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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 9  |  Issue : 5  |  Page : 201-204  

Incidence of risk and complications associated with orthodontic therapeutic extraction


1 Department of Oral and Maxillofacial Surgery, Vivekanandha Dental College for Women, Tiruchengode, Tamil Nadu, India
2 Department of Orthodontics, Vivekanandha Dental College for Women, Tiruchengode, Tamil Nadu, India
3 Department of Periodontics, Vivekanandha Dental College for Women, Tiruchengode, Tamil Nadu, India

Date of Web Publication27-Nov-2017

Correspondence Address:
Gowri Balakrishnan
No 41, S and P Garden, Nolambur, Mogappair West, Chennai - 600 095, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpbs.JPBS_160_17

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   Abstract 


Background: Extraction in orthodontics are carried out in the cases where there is space deficiency to align the teeth. The elective extraction of first or second premolars has been discussed in the literature for more than 50 years. In the 1940s and 1950s Nance, Dewel and Carey reviewed this as a useful option, and in the 1970s Logan and other leading orthodontists favoured the extraction as choice. It is not always the elective extraction of premolar is a smooth drive for the surgeon as well as to patient. Sometimes the elective extraction of premolar result in complications, which might be due to both anatomical and surgical factors. Methodology: The study sample consisted of 100 patients referred for one or more orthodontic extractions to the department of oral and maxillofacial surgery were included in this retrospective study at the vivekanandha dental college for women tiruchengode between November 2014 and May 2016. All referrals were from the department of orthodontics. A survey was carried out to record the intraoperative risks and correlated with its morbidity as when occured. All intraoperative morbities were managed appropriately as required. Result and Conclusion: Between November 2014 and May 2016, 100 patients had one or more premolar teeth removed by the oral surgeons. The sample size was 100 patients who had a total of 334 premolars removed. The sample's mean age was 11.4+\- 8.4 years, and 57.0% were male. The average number of teeth extracted per patient was 2.34 +\- 1.46, and 73.8% had complete root development. More than 93.4% of subjects had normal root and bone morphology, whereas 35.65% had variations in root forms and bone texture. The intra-operative and post operative complication rates were 7.4% and 1.9%, respectively. Complications were generally minor (91.9%) and were managed nonoperatively on an outpatient basis. There were no case of oral antral communication.

Keywords: Altered root morphology, maxillary sinus, therapeutic extraction


How to cite this article:
Narendar R, Balakrishnan G, Kavin T, Venkataraman S, Altaf SK, Gokulanathan S. Incidence of risk and complications associated with orthodontic therapeutic extraction. J Pharm Bioall Sci 2017;9, Suppl S1:201-4

How to cite this URL:
Narendar R, Balakrishnan G, Kavin T, Venkataraman S, Altaf SK, Gokulanathan S. Incidence of risk and complications associated with orthodontic therapeutic extraction. J Pharm Bioall Sci [serial online] 2017 [cited 2019 Nov 12];9, Suppl S1:201-4. Available from: http://www.jpbsonline.org/text.asp?2017/9/5/201/219290




   Introduction Top


Pain less removal of teeth is performed in order to gain space or relieve the crowding and in order to align the teeth in orthodontics. Extractions in orthodontics remain a relatively controversial area.[1] The role of extraction in orthodontics was introduced by John Hunter in his natural history of the teeth. Spooner in 1839 advised extraction of four premolar or first molar when defective. Farrar in 1888 advised judicious extraction as an essential requisite for the prevention and correction of tooth jaw irregularities.

The elective extraction of premolars sometimes associated with complications due to its anatomical and surgical trails. Here, in our study, we have discussed the factors contributing to the complications and its incidence in the therapeutic extraction.


   Methodology Top


The study sample consisted of 100 patients referred for one or more orthodontic extractions to the Department of Oral and Maxillofacial Surgery were included in this retrospective study at the Vivekanandha Dental College for Women, Tiruchengode, between November 2014 and May 2016. All referrals were from the Department of Orthodontics.

