The timing of extraction of non-restorable first permanent molars: a systematic review.

AIM To identify the ideal timing of first permanent molar extraction to reduce the future need for orthodontic treatment. MATERIALS AND METHODS A computerised database and subsequent manual search was performed using Medline database, Embase and Ovid, covering the period from January 1946 to February 2013. Two reviewers (JE and ME) extracted the data independently and evaluated if the studies matched the inclusion criteria. Inclusion criteria were specification of the follow-up with clinical examination or analysis of models, specification of the chronological age or dental developmental stage at the time of extraction, no treatment in between, classification of the treatment result into perfect, good, average and poor. The search was limited to human studies and no language limitations were set. RESULTS The search strategy resulted in 18 full-text articles, of which 6 met the inclusion criteria. By pooling the data from maxillary sites, good to perfect clinical outcome was estimated in 72% (95% confidence interval 63%-82%). Extractions at the age of 8-10.5 years tended to show better spontaneous clinical outcomes compared to the other age groups. By pooling the data from mandibular sites, extractions performed at the age of 8-10.5 and 10.5-11.5 years showed significantly superior spontaneous clinical outcome with a probability of 50% and 59% likelihood, respectively, to achieve good to perfect clinical result (p<0.05) compared to the other age groups (<8 years of age: 34%, >11.5 years of age: 44%). CONCLUSION Prevention of complications after first permanent molars extractions is an important issue. The overall success rate of spontaneous clinical outcome for maxillary extraction of first permanent molars was superior to mandibular extraction. Extractions of mandibular first permanent molars should be performed between 8 and 11.5 years of age in order to achieve a good spontaneous clinical outcome. For the extraction in the maxilla, no firm conclusions concerning the ideal extraction timing could be drawn.

A Dynamic Analysis: the Smile and Display of Dentition during Speech

The objective of this retrospective study is to follow up on a previous Dynamic Smile Analysis and videographically analyze and develop averages for soft tissue norms with respect to the display of dentition during speech. These values would then be compared cross-sectionally across different age groups to see whether changes attributable to the aging process could be seen. A secondary objective was to compare averages for soft tissue norms in the display of dentition during speech to averages for soft tissue norms in the display of dentition during the smile. Materials and Method: Records from a previous study in which video equipment was used to capture video for 26 1 subjects were re-evaluated to find appropriate frames to analyze for speech. Two frames for each subject were selected; one frame representing the maximal display of maxillary incisors during speech and the second representing the widest transverse display of dentition during speech. After excluding 40 subjects the data for the remaining 221 subjects was analyzed. These averages were then compared to averages attained in the previous study to compare the display of the dentition during speech to the display of the dentition during smile. Results: On average, a difference in 1.29 mm was seen in the display of the maxillary incisors during speech at maximal display and during the smile. An average of 7.23 mm of maxillary incisors is readily visible during maximum display of maxillary incisors during speech, as compared to 8.52 mm during the smile. The constructed smile index was also smaller when measured during the speech when compared to the smile index by an average of 2.58 units. Conclusion: This study helps to establish age-related dynamic norms for the display of dentition during speech. The dynamic measures indicate that the display of dectition is greater, on average, during the smile than at speech.