Dental and Medical Problems

Dent Med Probl
Index Copernicus (ICV 2020) – 128.41
MEiN – 70 pts
CiteScore (2021) – 2.0
JCI – 0.5
Average rejection rate (2021) – 81.35%
ISSN 1644-387X (print)
ISSN 2300-9020 (online)
Periodicity – quarterly

Download original text (EN)

Dental and Medical Problems

2020, vol. 57, nr 2, April-June, p. 157–163

doi: 10.17219/dmp/115169

Publication type: original article

Language: English

Download citation:

  • BIBTEX (JabRef, Mendeley)
  • RIS (Papers, Reference Manager, RefWorks, Zotero)

Creative Commons BY-NC-ND 3.0 Open Access

Effect of class II extractions and functional appliance treatment on smile esthetics

Wpływ ekstrakcji i leczenia czynnościowego wad zgryzu klasy II na estetykę uśmiechu

Umair Shoukat Ali1,A,B,D, Rashna Hoshang Sukhia1,C,E,F, Mubassar Fida1,A,F

1 Aga Khan University and Hospital, Karachi, Pakistan


Background. Class II malocclusion is routinely observed in orthodontics. Its treatment usually revolves around the growth modification or the extractions of the teeth. Identifying treatment that leads to the greatest improvement can aid clinicians in providing the desired smile esthetics.
Objectives. The aim of the study was to compare smile esthetics between treatment groups by measuring various smile variables and the esthetic perceptions of 3 panels of raters.
Material and Methods. A cross-sectional study was performed on 66 patients equally divided into the functional appliance (FA) and upper first premolar extraction (UPE) groups. Eight smile variables were measured on post-treatment photographs using the Adobe Photoshop® software. Ten orthodontic residents, general dentists and laypersons performed the subjective evaluations of smiles using the visual analog scale (VAS). The Mann–Whitney U-test was applied to compare smile variables between the groups. The Kruskal–Wallis test was used to compare esthetic scores (ES) among the raters. The simple linear regression analysis, followed by the multiple linear regression analysis was applied to determine the smile variables associated with the ES values.
Results. Statistically significant differences were found between the FA and UPE groups for the buccal corridor ratio (BCR) (p = 0.046), the visible dentition width ratio (VDWR) (p = 0.019) and the arch form index (AFI) (p < 0.001). The Kruskal–Wallis test showed significant differences in ES among the raters for the FA (p < 0.001) and UPE (p = 0.004) groups. The simple linear regression analysis showed significant associations between ES and the patient’s age (p = 0.002), BCR (p = 0.020) and VDWR (p = 0.006). The multiple linear regression analysis showed that age (p = 0.008) and VDWR (p = 0.021) were significantly associated with the ES values.
Conclusion. The FA group had narrower buccal corridor spaces, a greater visible dentition width and a wider arch form in their smiles. The UPE group showed an increase in the buccal corridor width. Each panel rated the FA appliance group as superior.

Key words

orthodontic appliances, malocclusion, Angle class II, smile

Słowa kluczowe

aparaty ortodontyczne, nieprawidłowy zgryz, wada zgryzu klasy II Angle’a, uśmiech

References (36)

