Effects of orthodontics on the facial profile: a comparison of changes during nonextraction and four premolar extraction treatment.

Cephalometric radiographs were used to examine soft tissue profiles of 198 orthodontic patients treated with full fixed appliances without extraction of any permanent teeth. Records were selected at random from five sources: cases treated by a Tweed Foundation instructor using the Tweed technique, patients treated with the Begg appliance, patients treated in one of two different practices with pretorqued, preangulated edgewise appliances, and patients treated in two stages with a functional appliance followed by full fixed edgewise appliances. The criteria for selection of cases and the methods of data collection were designed to allow comparisons with data collected by Drobocky and Smith on patients treated with extraction of four first premolars. Although the mean value of soft tissue changes were smaller in the nonextraction patients, the variability of these changes were generally as great as in the four premolar extraction cases. In addition, the percentage of undesirable facial changes was similar in the extraction and nonextraction samples. The results provide additional evidence that it is simplistic and incorrect to blame undesirable facial esthetics after orthodontic treatment on the extraction of premolars.