Extraction versus non-extraction: evaluation by digital subtraction radiography

Abstract

The aim of this study was to investigate the facial profile changes of patients treated with and without extractions of four first premolars using novel computer-based digital subtraction software. The pre- and post-treatment radiographic image pairs of 25 extraction (13 girls and 12 boys, mean age = 12.64 +/- 1.82 years) and 24 non-extraction (12 girls and 12 boys, mean age = 12.48 +/- 1.66 years) Class I patients were subtracted by the software. Student's t-tests were used to determine whether the subtraction values for the linear measurements of radiographic differences registered at various anatomical landmark parameters were statistically different between the groups. To further determine whether any variables related to upper and lower lip changes, regression analyses were performed. The main soft tissue differences between the groups were established at labrale superior, labrale inferior, and sulcus inferior points, with extraction patients showing significantly more retruded upper and lower lips. However, the mean differences between the groups did not exceed 1 mm for these variables. Changes at labrale superior and labrale inferior were associated with sagittal movement of the maxillary (r = 0.549) and mandibular (r = 0.630) incisor midpoints. Changes at sulcus inferior were associated with both sagittal and vertical displacement of mandibular incision point (r = 0.676). Some dentofacial alterations were found but in view of the differences between the groups pretreatment, the inter-group differences reflect different treatment intent rather than differences arising from the extraction and non-extraction modalities.