Reinventing serial extraction with a fresh perspective: does it inspire a change in current practice?

OBJECTIVE: To analyze the skeletal and dental effects of serial extraction with and without expansion on severe crowding. DATA SOURCE AND STUDY DESIGN: A retrospective controlled study using lateral cephalograms of 78 children of age 8.5 + /- 1.4 years. STUDY DESIGN: The study sample involved 52 orthodontic patients treated for severe crowding and 26 age matched controls who did not undergo orthodontic treatment. The treated cases were sorted into serial extraction (EX) only group and serial extraction and expansion (EX-EXP) group. Vertical and anteroposterior skeletal and dental cephalometric measurements of these subjects were analyzed at baseline time point and following eruption of posterior permanent dentition. RESULTS: The study found significant changes in vertical skeletal dimensions with a decrease in mandibular and occlusal plane angles in the experimental groups at the follow up. The facial height index was noted to be increased. The upper gonial angle decreased significantly in the groups that had extractions. There was no significant change in the inter-incisal angle among the groups, yet at follow-up the inter-incisal angle of the control group was significantly smaller than the intervention groups. CONCLUSIONS: The article concludes that serial extraction alone or in combination with expansion treatment performed prior to pubertal growth phase have comparable skeletal cephalometric findings primarily affecting the vertical dimension.

Skeletal and dental effects of serial extractions performed with or without maxillary expansion-A retrospective controlled study.

OBJECTIVES: The study aimed to compare severe crowding treatment's skeletal and dental effects by serial extractions or maxillary expansion and serial extractions in the mixed dentition phase. SETTING AND SAMPLE POPULATION: The retrospective controlled study included lateral cephalograms of 78 subjects aged 8.5 ± 1.4 years, 52 consecutively treated because of severe crowding, and 26 untreated controls matched for baseline age and observational period. METHODS: Subjects were clustered according to the treatment modality, either serial extraction (EX) or expansion and extraction (EXP-EX) group. Sagittal and vertical skeletal as well as dental cephalometric parameters were assessed at baseline and after the eruption of all permanent posterior teeth, and group comparisons were performed. RESULTS: Both treatment modalities significantly affected the vertical skeletal parameters in terms of decreasing the mandibular and occlusal plane inclination and increasing the facial height index. A distinct treatment effect on the gonial angle was observed, with a significant decrease in its superior part observed in both extraction groups. The annualized changes in the superior part of the gonial angle significantly differ (P = .036) between the Control (-0.04 ± 0.6), EX (-0.44 ± 0.6) and EXP-EX (-0.34 ± 0.5) groups. Upper and lower incisor inclination did not change significantly in any of the groups; however, the interincisal angle at follow-up was significantly smaller in the Control compared with both treated groups. CONCLUSIONS: Serial extractions and a combination of maxillary expansion and serial extractions have similar significant skeletal effects, mainly affecting vertical cephalometric parameters if performed during the pre-pubertal growth phase.

Study of total antioxidant capacity of red raspberry (Rubus idaeous L. ) shoots. / Estudio de la capacidad antioxidante total de brotes de frambuesa roja (Rubus idaeous L. ).

Background: Today, cardiovascular, oncological, and neurodegenerative diseases are the main causes of death in the world, according to official World Health Organization (WHO) statistics. Antioxidants are used to treat and prevent these diseases. In order to develop optimal technology for obtaining drugs based on plant extracts with antioxidant action, it is necessary to determine the total antioxidant capacity of raspberry shoots. Objectives: The study aimed to determine the total antioxidant capacity of red raspberry shoots, study the content of biologically active substances (BAS), and the antioxidant activity of red raspberry shoot extracts obtained during subsequent exhaustive extraction. Methods: The number of phenolic compounds, catechins, flavonoids, and hydroxycinnamic acids was determined by a spectrophotometric analysis method, whereas organic acids were determined by the alkalimetric method in red raspberry shoot extracts; the antioxidant activity of obtained extracts was evaluated by potentiometric method. Results: The total antioxidant capacity of red raspberry shoots was 164.12 mmol-equiv./m dry weight, the sum of the total content of phenolic compounds was 24.40 mg gallic acid (GA)/mL, catechins ­ 21.36 mg epigallocatechin-3-O-gallate (EGCG)/mL, flavonoids ­ 0.77 mg rutin (R)/mL, hydroxycinnamic acids derivatives ­ 2.56 mg chlorogenic acid (ChA)/mL and organic acids ­ 1.88 mg citric acid (CA)/mL in red raspberry shoot extracts obtained during subsequent exhaustive extraction. The analysis showed that there is a very high positive correlation between antioxidant activity and total phenolic compounds, catechin, flavonoid, hydroxycinnamic acids derivatives, and organic acids content in red raspberry shoot extracts. Conclusions: Total red raspberry shoots' antioxidant capacity has been determined. The study results can be used to develop optimal technology for obtaining drugs based on the extract of red raspberry shoots, which has an antioxidant effect