  1. Davis LG, Ashworth PD, Spriggs LS. Psychological effects of aesthetic dental treatment. J Dent. 1998;26(7):547–554.
  2. Işiksal E, Hazar S, Akyalçın S. Smile esthetics: Perception and comparison of treated and untreated smiles. Am J Orthod Dentofacial Orthop. 2006;129(1):8–16.
  3. Kiyak HA. Does orthodontic treatment affect patients’ quality of life? J Dent Educ. 2008;72(8):886–894.
  4. Goldstein RE. Study of need for esthetics in dentistry. J Prosthet Dent. 1969;21(6):589–598.
  5. Ackerman MB, Ackerman JL. Smile analysis and design in the digital era. J Clin Orthod. 2002;36(4):221–236.
  6. Chew MT. Spectrum and management of dentofacial deformities in a multiethnic Asian population. Angle Orthod. 2006;76(5):806–809.
  7. Helm S. Malocclusion in Danish children with adolescent dentition: An epidemiologic study. Am J Orthod. 1968;54(5):352–366.
  8. Proffit WR, Fields HW Jr, Moray LJ. Prevalence of malocclusion and orthodontic treatment need in the United States: Estimates from the NHANES III survey. Int J Adult Orthodon Orthognath Surg. 1998;13(2):97–106.
  9. Rothstein T, Yoon-Tarlie C. Dental and facial skeletal characteristics and growth of males and females with class II, division 1 malocclusion between the ages of 10 and 14 (revisited) – part I: Characteristics of size, form, and position. Am J Orthod Dentofacial Orthop. 2000;117(3):320–332.
  10. Baccetti T, Franchi L, McNamara JA Jr, Tollaro I. Early dentofacial features of Class II malocclusion: A longitudinal study from the deci­duous through the mixed dentition. Am J Orthod Dentofacial Orthop. 1997;111(5):502–509.
  11. Baccetti T, Franchi L, McNamara JA Jr. An improved version of the cervical vertebral maturation (CVM) method for the assessment of mandibular growth. Angle Orthod. 2002;72(4):316–323.
  12. Cozza P, Baccetti T, Franchi L, De Toffol L, McNamara JA Jr. Mandibular changes produced by functional appliances in Class II malocclusion: A systematic review. Am J Orthod Dentofacial Orthop. 2006;129(5):599.e1–e12;discussion e1–e6.
  13. Clark WJ. The twin block technique: A functional orthopedic appliance system. Am J Orthod Dentofacial Orthop. 1988;93(1):1–18.
  14. Tucker MR. Orthognathic surgery versus orthodontic camouflage in the treatment of mandibular deficiency. J Oral Maxillofac Surg. 1995;53(5):572–578.
  15. Proffit WR, Phillips C, Douvartzidis N. A comparison of outcomes of orthodontic and surgical-orthodontic treatment of Class II malocclusion in adults. Am J Orthod Dentofacial Orthop. 1992;101(6):556–565.
  16. Stirling J, Latchford G, Morris DO, Kindelan J, Spencer RJ, Bekker HL. Elective orthognathic treatment decision making: A survey of patient reasons and experiences. J Orthod. 2007;34(2):113–127;discussion 111.
  17. Guo Y, Han X, Xu H, Ai D, Zeng H, Bai D. Morphological characteristics influencing the orthodontic extraction strategies for Angle’s class II division 1 malocclusions. Prog Orthod. 2014;15(1):44.
  18. Nangia A, Darendeliler M. Finishing occlusion in Class II or Class III molar relation: Therapeutic Class II and III. Aust Orthod J. 2001;17(2):89–94.
  19. Johnson DK, Smith RJ. Smile esthetics after orthodontic treatment with and without extraction of four first premolars. Am J Orthod Dentofacial Orthop. 1995;108(2):162–167.
  20. Bishara SE, Cummins DM, Jakobsen JR, Zaher AR. Dentofacial and soft tissue changes in Class II, division 1 cases treated with and without extractions. Am J Orthod Dentofacial Orthop. 1995;107(1):28–37
  21. Desai S, Upadhyay M, Nanda R. Dynamic smile analysis: Changes with age. Am J Orthod Dentofacial Orthop. 2009;136(3):310.e1–e10;discussion 310–311.
  22. Chetan P, Tandon P, Singh GK, Nagar A, Prasad V, Chugh VK. Dyna­mics of a smile in different age groups. Angle Orthod. 2012;83(1):90–96.
  23. Cheng HC, Wang YC. Effect of nonextraction and extraction orthodontic treatments on smile esthetics for different malocclusions. Am J Orthod Dentofacial Orthop. 2018;153(1):81–86.
  24. Moore T, Southard KA, Casko JS, Qian F, Southard TE. Buccal corridors and smile esthetics. Am J Orthod Dentofacial Orthop. 2005;127(2):208–213.
  25. Kim E, Gianelly AA. Extraction vs nonextraction: Arch widths and smile esthetics. Angle Orthod. 2003;73(4):354–358.
  26. Hulsey CM. An esthetic evaluation of lip–teeth relationships present in the smile. Am J Orthod. 1970;57(2):132–144.
  27. Prasad V, Tandon P, Singh GK, Nagar A, Maurya RP. Comparison of smile esthetics after extraction and non-extraction orthodontic treatment. IJODR. 2018;4(4):182–189.
  28. Van Der Geld P, Oosterveld P, Kuijpers-Jagtman AM. Age-related changes of the dental aesthetic zone at rest and during spontaneous smiling and speech. Eur J Orthod. 2008;30(4):366–373.
  29. Sarver DM, Ackerman MB. Dynamic smile visualization and quantification: Part 2. Smile analysis and treatment strategies. Am J Orthod Dentofacial Orthop. 2003;124(2):116–127.
  30. Ahrari F, Heravi F, Rashed R, Zarrabi MJ, Setayesh Y. Which factors affect dental esthetics and smile attractiveness in orthodontically treated patients? J Dent (Tehran). 2015;12(7):491–503.
  31. Bhavsar A, Nehete AL, Gulve ND, Shah KA, Aher S. Factors affecting smile esthetics in adults with different types of growth patterns. IOSR-JDMS. 2018;17(8):44–50.
  32. Gianelly AA. Arch width after extraction and nonextraction treatment. Am J Orthod Dentofacial Orthop. 2003;123(1):25–28.
  33. Yang IH, Nahm DS, Baek SH. Which hard and soft tissue factors relate with the amount of buccal corridor space during smiling? Angle Orthod. 2008;78(1):5–11.
  34. Ghaffar F, Fida M. Effect of extraction of first four premolars on smile aesthetics. Eur J Orthod. 2011;33(6):679–683.
  35. Peck S, Peck L, Kataja M. The gingival smile line. Angle Orthod. 1992;62(2):91–100;discussion 101–102.
  36. Roden-Johnson D, Gallerano R, English J. The effects of buccal corridor spaces and arch form on smile esthetics. Am J Orthod Dentofacial Orthop. 2005;127(3):343–350.