Demographic variables

The demographic variables included are age and gender of the patients.

Anatomic variables

The anatomic variables include unfavorable premolar functional anatomy (i.e., malopposed, unopposed, or supraerupted teeth), root development, and proximity to the floor of the maxillary sinus, root forms, texture of tooth supporting structures, loss of cortical outline, and altered root morphology.

Study design

All patients were clinically and radiologically examined, consent for the extraction was taken either from patient or parent if patient is minor, and therapeutic extraction of premolars was carried out under local anesthesia by oral surgeons as per advised by the Department of Orthodontics. A survey was carried out to record the intraoperative risks and correlated with its morbidity as when occurred. All intraoperative morbidities were managed appropraitely as required.


   Results Top


Between November 2014 and May 2016, 100 patients had one or more premolar teeth removed by the oral surgeons. The sample size was 100 patients who had a total of 334 premolars removed. The descriptive statistics and the bivariate relationships between the predictor variables and complications for the sample are summarized in [Table 1].
Table 1: Incidence of risk and complications associated with orthodontic therapeutic extraction

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The sample's mean age was 11.4 ± 8.4 years, and 57.0% were male.

The average number of teeth extracted per patient was 2.34 ± 1.46, and 73.8% had complete root development. More than 93.4% of subjects had normal root and bone morphology, whereas 35.65% had variations in root forms and bone texture. All extractions were performed under local anesthesia. The following variables were statistically associated with complications and number of tooth extracted (P < 0.53), with dental factors (P < 0.47), and with anatomical (P < 0.51).

[Table 2] summarizes the types and frequencies of intra- and post-operative complications, grouped into intra- and post-operative complications. The overall complication rates for therapeutic extraction sites and subjects were 5.3% and 9.6%, respectively.
Table 2: Complications associated with orthodontic therapeutic extraction

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The intra- and post-operative complication rates were 7.4% and 1.9%, respectively. Complications were generally minor (91.9%) and were managed nonoperatively on an outpatient basis. There was no case of oral antral communication.


   Discussion Top


Orthodontic treatment is usually associated with dental extraction, and maxillary/mandibular first premolar teeth are most commonly extracted teeth for this purpose.[2],[3],[4],[5],[6] Maxillary first premolars are usually thought to have two roots. However, there are numerous racial differences on the root form, number of root, and root canal system.[7],[8],[9],[10] Proffit in a 40-year review of extraction patterns showed that 30% of cases were treated with extractions in 1953, 76% in 1968, and 28% in 1993. He suggested the decline in extractions since 1968. Nowadays, orthodontic treatment swifted to the straight wire technique, which seems to require fewer extractions.[11] The extraction of teeth is a potentially traumatic experience. The decision to extract should be made with an awareness of the risks of treatment, including the psychological impact of the procedure.[1] Certain teeth are extracted preferentially for orthodontic reasons. A survey of extraction patterns in various studies indicates that first premolars were most commonly extracted (59%), followed by second premolars (13%). The choice between first or second premolar depends on a number of factors, for example, degree of crowding, anchorage requirements, and overjet and overbite.[12]

The specific aims of this investigation were to identify (1) the types and frequency of complications after therapeutic/elective orthodontic premolar extractions and (2) risk factors associated with intraoperative as well as postoperative complications. The overall complication rate was 5.3%. A majority of complications were intraoperative and root fractures being the most common. Risk factors associated with overall complications were age, root morphology, and resilence of bone.

The complication rates documented in this study were within the ranges reported in the referenced literature. The three most common intraoperative complications reported in the literature were crown fracture, root fracture, and fracture of alveolar cortices. The reported frequency of root fracture ranged from 5% to 7% for all extractions but was as high as 30% in cases of dilacerated and divergent roots of maxillary premolars. Consistent with previous studies, root fracture was the most common complication identified in this study. The rate of root fracture was 1.4% of all premolar extractions and accounted for 31.1% of all complications. This rate is slightly higher than the cited range and probably reflects the liberal definition used.