Contexto: Hoy en día, las enfermedades cardiovasculares, oncológicas y neurodegenerativas son las principales causas de muerte en el mundo según estadísticas oficiales de la Organización Mundial de la Salud OMS. Los antioxidantes se utilizan para tratar y prevenir estas enfermedades. Para desarrollar una tecnología óptima para la obtención de fármacos a base de extractos de plantas con acción antioxidante, es necesario determinar la capacidad antioxidante total de los brotes de frambuesa.Objetivos: El estudio tuvo como objetivo determinar la capacidad antioxidante total de los brotes de frambuesa roja, estudiar el contenido de sustancias biológicamente activas (SBA) y la actividad antioxidante de los extractos de brotes de frambuesa roja obtenidos mediante extracción exhaustiva. Métodos: La cantidad de compuestos fenólicos, catequinas, flavonoides y ácidos hidroxicinámicos se determinó por método de análisis espectrofotométrico, mientras que los ácidos orgánicos por método alcalimétrico en extractos de brotes de frambuesa roja; La actividad antioxidante de los extractos obtenidos se evaluó por método potenciométrico. Resultados: La capacidad antioxidante total de los brotes de frambuesa roja fue de 164.12 mmol-equiv./m de peso seco, la suma del contenido total de compuestos fenólicos fue de 24.40 mg gálico ácido (GA)/mL, catequinas ­ 21.36 mg epigalocatequina-3-O-galato (EGCG)/mL, flavonoides ­ 0.77 mg rutina (R)/mL, derivados de ácidos hidroxicinámicos ­ 2.56 mg clorogénico ácido (ChA)/mL y ácidos orgánicos ­ 1.88 mg cítrico ácido (CA)/mL en extractos de brotes de frambuesa roja obtenidos durante extracción exhaustiva. La correlación analizada mostró que existe una correlación positiva entre la actividad antioxidante y el contenido de compuestos fenólicos totales, catequinas, flavonoides, derivados de ácidos hidroxicinámicos y ácidos orgánicos en extractos de brotes de frambuesa roja. Conclusiones: Gracias a nuestros resultados se ha determinado la capacidad antioxidante total de los brotes de frambuesa roja. Los resultados del estudio se pueden utilizar para desarrollar una tecnología óptima para la obtención de fármacos basados en el extracto de brotes de frambuesa roja, que tiene un efecto antioxidante

Long-term dental intervention and laboratory examination in a patient with Vitamin D-dependent rickets type I: A case report.

RATIONALE: Vitamin D-dependent rickets type I (VDDR-I) is a rare form of rickets, which is an autosomal recessive disease caused by 1α-hydroxylase enzyme deficiency. However, long-term dental management and microscopic morphology of teeth remain largely unclear. PATIENT CONCERNS: We report the case of a 10-year-old Chinese boy complaining of yellowish-brown teeth with extensive caries. DIAGNOSES: Clinical and laboratory examinations were performed, and VDDR-I was confirmed. Scanning electron microscopy confirmed amelogenesis imperfecta. INTERVENTIONS: The patient had been taking drugs intervention for VDDR-I from the age of 3 years. The decayed teeth were treated, and metal-preformed crowns were placed to prevent further impairment. Sequence tooth extraction and remineralization therapy were also performed. OUTCOMES: After 3 years of follow-up, the patient exhibited normal tooth replacement and an acceptable oral hygiene status. However, the new erupted teeth had amelogenesis imperfecta. LESSONS: This case is the first to confirm amelogenesis imperfecta in a patient with VDDR-I that was not prevented by drug intervention. Importantly, it provides evidence that long-term dental intervention in patients with VDDR-I can result in an acceptable oral hygiene status. Therefore, early and long-term dental intervention is necessary in VDDR-I patients.

Mandibular dental changes following serial and late extraction of mandibular second premolars.

