Tratamento atípico da biprotrusão dentoalveolar / Atipical treatment of dentoalveolar biprotrusion ­ a case report

A biprotrusão dentoalveolar é caracterizada pelo posicionamento mais anterior dos incisivos superiores e inferiores, o que traz como consequência um selamento labial deficiente e um perfil convexo, comprometendo a estética facial do paciente e fazendo com que este busque no tratamento ortodôntico a sua correção. O plano de tratamento destes casos, na sua maioria, envolve a realização de extrações, porém, quando já previamente ao tratamento o paciente apresenta ausências dentárias, o planejamento é simplificado, já que a retração anterior necessária pode ser direcionada para estes espaços sem que haja necessidade de extrações nestas regiões. O objetivo deste trabalho foi apresentar um caso clínico que promoveu a correção da biprotrusão e, consequentemente, da estética do sorriso e facial da paciente, através da realização da exodontia de apenas dois primeiros pré-molares superiores e retração anteroinferior redirecionada para os espaços já existentes, em consequência da perda do molar inferior esquerdo e devido à agenesia do incisivo lateral inferior direito. Além disso, no controle de sete anos pós-tratamento, observou-se estabilidade oclusal e manutenção da estética facial.

Dental biprotrusion is characterized by greater buccal tipping of the upper and lower incisors, rendering poor lip closure and convex profile, compromising the patient's facial esthetics and making him/her to seek orthodontic treatment for correction. In these cases the treatment plan, mostly involves performing extractions, but when already prior to treatment the patient has missing teeth, the treatment plan becomes simplified, since the anterior retraction required might be directed to these areas with no need for removal. The goal of this study is to show a case that promoted the correction of biprotrusion and consequently the patient smile and facial esthetics by performing the extraction of only two first maxillary premolars and anterior retraction redirected for the existing spaces as a result of the mandibular left molar loss and due to agenesis of the right lateral incisor. In addition, the 7-year follow-up control demonstrated occlusal stability and maintenance of the facial esthetics.

Effect of orthodontic extraction treatment and non-extraction treatment on esthetical smile / 中华医学美学美容杂志

Objective To investigate the effect of orthodontic tooth extraction and non-extraction on dental arch width and esthetical smile. Methods 100 patients treated without extraction and 100 patients treated by 4 first-premolars extraction were selected. The study models of the patients were measured before and after the treatment and compared statistically. Measurements were made in the maxillary and mandibular canine regions from the most labial aspect of the buccal axial surfaces of the canine roots. Results Before treatment, maxillary and mandibular arch widths were the same between both groups (P＞0.05). In non-extraction group, mandibular arch width of posttreatment was 0.88 mm larger than that of pretreatment (P＜0.001), and maxillary arch width of posttreatment was 0.84 mm large (P＜0.001). In extraction group, mandibular arch width of posttreatment was 1.64 mm larger than that of pretreatment (P＜0.001), and maxillary arch width of posttreatment was 1.50 mm large (P＜0.001). After treatment, the width of mandibular arch in the extraction group was 0.59 mm larger than that in the non-extraction group (P>0.05), while the width of maxillary arch in the extraction group was 0.10 mm less (P>0.05).Conclusion Both extraction treatment and non-extraction treatment do not result in narrower dental arch, but wider. The view that orthodontic extraction results in narrower arch widths and unaesthetic smiling is untenable.