Facial changes in extraction and nonextraction patients

The purpose of this study was to determine if there are any differences in the posttreatment faces of patients treated nonextraction and those treated with premolar extraction in properly diagnosed and treated cases. The study was conducted in two parts. In Part 1, perceptions of 192 experienced general dentists and orthodontists were tested. Facial photos of 25 consecutively treated nonextraction patients and 25 consecutively treated four-premolar-extraction patients were shown to the study participants. They were asked if the patient was treated with the extraction of four premolars or without extractions. The mean score of the respondents was 54%, only slightly better than pure chance. In Part 2, profiles were evaluated based on cephalometric tracings. There was no significant difference between pretreatment and posttreatment profiles of the groups. The mean H-line values for both groups were within the desired esthetic range. It was concluded that experienced orthodontists and general dentists could not determine whether treatment was nonextraction or extraction by looking at the face alone. Also, there was no significant difference between the faces produced by the two types of treatments. Therefore, the avoidance of extracting premolars based on a fear of a significant detrimental effect on the face is unjustified when the case has been properly diagnosed and treated.