Growth and treatment changes distal to the mandibular first molar: a lateral cephalometric study

This study examined space changes occurring distal to the mandibular first molar in growing patients treated using two different approaches. Two groups of 50 patients were selected for the study. The patients in group I were treated with the extraction of mandibular second premolars, whereas those in group II were treated without mandibular premolar extractions, by holding E-spaces with utility arches. Lateral cephalograms taken before and after treatment were used to measure space changes within the mandible. Follow-up written treatment records and radiographs were also examined to ascertain whether the mandibular third molars were ultimately extracted or retained. A greater mean space increase between Xi point and the mandibular first molar was found in boys and girls treated with second premolar extractions. The mean space increase between Xi point and the mandibular first molar, as well as the average increase in total mandibular length, was greater in boys than in girls for both treatment modalities. This reflects a greater amount of growth in boys during the treatment period. The greater mean space increase in the groups treated with second premolar extractions could be attributed to the fact that the first molar generally moved further mesially during treatment in the extraction subjects, whereas in the E-space subjects, the first molars were perhaps held back. It was noted that the mandibular third molars were ultimately more likely to have been extracted in the E-space groups than in the second premolar extraction groups within this sample.