Premolar Extraction/Retraction (PER) Effects on the Airway

Oct 13, 2023 22:14

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1) Bhatia S, Jayan B, Chopra SS. Effect of retraction of anterior teeth on pharyngeal airway and hyoid bone position in Class I bimaxillary dentoalveolar protrusion Med J Armed Forces India. 2016 Dec;72(Suppl 1):S17-S23. doi: 10.1016/j.mjafi.2016.06.006. Epub 2016 Oct 17. PMID: 28050064; PMCID: PMC5192225.

https://pubmed.ncbi.nlm.nih.gov/28050064/

"The size of the pharyngeal (velopharyngeal and glossopharyngeal) airway reduced and hyoid bone position changed after retraction of the incisors in extraction space in bimaxillary protrusive adult patients."

2) Chen Y, Hong L, Wang CL, Zhang SJ, Cao C, Wei F, Lv T, Zhang F, Liu DX.Effect of large incisor retraction on upper airway morphology in adult bimaxillary protrusion patients - PMC.. Angle Orthod. 2012 Nov;82(6):964-70. doi: 10.2319/110211-675.1. Epub 2012 Mar 30. PMID: 22462464; PMCID: PMC8813144.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8813144/#:~:text=Conclusion%3A,in%20adult%20bimaxillary%20protrusion%20patients

"Large incisor retraction leads to narrowing of the upper airway in adult bimaxillary protrusion patients."

3) Choi JY, Lee K. (2022) Effects of Four First Premolar Extraction on the Upper Airway Dimension in a Non-Growing Class I Skeletal Patients: A Systematic Review. J Oral Med and Dent Res. 3(1):1-16.

2022 systematic review of research on the airway and extractions. Concludes that premolar extraction/retraction can cause the narrowing of the pharyngeal airway, a change in the tongue position, and the reduction of oral cavity space, and hence is a risk for sleep apnea.

https://www.genesispub.org/effects-of-four-first-premolar-extraction-on-the-upper-airway-dimension-in-a-non-growing-class-i-skeletal-patients:-a-systematic-review

4) Guilleminault Christian, Abad Vivien C., Chiu Hsiao-Yean, Peters Brandon, Quo Stacey. Missing teeth and pediatric obstructive sleep apnea

https://pubmed.ncbi.nlm.nih.gov/26330227/

"Our children with permanent teeth missing due to congenital agenesis or permanent teeth extraction had a smaller oral cavity, known to predispose to the collapse of the upper airway during sleep."

5) Hang William M., Gelb Michael. Airway Centric® TMJ philosophy/Airway Centric® orthodontics ushers in the post-retraction world of orthodontics.Cranio. 2017 Mar;35(2):68-78. doi: 10.1080/08869634.2016.1192315. Epub 2016 Jun 30. PMID: 27356671.

https://pubmed.ncbi.nlm.nih.gov/27356671/

"We recommend that optimizing the airway for every patient and never doing any treatment [such as retraction] which will diminish the airway, even minutely, needs to become the standard of care in Airway Centric® Dentistry."

6) Hu Z, Yin X, Liao J, Zhou C, Yang Z, Zou S. The effect of teeth extraction for orthodontic treatment on the upper airway: a systematic review. 2015 May;19(2):441-51. doi: 10.1007/s11325-015-1122-1. Epub 2015 Jan 28. PMID: 25628011.

https://pubmed.ncbi.nlm.nih.gov/25628011/#:~:text=Extractions%20followed%20by%20large%20retraction,enlarge%20the%20upper%20airway%20dimensions

"Extractions followed by large retraction of the anterior teeth in adult bimaxillary protrusion cases could possibly lead to narrowing of the upper airway. Mesial movement of the molars [instead of retraction] to close the extraction spaces appeared to increase the posterior space for the tongue and enlarge the upper airway dimensions."

7) Ozbek MM, Memikoglu TU, Gögen H, Lowe AA, Baspinar E. Oropharyngeal airway dimensions and functional-orthopedic treatment in skeletal class II cases. Angle Orthod 1998;68:327-36. Study concludes that by closing extraction spaces, the maxilla and the mandible retrude, causing a retrognathic mandibular position and consequent constriction of the oropharyngeal airway.

8) Pliska BT, Tam IT, Lowe AA, Madson AM, Almeida FR. Effect of orthodontic treatment on the upper airway volume in adults. Am J Orthod Dentofacial Orthop. 2016;150(6):937-944.