OBJECTIVES: To determine changes in occlusal curves and dental tipping occurring from mandibular second premolar serial extraction, early extraction of deciduous mandibular second molars with missing second premolars, and late second premolar extraction compared with untreated controls. MATERIALS AND METHODS: Information was collected from 85 subjects at three time points: T0, prior to serial extraction; T1, after serial extraction and drift prior to orthodontic treatment, and pretreatment for the late premolar extraction patients; and T2, posttreatment. Untreated age- and gender-matched controls were used for comparison. Three occlusal curves were measured on digitized mandibular casts, and dental tipping was assessed using lateral cephalograms. RESULTS: At T0, there were no significant differences among groups. At T1, there was significant steepening of Monson's sphere and the curve of Wilson between early and late extraction and control groups. At T2, the differences in Monson's sphere and the curve of Wilson were fully corrected. At T1, there were significant differences in the tipping of mandibular 6's, 4's, and 3's between the early extraction groups compared with the late extraction and control groups. At T2, these differences in tipping were fully corrected. There were no differences in mandibular incisor tipping between groups at T1 or T2. CONCLUSIONS: Serial extraction produced steeper occlusal curves and significant tipping of mandibular first molars, first premolars, and canines after extraction and physiologic drift (T1). Accentuated occlusal curves and tooth tipping were fully corrected following orthodontic treatment (T2). Mandibular incisor position was unchanged by serial or late second premolar extraction.

Effect of orthodontic treatment with 4 premolar extractions compared with nonextraction treatment on the vertical dimension of the face: A systematic review.

INTRODUCTION: Our aim was to assess the available evidence for the effects of orthodontic treatment with 4 premolar extractions on the skeletal vertical dimension of the face compared with nonextraction treatment. METHODS: Electronic database searches (MEDLINE, EMBASE, Cochrane Oral Health Group's Trials Register, and CENTRAL) of published and unpublished literature and hand searches of eligible studies were performed, with no language or publication date restrictions. Two authors performed data extraction independently and in duplicate. Risk of bias was assessed. RESULTS: After application of the eligibility criteria, 14 studies were included in this systematic review. All were retrospective. Risk of bias ranged from moderate to critical. Ten studies investigated patients with various skeletal vertical patterns and classes of malocclusion and found no difference between extraction (Ex) and nonextraction (Nonex) treatment in regard to the vertical dimension. Only 2 studies found statistically significant increases in the nonextraction groups, one in N-Me (Ex: +1.5 mm; Nonex: +5.5 mm; P <0.05) and one in SN-GoGn (Ex: -0.9°; Nonex: +0.8°; P <0.05), but without a concurrent significant change in other vertical measurements such as FMA. Two other studies showed opposite findings regarding N-Me (Ex: +2.3 mm; Nonex: +0.9 mm; P <0.05) and FMA (Ex: +0.3°; Nonex: -2.0°; P <0.05). CONCLUSIONS: Although the quality of evidence ranged from moderate to low, there was considerable agreement among these studies, suggesting that orthodontic treatment with 4 premolar extractions has no specific effect on the skeletal vertical dimension. Thus, an extraction treatment protocol aiming to reduce or control the vertical dimension does not seem to be an evidence-based clinical approach.

Asymmetric extractions in a patient with a hopeless maxillary central incisor, followed by treatment with mini-implant anchorage.

Premolar extraction is 1 option for treatment of patients with malocclusion and severe crowding or protrusion. When the patient has missing or hopeless teeth other than premolars, it is possible to consider removal of those teeth to use the space to decrease crowding. A 15-year-old girl sought treatment for severe crowding. She had already lost her maxillary right first premolar as a result of caries 1 year previously and had a hopeless maxillary right central incisor. Her mandibular left first molar still caused discomfort even after endodontic treatment. Extractions of the maxillary right central incisor and mandibular right first premolar and left first molar were chosen to resolve the occlusion problems. Orthodontic mini-implants were placed to translocate the maxillary left central incisor across the midpalatal suture to use the space in the maxillary right quadrant to relieve the crowding. Although a different extraction option was used in each quadrant, the final occlusion was acceptable. After debonding, porcelain crowns were placed on the anterior teeth to improve esthetics. The treatment result remained stable after 2 years of retention.

Orthodontic treatment of a patient with maxillary lateral incisors with dens invaginatus: 6-year follow-up.

