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Does Fixed Retention Prevent Overeruption of Unopposed University of Groningen Does fixed retention prevent overeruption of unopposed mandibular second molars in maxillary first molar extraction cases? Livas, Christos; Halazonetis, Demetrios J; Booij, Johan W; Katsaros, Christos; Ren, Yijin Published in: Progress in Orthodontics DOI: 10.1186/s40510-016-0119-z IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please check the document version below. Document Version Publisher's PDF, also known as Version of record Publication date: 2016 Link to publication in University of Groningen/UMCG research database Citation for published version (APA): Livas, C., Halazonetis, D. J., Booij, J. W., Katsaros, C., & Ren, Y. (2016). Does fixed retention prevent overeruption of unopposed mandibular second molars in maxillary first molar extraction cases? Progress in Orthodontics, 17(6). https://doi.org/10.1186/s40510-016-0119-z Copyright Other than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons). Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons the number of authors shown on this cover page is limited to 10 maximum. Download date: 26-09-2021 Livas et al. Progress in Orthodontics (2016) 17:6 DOI 10.1186/s40510-016-0119-z RESEARCH Open Access Does fixed retention prevent overeruption of unopposed mandibular second molars in maxillary first molar extraction cases? Christos Livas1*, Demetrios J. Halazonetis2, Johan W. Booij3, Christos Katsaros4 and Yijin Ren1 Abstract Background: The objective of this study was to investigate whether multistranded fixed retainers prevented overeruption of unopposed mandibular second molars in maxillary first molar extraction cases. Methods: The panoramic radiographs of 65 Class II Division 1 Caucasian Whites (28 females, 37 males) consecutively treated with bilateral maxillary first molar extraction and the Begg technique, and with records taken after treatment (T1) and in retention (T2), were withdrawn from private practice records. After appliance removal, mandibular second molars were retained with sectional wires till at least T2 in case of lack of occlusal contact with the antagonist. The subjects were assigned to study-retention and control-nonretention groups based on the retention status of mandibular second molars. Radiographic analysis was carried out to determine inclination of mandibular molarsandtheresultingmovementofsecondmolarcentroids.Parametricandnonparametrictestswere performed to assess the changes between T1 and T2. Results: No statistically significant differences in molar inclination were observed between groups and timepoints (P > 0.05). There were no statistically significant differences in molar movement percentages (P > 0.05) irrespective of whether fixed retention had been used or not. Conclusions: No significant eruption occurred in unopposed mandibular second molars bonded with fixed sectional retainers compared to molars partially occluded with the antagonists without fixed retention. Given the study limitations, fixed retention should be considered with caution in restricting tooth overeruption in unopposed molars. Keywords: Tooth overeruption, Fixed retainers, Unopposed molars, Maxillary first molar extraction Background antagonist will necessarily overerupt, not even in a long- A plethora of terms including overeruption [1], hyperer- term perspective. Examination of the position of molars uption [2], supraeruption [3], supereruption [4], and that had been unopposed for a long period showed that continuous eruption [5, 6] have been used to describe 18 % of the teeth exhibited no signs of overeruption [1]. the tendency of tooth movement in an occlusal direction Maxillary unopposed teeth appear to migrate vertically following loss of antagonist contact. This phenomenon more than mandibular [4, 8] with the eruption being has been claimed to induce occlusal interferences and most pronounced during the first years after the loss of changes in the dental equilibrium [2, 7]. A 12-year study the opposed tooth [9]. Age and periodontal condition in females with missing opposed and/or adjacent molars may be associated with the severity of changes. A higher showed 4.9 times higher risk of overeruption of ≥2mm incidence of severe overeruption has been observed in in unopposed molars [8]. Not all teeth without studies with younger age and periodontally affected groups [10]. Unlike young age [11], compromised peri- * Correspondence: [email protected] odontal condition was not associated with the severity of 1Department of Orthodontics, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Triade gebouw, Ingang 24, 9700 RB changes in animal experiments [12]. A recent systematic Groningen, The Netherlands review on the treatment need for posterior bounded Full list of author information is available at the end of the article © 2016 Livas et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Livas et al. Progress in Orthodontics (2016) 17:6 Page 2 of 5 edentulous spaces [10] demonstrated that overeruption the subjects were allocated to the study-retention group was limited to 2 mm for most studies reviewed. How- (12 females, 18 males; mean age at T1, 15.2 years; SD, ever, the authors classified the quality of evidence as very 1.6 years), and the control-nonretention group (16 fe- low and concluded that tooth replacement should not be males, 19 males; mean age at T1, 16.2 years; SD, considered as the mainstay of therapy. 1.7 years) (Table 1). Placement of etched metal splints on the lingual sur- All panoramic radiographs were scanned (Epson Ex- faces of unopposed molars has been recommended to pression 1680 Pro, Suwa, Nagano, Japan; resolution of counteract tooth extrusion [13, 14]. According to the re- 600 dpi) and traced by the first author using a cephalo- tention protocol of a Class II Division 1 malocclusion metric analysis software (Viewbox 3.0; dHAL Software, treatment technique involving extraction of maxillary Kifissia, Greece). The centroids of the mandibular right first molars, multistranded sectional wires are bonded and left second molars were selected to represent the on mandibular first and second molars to prevent verti- molar teeth. A set of 77 points lying on the outline of cal displacement of the out-of-occlusion second molars the teeth were digitized, 11 points on the occlusal sur- as a result of the late eruption of maxillary third molars face of premolars and 33 points on each molar, 11 points [15, 16]. To the authors’ knowledge, no clinical study on the mesial outline, 11 points on the distal outline, 4 has been published so far aiming to explore the potential points on the occlusal surface, and 7 points between the overeruption of nonoccluding teeth retained with sec- molar roots (Fig. 1a). The centroid of a collection of tional wires. points is the average of the points, and its location is cal- The objective of this study was to investigate whether culated by taking the average of the x and y coordinates overeruption occurred in unopposed mandibular second of the points. In this study, the centroid of the second molars with multistranded fixed retainers in patients molar was computed as the average of outline points treated with orthodontic extraction of maxillary first and subsequently transferred from the T2 to the T1 molars. dataset by means of Procrustes and best fit superimposi- tions. By applying the first superimposition on the two Methods molars and the occlusal surfaces of the two premolars of A total of 65 consecutively treated Class II Division 1 the buccal segment under investigation, the size between cases (28 females, 37 males) were retrieved from the ar- the two panoramic radiographs was adjusted. The sec- chives of a private practice. They comprised a subgroup ond superimposition was carried out on the first molar from a prospective clinical study [15] with the following and the occlusal surfaces of the premolars to measure inclusion criteria: Caucasian Whites, overjet ≥4 mm, no the distance between the second molar centroids along missing tooth or agenesis including maxillary third mo- the direction of the long axis of the tooth (distance V in lars, permanent dentition, available panoramic radio- Fig. 1b). Given the limitations of panoramic radiography graphs after treatment (T1) and at a follow-up (T2) and in providing absolute linear measurements [17], we de- treatment with 2-maxillary first molar extraction and cided to express the molar movement as a percentage of Begg fixed appliances. The treatment approach has been its mesiodistal size. Therefore, the software was set to described in detail in the literature [15, 16]. In case that calculate the ratio of this distance (V) to the mesiodistal the mandibular
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