Long-term spontaneous changes following removal of all first premolars in Class I cases with crowding

The purpose of the study was to evaluate the result in adults of Class I malocclusion cases who had all their first premolars extracted as the sole treatment of space deficiency in the mixed or early permanent dentition. The mean age at premolar removal was 10 1/2 years. Forty-two out of 44 cases were re-examined at a mean age of 30 years and 4 months. Observations of dental occlusion and oral health were compared to observations of control samples. The average malocclusion in the adults, as judged by a score method, was similar to that reported for an appliance-treated sample. Marked spontaneous arch alignment and residual space closure with age was seen in most cases. Despite earlier tooth removal, on average crowding developed to about the same degree as that of an non-extraction normal occlusion sample. No detrimental effects were seen with regard to overjet or overbite. Neither did the figures for lower incisor position at the follow-up examination differ from that of the normal occlusion sample. Although tipping of adjacent teeth towards the extraction site was frequent, especially in the mandible, no effect on marginal bone height was evident as judged by comparison with a non-extraction control sample. The results reveal a significant capacity for spontaneous improvements with age in dental arch morphology and relationship in extraction cases, provided that specific features have been looked for in case selection.