INTRODUCTION: Dens invaginatus is an anomaly of dental development in which calcified tissues, such as enamel and dentin, are invaginated into the pulp cavity. This morphologic alteration is more frequent in maxillary permanent lateral incisors and makes them more susceptible to carious lesions and pulp alterations. METHODS: This case report describes a patient with maxillary lateral incisors affected by dens invaginatus. The maxillary right lateral incisor had already undergone endodontic treatment, and the maxillary left one had a periapical lesion. Additionally, the patient had a Class II Division 1 malocclusion, with anterior open bite, posterior crossbite, and an impacted mandibular left second molar. RESULTS: The orthodontic treatment involved extraction of the maxillary lateral incisors and 2 mandibular premolars, resulting in proper overjet and overbite with good arch coordination and occlusal stability. CONCLUSIONS: Treatment results were stable, as evaluated in a 6-year posttreatment follow-up.

Nueva visita al mundo del anclaje. Extracciones diferenciales / New visit to anchorage world. Differentials extraction

Las extracciones de premolares son un procedimiento reconocido y ampliamente aceptado en el tratamiento de ortodoncia. La elección de extraer los primeros o segundos premolares es una decisión importante que está determinada por el grado de discrepancia y la cantidad de retracción requerida de los incisivos, lo que influye de manera considerable en el anclaje y la mecánica de tratamiento. Se presenta una alternativa a la solución más ampliamente aceptada para los pacientes de Clase I con extracciones, que es la extracción de los cuatro primeros molares(AU)

Premolar extractions are a recognized and widely accepted procedure in orthodontic treatment. The choice of extracting the first or second premolars is an important decision that is determined by the degree of discrepancy and the required amount of retraction of the incisors, which has a significant influence an the anchorage and the treatment mechanics. It is presented an alternative to the most widely accepted solution for Class I patients with extractions, which is the extraction of the first four premolars(AU)

A review of machines and devices to potentize homeopathic medicines.

BACKGROUND: Potentization, consisting of serial dilution and succussion, is a key step in the manufacture of homeopathic medicines. Originally prescribed as a manual process, several attempts at mechanization have been published, patented and even commercialised in order to remove the human element and introduce reproducibility without drudgery. Various machines have been used over the years to prepare homeopathic medicines. Although these machines follow the same principles, i.e. energetically mixing the medicines and diluting them significantly, their mode of operation is different from each other. METHODS: This review paper surveys the main methods of preparation of homeopathic medicines. The main machines discussed are: Boericke's potentizer, Tyler Kent's instrument, John Alphonse's machine and the fluxion potentizer, which were used in the past, as well as more recent potentizers like arm-and-weight instruments, the K-Tronic potentizer and Quinn's machine. We review the construction and operating principle of each of these machines, along with their advantages and limitations. A scheme for relative performance assessment of these machines is proposed based on the parameters mechanical efficiency, physico-chemical efficiency, turbulence generation, energy dissipation, and accuracy of dilution. RESULTS: Quinn's machine and the arm-and-weight potentizer perform well for generating turbulence due to high impaction forces, while John Alphonse's machine is much more accurate in diluting the homeopathic medicines at every step. CONCLUSIONS: Both the commercial potentizers, Quinn's machine and the K-Tronic potentizer, are completely automated and therefore reduce the manual labour and variation in succussive forces during each step, which may produce uniformity in physico-chemical changes within the resulting homeopathic medicines.

The effect of first and second premolar extractions on third molars: A retrospective longitudinal study.

OBJECTIVES: To analyse the effect of first and second premolar extractions on eruption space for upper and lower third molars and on third molar position and angulation during orthodontic treatment. METHODS: The sample consisted of 296 patients of which 218 patients were orthodontically treated without extraction and 78 patients with extraction of first or second premolars. The eruption space for third molars was measured on pre- and posttreatment lateral cephalograms, whereas the angulation, vertical position, the relation with the mandibular canal and the mineralization status of third molars were evaluated using pre- and posttreatment panoramic radiographs. All data were statistically analyzed. RESULTS: The increase in eruption space and the change in vertical position of upper and lower third molars significantly differed between patients treated with and without premolar extractions, whereas the change in angulation, relationship with the mandibular canal and mineralization status of the third molars did not significantly differ between patients treated with and without premolar extractions. CONCLUSIONS: The retromolar space and the position of third molars significantly change during orthodontic treatment in growing patients. Premolar extractions have a positive influence on the eruption space and vertical position of third molars, whereas they do not influence the angular changes of third molars. Due to the retrospective character of the study, these conclusions should be carefully considered. Further prospective research is necessary for better insights into this complex topic. CLINICAL SIGNIFICANCE: This study stresses the importance of considering the possible effects of orthodontic treatment on third molars during treatment planning.

