Profile changes in patients treated with and without extractions: Assessments by lay people

The purpose of this study was to assess the profile changes in subjects with Class II, Division 1 malocclusions who were treated either with or without the extraction of the four first premolars. The assessments were made by 39 lay persons. Profile silhouettes on 91 (44 extraction and 47 nonextraction) patients were evaluated at three stages: pretreatment, posttreatment, and approximately 2 years after treatment. Photographs matched for age and sex were also evaluated on 20 normal untreated subjects (10 males and 10 females). All rater assessments were analyzed statistically as to the effects of the following variables: (a) occlusion, i.e., normal or Class II, (b) treatment rendered, i.e., extraction or nonextraction, (c) gender, i.e., male or female, and (d) stage of observation, i.e., pretreatment, end of treatment or in retention. The current findings indicate that (1) before treatment, lay persons perceived the profile of normal patients more favorably than untreated patients with Class II, Division 1 malocclusions. (2) Immediately after treatment, raters perceived the changes in the profile of the extraction group more favorably than those in the nonextraction and normal groups. (3) At the end of the observation period (approximately 2 years posttreatment), raters did not evaluate the profile of any of the groups as being more favorable, but all groups were perceived more favorably than at the initial observation. (4) Raters perceived the profile changes with treatment more favorably in female subjects than in male subjects. In conclusion, orthodontic treatment seems to have a favorable effect on the profiles of both the extraction and nonextraction groups, both short- and long-term. Therefore, when based on proper diagnostic criteria, the posttreatment changes in the facial profile were perceived as favorable in both the extraction and nonextraction Class II, Division 1 groups when compared with the pretreatment profile. (Am J Orthod Dentofac Orthop 1997;112:639-44.)