Effects of premolar extractions on Bolton overall ratios and tooth-size discrepancies in a Japanese orthodontic population.

INTRODUCTION: The purpose of this study was to investigate the effects of premolar extractions on the Bolton overall ratios and overall tooth-size discrepancies in a Japanese orthodontic population. METHODS: Mesiodistal tooth widths were measured on 198 pretreatment dental casts of subjects with Class I, Class II, and Class III malocclusions. The overall ratios and tooth-size discrepancies were determined before and after hypothetical premolar extractions. Before and after extractions, the subjects were divided into small, normal, and large overall ratio groups categorized by the Bolton standard deviation definition, and into small, normal, and large correction groups by the actual amount of change calculated for tooth-size correction in millimeters. Extractions were performed in the following combinations: (1) all first premolars, (2) all second premolars, (3) maxillary first and mandibular second premolars, and (4) maxillary second and mandibular first premolars. For statistical evaluations, analysis of variance, Kruskal-Wallis, Friedman, Scheffé, Bonferroni, and Tukey tests were performed. RESULTS: The overall ratios decreased in every malocclusion group after extraction of any combination of premolars. The decreases were significantly notable in combinations 2 and 4. Some subjects in the normal overall ratio and maxillary and mandibular correction groups moved into the clinically significant tooth-size discrepancy group after premolar extraction, and the reverse was also true. CONCLUSIONS: In formulating a treatment plan involving premolar extractions, orthodontists should consider that the overall ratios might decrease, and normal and clinically significant tooth-size discrepancies could change mutually after extractions.

Thresholds for clinically significant tooth-size discrepancy.

OBJECTIVE: To determine an appropriate threshold for clinically significant tooth-size discrepancy using both a Bolton standard deviation (SD) definition and a millimetric definition. MATERIALS AND METHODS: Mesiodistal tooth widths were measured in 250 pretreatment dental casts of patients with Class I, Class II, and Class III malocclusions. The anterior and overall ratios and the required amount of maxillary and mandibular corrections were calculated. The casts were divided into small, normal, and large groups according to the anterior and overall ratios categorized by the Bolton SD definition, and into small, normal, and large groups according to the required amount of maxillary and mandibular corrections expressed in millimeters. RESULTS: The small and large anterior ratio groups which fell under the category of the 2 SD threshold did not always need maxillary or mandibular corrections greater than 2 mm, while the small and large overall ratio groups always needed maxillary and mandibular corrections greater than 2 mm. The small and large maxillary correction groups in the 2 mm threshold category did not always have anterior or overall ratios greater than 2 SDs from the Bolton mean. However, the small and large mandibular correction groups always had anterior ratios greater than 2 SDs and did not always have overall ratios greater than 2 SDs. CONCLUSIONS: The tooth-size discrepancies could be better expressed in terms of both percentage and actual amount of millimeters required for correction. The ratios outside 2 SDs from the Bolton mean and the discrepancies requiring more than 2 mm of maxillary and/or mandibular corrections are recommendable as the appropriate thresholds for clinical significance.