9) Sharma Krishna, Shrivastav Sunita, Sharma Narendra, Hotwani Kavita, Murrell Michael D. Effects of first premolar extraction on airway dimensions in young adolescents: A retrospective cephalometric appraisal. Contemp Clin Dent. 2014 Apr;5(2):190-4. doi: 10.4103/0976-237X.132314. PMID: 24963245; PMCID: PMC4067782.

https://pubmed.ncbi.nlm.nih.gov/24963245/

"In the present study, the nasopharyngeal dimension and TAL were not found to be directly affected by the retraction of anterior teeth. [However] other findings indicated direct correlation of tongue position to oropharynx and hypopharynx."

"An existing strife is that orthodontic treatment can move the denture back in the mouth, reducing oral space and restricting pharyngeal volume. The present study probed this assertion, and analysis shows that the extraction of premolars has a detrimental effect on oropharyngeal structures… Extraction of four premolars did affect velopharyngeal, glossopharyngeal, hypopharyngeal, and hyoid position in bimaxillary protrusive young adolescents. The velopharyngeal, glossopharyngeal, and hypopharyngeal airway became narrower following orthodontic therapy. The hyoid bone tends to move in a posterior and inferior direction. The other findings of our study also proved direct correlation of tongue to oropharynx and hypopharynx. Postextraction tongue position directly influenced the hyoid; this again can be attributed to anatomical dependence of hyoid with the hyoglossal muscle."

10) Stefanovic N, El H, Chenin DL, Glisic B, Palomo JM. Three-dimensional pharyngeal airway changes in orthodontic patients treated with and without extractions. Orthod Craniofac Res. 2013;16(2):87-96.

11) Sun F. C., Yang W. Z., Ma Y. K. Effect of incisor retraction on three-dimensional morphology of upper airway and fluid dynamics in adult class Ⅰ patients with bimaxillary protrusion. 2018 Jun 9;53(6):398-403. Chinese. doi: 10.3760/cma.j.issn.1002-0098.2018.06.007. PMID: 29886634.

https://pubmed.ncbi.nlm.nih.gov/29886634/

"The oropharynx was constricted and the pharyngeal resistance was increased after incisor retraction in adult class I patients with bimaxillary protrusion."

12) Wang Qingzhu, Jia Peizeng, Anderson Nina K., Wang Lin, Lin Jiuxiang.
Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of Class I bimaxillary protrusion. Angle Orthod. 2012 Jan;82(1):115-21. doi: 10.2319/011011-13.1. Epub 2011 Jul 27. PMID: 21793712; PMCID: PMC8881045.

https://pubmed.ncbi.nlm.nih.gov/21793712/

"The pharyngeal airway size became narrower after the treatment. Extraction of four premolars with retraction of incisors did affect velopharyngeal, glossopharyngeal, hypopharyngeal, and hyoid position in bimaxillary protrusive adult patients."

13) Zheng Zhe, Liu Hong, Xu Qi, Wu Wei, Du Liling, Chen Hong, Zhang Yiwen, Dongxu Liu. Computational fluid dynamics simulation of the upper airway response to large incisor retraction in adult class I bimaxillary protrusion patients. Sci Rep. 2017 Apr 7;7:45706. doi: 10.1038/srep45706. PMID: 28387372; PMCID: PMC5384277.

https://pubmed.ncbi.nlm.nih.gov/28387372/

"This study suggested that the risk of pharyngeal collapsing become higher after extraction treatment with maximum anchorage in bimaxillary protrusion adult patients. Those adverse changes should be taken into consideration especially for high-risk patients to avoid undesired weakening of the respiratory function in clinical treatment."

14) https://pubmed.ncbi.nlm.nih.gov/21118911/
Comparative Study Eur J Orthod. 2011 Oct;33(5):515-20.
doi: 10.1093/ejo/cjq109. Epub 2010 Nov 30.
Uvulo-glossopharyngeal dimensions in non-extraction, extraction with minimum anchorage, and extraction with maximum anchorage
Derya Germec-Cakan 1, Tulin Taner, Seden Akan Affiliations PMID: 21118911 DOI: 10.1093/ejo/cjq109

"The findings show that extraction treatment using maximum anchorage has a reducing effect on the middle and inferior airway dimensions."

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