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The extraction-nonextraction dilemma as it relates to TMD
1University of Bristol, London, England.
The Angle Orthodontist
|January 1, 1995
Summary
Orthodontic premolar extraction does not cause temporomandibular disorders or facial profile flattening. Studies show no increased incidence of temporomandibular disorders in patients who have undergone premolar extraction.
Area of Science:
- Orthodontics
- Dental Research
- Temporomandibular Disorders
Background:
- Premolar extraction in orthodontics is controversial.
- Concerns exist regarding potential links to temporomandibular disorders (TMD) and facial profile changes.
Purpose of the Study:
- To evaluate the association between premolar extraction and temporomandibular disorders.
- To assess the impact of premolar extraction on vertical dimension and facial profile in orthodontic patients.
Main Methods:
- Review of existing dental literature and correlation studies.
- Analysis of cases involving premolar extraction in orthodontic treatment.
Main Results:
- No higher incidence of temporomandibular disorders found in patients treated with premolar extraction compared to controls.
- Premolar extraction does not lead to vertical dimension collapse; it is maintained or slightly opened.
- No evidence suggests premolar extraction causes undesirable facial profile flattening.
Conclusions:
- The contention that premolar extraction causes temporomandibular disorders is not supported by current evidence.
- Facial profile changes are primarily determined by diagnostic decisions and treatment mechanics, not extraction itself.
- Proper orthodontic mechanics, including arch leveling and space closure, prevent adverse outcomes like anterior interferences and condylar displacement.