Mandibular changes secondary to serial extractions compared with late premolar extractions and controls.

INTRODUCTION: Variations in treatment times for serial extraction and late premolar extraction patients may be due to differences in the time needed to flatten the occlusal curves. In this study, we compared tooth tipping and occlusal curves in patients treated by serial extractions or late premolar extractions with untreated controls. METHODS: Mandibular dental casts and cephalometric radiographs were collected from 90 subjects (30 Class I control subjects, 30 patients with serial extractions, and 30 with late premolar extractions) at 3 time points: T0, baseline for the controls and serial extraction patients; T1, after natural drift and preorthodontics for the controls and the serial extraction patients, and pretreatment for the late premolar extraction patients; and T2, after comprehensive orthodontic treatment for the serial extraction and the late premolar extraction groups. The long axes of the central incisor, canine, and first molar to the palatal plane were measured on digitized headfilms to determine the direction and the amount of tipping between the time points. Three occlusal curves were measured by sphere fitting cusp-tip landmarks on digitized mandibular casts. RESULTS: From T0 to T1, incisors and canines in the patients with serial extractions tipped distally. Molars at T1 in the patients with serial extractions were tipped forward more than in the late premolar extraction patients and the controls. From T1 to T2, canines and molars in the patients with serial extractions were uprighted. CONCLUSIONS: Serial extractions produce steeper occlusal curves and distal tipping of the incisors and canines after drift (T1). Posttreatment (T2) occlusal curves in the patients with serial extractions are steeper than in the late premolar extraction patients and controls (except for the curve of Spee). After the serial extractions, orthodontic treatment included incisor and canine proclination, with molar uprighting and occlusal curve flattening.

Efficiency of Class I and Class II malocclusion treatment with four premolar extractions

Four premolar extractions is a successful protocol to treat Class I malocclusion, but it is a less efficient way when compared with other Class II treatment protocols. Objective: The objective of this study was to evaluate the influence of anteroposterior discrepancy on the success of four premolar extractions protocol. For that, treatment efficiency of Class I and complete Class II malocclusions, treated with four premolar extractions were compared. Methods: A sample of 107 records from 75 Class I (mean age of 13.98 years - group 1) and 32 Class II (mean age of 13.19 years - group 2) malocclusion patients treated with four premolar extractions was selected. The initial and final occlusal status of each patient was evaluated on dental casts with the PAR index. The treatment time was calculated based on the clinical charts, and the treatment efficiency was obtained by the ratio between the percentage of PAR reduction and treatment time. The PAR index and its components, the treatment time and the treatment efficiency of the groups were statistically compared with t tests and Mann-Whitney U-test. Results: The Class II malocclusion patients had a greater final PAR index than Class I malocclusion patients, and similar duration (Class I - 28.95 mo. and Class II - 28.10 mo.) and treatment efficiency. Conclusion: The treatment of the complete Class II malocclusion with four premolar extractions presented worse occlusal results than Class I malocclusion owing to incomplete molar relationship correction. .

Efficiency of class I and class II malocclusion treatment with four premolar extractions.

UNLABELLED: Four premolar extractions is a successful protocol to treat Class I malocclusion, but it is a less efficient way when compared with other Class II treatment protocols. OBJECTIVE: The objective of this study was to evaluate the influence of anteroposterior discrepancy on the success of four premolar extractions protocol. For that, treatment efficiency of Class I and complete Class II malocclusions, treated with four premolar extractions were compared. METHODS: A sample of 107 records from 75 Class I (mean age of 13.98 years--group 1) and 32 Class II (mean age of 13.19 years--group 2) malocclusion patients treated with four premolar extractions was selected. The initial and final occlusal status of each patient was evaluated on dental casts with the PAR index. The treatment time was calculated based on the clinical charts, and the treatment efficiency was obtained by the ratio between the percentage of PAR reduction and treatment time. The PAR index and its components, the treatment time and the treatment efficiency of the groups were statistically compared with t tests and Mann-Whitney U-test. RESULTS: The Class II malocclusion patients had a greater final PAR index than Class I malocclusion patients, and similar duration (Class I - 28.95 mo. and Class II - 28.10 mo.) and treatment efficiency. CONCLUSION: The treatment of the complete Class II malocclusion with four premolar extractions presented worse occlusal results than Class I malocclusion owing to incomplete molar relationship correction.