Most reports focus on frequently occurring or seriously morbid complications. As such, there are sparse data available on the other complications. The rates of the other less commonly cited complications in this study are consistent with those reported in Calhoun et al.[13] Both studies found the rate of oroantral communication and excessive bleeding to be <1%. We did not, however, encounter complications such as oral antral communication and damage to the adjacent tooth, which was reported in their study.

This study's second major goal was to identify risk factors associated with adverse outcomes. Frequently cited risk factors for complications arising from premolar extraction include age, gender, site of extraction, anesthesia, and surgeon experience.[14] Other factors that may be associated with increased complications were anatomic position, variation in root morphology, and bone texture. Although many of these variables are often cited as risk factors, the relevant data are equivocal.


   Conclusion Top


Based on the findings of the study, we conclude that the maxillary first premolars have a tendency to encounter root fracture when the root is slender dilacerated, divergent separate rooted. In orthodontic practice, therapeutic extraction of these teeth should be performed cautiously. When there is fracture of roots, extreme precaution should be taken to preserve the buccal cortical plate. If prior information about the number and curvature of the root should be taken into consideration, then necessary precautions instilled while performing any clinical procedures.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Travess H, Roberts-Harry D, Sandy J. Orthodontics. Part 8: Extractions in orthodontics. Br Dent J 2004;196:195-203.  Back to cited text no. 1
    
2.
Angelillo IF, Nobile CG, Pavia M. Survey of reasons for extraction of permanent teeth in Italy. Community Dent Oral Epidemiol 1996;24:336-40.  Back to cited text no. 2
    
3.
Baqain ZH, Khraisat A, Sawair F, Ghanam S, Shaini FJ, Rajab LD, et al. Dental extraction for patients presenting at oral surgery student clinic. Compend Contin Educ Dent 2007;28:146-50.  Back to cited text no. 3
    
4.
McCaul LK, Jenkins WM, Kay EJ. The reasons for the extraction of various tooth types in Scotland: A 15-year follow up. J Dent 2001;29:401-7.  Back to cited text no. 4
    
5.
Reich E, Hiller KA. Reasons for tooth extraction in the western states of Germany. Community Dent Oral Epidemiol 1993;21:379-83.  Back to cited text no. 5
    
6.
Sayegh A, Hilow H, Bedi R. Pattern of tooth loss in recipients of free dental treatment at the University Hospital of Amman, Jordan. J Oral Rehabil 2004;31:124-30.  Back to cited text no. 6
    
7.
Chaparro AJ, Segura JJ, Guerrero E, Jiménez-Rubio A, Murillo C, Feito JJ. Number of roots and canals in maxillary first premolars: Study of an Andalusian population. Endod Dent Traumatol 1999;15:65-7.  Back to cited text no. 7
    
8.
Jayasimha Raj U, Mylswamy S. Root canal morphology of maxillary second premolars in an Indian population. J Conserv Dent 2010;13:148-51.  Back to cited text no. 8
    
9.
Loh HS. Root morphology of the maxillary first premolar in Singaporeans. Aust Dent J 1998;43:399-402.  Back to cited text no. 9
    
10.
Walker RT. Root form and canal anatomy of maxillary first premolars in a southern Chinese population. Endod Dent Traumatol 1987;3:130-4.  Back to cited text no. 10
    
11.
Proffit WR. Forty-year review of extraction frequencies at a university orthodontic clinic. Angle Orthod 1994;64:407-14.  Back to cited text no. 11
    
12.
Bradbury AJ. The influence of orthodontic extractions on the caries indices in schoolchildren in the United Kingdom. Community Dent Health 1985;2:75-82.  Back to cited text no. 12
    
13.
Calhoun NR. Dry socket and other postoperative complications. Dent Clin North Am 1971;15:337-48.  Back to cited text no. 13
    
14.
Heasman PA, Jacobs DJ. A clinical investigation into the incidence of dry socket. Br J Oral Maxillofac Surg 1984;22:115-22.  Back to cited text no. 14
    



 
 
    Tables

  [Table 1], [Table 2]



 

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