6 -6B C7 CE CF C<"<
6< Aasmeen 6E"7 2 6>D 6;E F> F> <C <; 7E 7B 7D"6 7D"6 C6 C> -;6 -6B CE CB"< CB CF"<
67 Gowri 6B 2 6;F 6;E FD FD <6 <6 7F 7F <B"C <B"B CD C; -;6 -6B CB <6 <D CE
6F /oopa ;D 2 6;E 6;< F; F; <; <; 7F 7E <E"7 <E CD C; -;D -6E CF CB CE C7"<
6E /eena ;6 2 6;F 6;C F6 F6 <; <; 77 77 <B"> <B C6 C>"< -;6 -6E"< CC C7"< C< C>
6B *harada ;D 2 6;C 6;C 7B 7B <> <> 7< 7< 7D"6 7D"> C; C< -;; -6B C< CF C7 C<
;D Ashwini 6E 2 6;< 6;F 7E 7E <D <D 77 77 7D 7D"> >B C6 -6B -6F CC C7"< C< CC
;6 *hobha 6B 2 6;F 6;7 7B 7B <D <6 7E 7E 7D"> 7D"> >B C; -6B 67 CC CF C< C>
;; Bha!ya 6B 2 6;E 6;F 77 77 <D <D 7F 7E <B"B <B"6 >B C; -6E -6F C7 CE"< CF C<
;> Vineeta ;D 2 6;C 6;7 7F 7F <; <> 77 7< <B"6 <B"C CD C; -;D -6E CE <D CB CF
;C Deepa 6B"7 2 6;C 6;7 FC F> <6 <6 F> F< <B"7 <B"C CD C; -;D -6E CF CB"< CE C7
;< +alamma ;D 2 6;C 6;> F> F; <6 <6 FC F> <E"E <E"< C6 C> -;6 -6B CF CB CE C7"<
!nne"ures
#S$ER CHR$ , ? = PRE , P"S$ "&ERB%$E CEPH!"#E$R%C #ESURE#E'$S
*l"
5o"
5ame
A!e
0Ars1
*e
%
39*8 BU6 TU6 B,6 T,6 35*8 (B
P/: P(*T P/: P(*T P/: P(*T P/: P(*T P/: P(*T P/: P(*T P/: P(*T
6 Veeranna ;6 3 6F 6B 6< 6F 6B ;D ;E ;> 6> 6; F; FC 6CF 6CF
; 3an.unath 3 G ;D 3 ;; ;6 6F 6B 6E ;D ;F ;> 6 6; FC F< 6<6 6<;
> *antosh 6B 3 ;C ;<"< 6F 6B ;; ;6 ;< ;> 6< 6> F< F7 6<< 6<C
C 5abi 6E"7 3 ;> ;< 6F 6B ;D"< ;6 ;7 ;C 6< 6C F; FC 6<; 6<6
< ,oesh 6E 3 ;C ;< 6< 6E 6B ;6 ;7 ;> 6< 6C F7 FC 6<> 6<6
7 Pradeep 6F"7 3 ;> ;C 67 6E 6E ;D ;F"< ;C 6C 6; F< FC 6<; 6<D
F Basavalin!appa ;D 3 ;< ;7 67 ;D ;D ;; ;7 ;>"< 6> 6; FC F< 6<6 6<;
E Pradeep ;D 3 ;< ;C 6F ;D ;D ;; ;< ;> 6C 6; F> FC 6<D 6<;
B *aneth 6E 3 ;< ;C 6E ;6 ;D ;; ;7 ;C 6C 6; FC F; 6<; 6<;
6D Girish U T ;6 3 ;< ;> 67 6B 6B ;6 ;F ;C 6< 6> FC F> 6<> 6<;
66 Praveen G 3 6E 3 ;C ;> 6F ;D 6B ;6 ;< ;C 6> 6; F> F; 6CF 6CB
6; Basavara. ;D 2 ;C ;< 6< 6B 6B ;6 ;< ;; 6; 66 F> FC 6C7 6CE
6> Tabussam 6B 2 ;> ;C 67 6E 6E ;D ;F ;C 6C 6; F< FC 6<; 6<D
6C *wathi ;6 2 ;C ;< 6< 6E 6B ;D ;> ;< 66 6; F> F> 6CE 6CB
6< Aasmeen 6E"7 2 ;; ;C 67 6B 6B"< 6B ;<"< ;> 6C 6> F; FC
6CE"
< 6CE
67 Gowri 6B 2 ;C ;; 6F 6B 6B ;6 ;7 ;C 6< 6; F> F; 6<6 6CB
6F /oopa ;D 2 ;C ;7 67 6B ;6 ;; ;;"< ;C 66 6> F< F>
6C7"
< 6CB
6E /eena ;6 2 ;< ;C 6F ;D ;D ;6 ;C ;; 6> 66 FC F; 6CB 6CE
6B *harada ;D 2 ;> ;C 67 6E ;6 ;; ;C ;; 6< 6C F< F7 6<; 6<;
;D Ashwini 6E 2 ;C ;< 6B 6F ;D 6B ;; ;D 6> 6< F7 FC 6<6 6<D
;6 *hobha 6B 2 ;> ;C 67 6B 6F 6B ;F ;> 6C 6< F> FC
6CE"
< 6<D
;; Bha!ya 6B 2 ;; ;> 6F 6B 6B 6E ;B ;7 6C 66 6F"> F7
6CB"
< 6CF
;> Vineeta ;D 2 ;; ;> 6F"< ;D 6E"< ;D ;F ;C 6C 6; FC F< 6<6 6<;
!nne"ures
;C Deepa 6B"7 2 ;C ;< 6<"< 6E 6B ;6 ;7 ;> 6< 6C F7 FC
6<>"
< 6<6
;< +alamma ;D 2 ;< ;C 6E ;6 ;D ;; ;7 ;C 6> 6; FC F; 6<; 6<;