Extração seriada: considerações clínicas / Serial extraction: clinical considerations

O tratamento “precoce” das más-oclusões tem despertado interesse crescente da comunidade ortodôntica. Dentre estes, destaca-se a extração seriada que visa conciliar as diferenças entre a quantidade conhecida do material dentário e a deficiência permanente do osso de suporte. A técnica é aplicada na dentadura mista, por meio de uma sequência pré-determinada de exodontias entre dentes decíduos e permanentes, na busca do alinhamento imediato, de preferência espontâneo, dos dentes permanentes remanescentes com uma terapia ortodôntica mecânica mínima. Será relatado um caso clínico no qual foi realizada a extração seriada em um paciente com má-oclusão de Classe I, em crescimento, com apinhamento severo e biprotruso. Todos os objetivos estéticos e funcionais foram alcançados...

The early malocclusion treatment has increased interest of orthodontic community. Among these is the serial extraction that harmonizes the differences between the amount of dental material and permanent deficiency of supporting bone. The technique is applied in mixed dentition through a predetermined sequence of extractions between deciduous and permanent teeth, in order to reach spontaneous immediately alignment of remaining permanent teeth with a minimum orthodontic mechanics. It will be reported a case where the serial extraction was performed in a growing patient with biprotrusion, Class I malocclusion and severe crowding. All functional and aesthetics goals were reached...

Extração seriada: uma opção para tratamento interceptivo do Padrão de Face Longa / Serial extraction: an interceptive treatment option for Long Face Pattern

O programa de extrações seriadas (PES) é baseado na extração de dentes, inicialmente decíduos, e, então, permanentes, em pacientes com relação oclusal de Classe I que apresentam discrepância de modelo negativa grave. O tratamento tem início na dentição mista, com a extração de molares ou, até mesmo, de caninos decíduos, e, posteriormente, a extração dos primeiros pré-molares, na dentição permanente. A sequência das extrações pode sofrer algumas variações e demanda um longo período de acompanhamento entre as fases do tratamento, até que o programa de extrações seja finalizado e o paciente esteja apto para a fase corretiva. O presente artigo tem como objetivo apresentar, por meio de um caso clínico, o tratamento de uma paciente Padrão Face Longa subtipo médio, que foi submetida ao PES e, em seguida, ao tratamento ortodôntico compensatório

Modified serial extraction in a case with missing mandibular second premolars and a brief review of related treatment modalities.

This article discusses a case of an 8-year-old female child who presented with severe lower anterior crowding and congenitally missing lower second premolars. A conventional serial extraction procedure could not be performed due to the congenital absence of teeth. Instead, planned extraction of a few primary teeth was done to relieve the lower anterior crowding, the results of which were near satisfactory.

The fallacy of serial extractions.

It is suggested that lingually-positioned lower lateral incisors in young children are anatomically correct and not a symptom of crowding. Primary canines with intact periodontal attachments have an important role to play as proprioceptors to encourage growth of the alveolar arch. Extractions of primary cuspids would deprive the alveolus of important growth stimuli. Clinical evidence suggests that serial extraction is counter-productive. The early extraction of primary cuspids will invariably result in crowding of the permanent cuspids. It is a common belief that serial extraction corrects the crowding of lower incisors but the procedure is not evidence based. In reality, the problem is maintained and the 'crowding' shifts to involve the permanent cuspids. Let us not forget the most basic canon of the health profession which is 'first do no harm, and if it is not broken, do not try to fix it'.

Serial extraction: 20 years of follow-up.

This paper reports a case treated by a serial extraction program at the mixed dentition stage followed by a corrective orthodontic treatment, with a long-term follow-up period. Twenty years after the interceptive treatment, a harmonious face was observed along with treatment stability in the anterior posterior direction, deep overbite (which has been mentioned as a disadvantage of the serial extraction program), and a small relapse of anterior tooth crowding. All these conditions have been regarded as normal occurrences for most orthodontic treatments with a long-term follow-up period. This case report demonstrated that the establishment of a serial extraction protocol determined relevant esthetic changes that afforded an improvement of the patient's self-esteem, with a positive social impact. Furthermore, the low cost of this protocol permits the use of this therapy with underprivileged populations. It is important to emphasize that an early correction of tooth crowding by this protocol does not guarantee stability, but small relapses do not invalidate its accomplishment.