Effects of mandibular incisor extraction on anterior occlusion in adults with Class III malocclusion and reduced overbite

Abstract

The aim of this study was to assess the treatment outcome and changes in mandibular incisor position after extraction of one single incisor in 36 adult orthodontic cases with combined Class III and open bite tendencies. The cases consisted of 21 female and 15 male patients with an average age of 27.8 years (standard deviation [SD], 11.1 years) at the start. Fixed 0.018-inch Edgewise appliances were used in both arches in 19 patients and in the mandibular arch in 17 patients. Average treatment time was 18 months (SD, 7.1 months). Pretreatment ANB was 0.5(o) (SD, 2.7 degrees), overjet 1.4 mm (SD, 1.9 mm), and overbite 1.5 mm (SD, 1.1 mm). The lower incisors were 3.6 mm (SD, 2.8 mm) in front of the APg-line, and the Averaged Irregularity Index was 1.1 mm (SD, 0.6 mm). Records representing pretreatment (T1), posttreatment (T2), and average 4.3 years (SD, 2.3 years) retention (T3) included cephalograms, panoramic films, intraoral and extraoral photographs, and plaster models. All cast measurements were made with digital calipers. On the cephalograms, the lower incisor tips moved posteriorly 1.7 mm (SD, 2.0 mm) and occlusally 1.5 mm (SD, 1.8 mm) from pretreatment to posttreatment. Relative to the x-axis, they tipped lingually 5.9(o) (SD, 5.6 degrees). On the cast analysis, overjet increased 1.0 mm (SD, 1.9 mm) and 1.5 mm (SD, 1.5 mm) for the maxillary central and lateral incisors, respectively, whereas overbite increased 0.6 mm for both the central and lateral incisors. The intercanine width was reduced by 3.3 mm (SD, 2.0 mm), while the intermolar width was unchanged. The Average Irregularity Index was reduced from 1.1 to 0. 2 mm. Arch-length was reduced 3.6 mm from pretreatment to posttreatment, and another 0.3 mm from posttreatment to 4.3-years retention. Other changes from posttreatment to 4.3-years retention were slight. No loss of the interdental gingival papillae was normally observed. It is concluded that the extraction of one mandibular incisor can lead to satisfactory treatment results in adults with mild Class III malocclusion and reduced overbite, particularly when coupled with a large mandibular intercanine width and minor crowding, and some mandibular tooth size excess. However, the orthodontic treatment frequently became more complicated and time-consuming than expected at the start.