The esthetic impact of extraction and nonextraction treatments on Caucasian patients

This investigation was designed to compare the esthetic effects of extraction and nonextraction treatments. Panels of 58 laypersons and 42 dentists evaluated randomly presented pre- and posttreatment profiles of 70 extraction and 50 nonextraction Class I and II Caucasian patients. The samples were similar at the outset; however, at the end of treatment, the extraction patients' faces were, on average, 1.8 mm "flatter" than the faces of nonextraction subjects. The flatter faces were preferred by both panels, dentists more so than laypersons. In general, nonextraction treatment was seen as having little effect on the profile, whereas the perceived effect of extraction treatment was a statistically significant function of initial soft tissue protrusion-the greater the initial protrusion, the greater the benefit. The point at which a reduction in protrusion produces a perceived improvement was explored by way of regression analysis. Both panels saw extraction as being potentially beneficial when the lips were more protrusive than 2 to 3 mm behind Ricketts' E-plane. It is concluded that extraction treatment can produce improved facial esthetics for many patients who present with some combination of crowding and protrusion.