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Soft tissue changes following extraction vs. nonextraction orthodontic fixed appliance treatment: a systematic review and meta‐analysis
Author(s) -
Konstantonis Dimitrios,
Vasileiou Dimitrios,
Papageorgiou Spyridon N.,
Eliades Theodore
Publication year - 2018
Publication title -
european journal of oral sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.802
H-Index - 93
eISSN - 1600-0722
pISSN - 0909-8836
DOI - 10.1111/eos.12409
Subject(s) - medicine , premolar , meta analysis , dentistry , soft tissue , confounding , incisor , data extraction , orthodontics , systematic review , medline , surgery , molar , political science , law
The aim of this systematic review was to assess the effect of systematic extraction protocols during orthodontic fixed appliance treatment on the soft tissue profile of human patients. Nine databases were searched until December 2016 for controlled clinical studies including premolar extraction or nonextraction treatment. After elimination of duplicate studies, data extraction, and risk‐of‐bias assessment according to the Cochrane guidelines, random‐effects meta‐analyses of mean differences ( MD ) or standardized mean differences ( SMD ) and their 95% CI s were performed, followed by subgroup, meta‐regression, and sensitivity analyses. Extraction treatment was associated with increased lower lip retraction (24 studies; 1,456 patients; MD = 1.96 mm), upper lip retraction (21 studies; 1,149 patients; MD = 1.26 mm), nasolabial angle (21 studies; 1,089 patients; MD = 4.21°), soft‐tissue profile convexity (six studies; 408 patients; MD = 1.24°), and profile pleasantness (three studies; 249 patients; SMD = 0.41). Patient age, extraction protocol, and amount of upper incisor retraction during treatment were significantly associated with the observed extraction effects, while the quality of evidence was very low in all cases due to risk of bias, baseline confounding, inconsistency, and imprecision. Although tooth extractions seem to affect patient profile, existing studies are heterogenous and no consistent predictions of profile response can be made.