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PIIS0889540604009242 EnigmaofClassIImolarfinishing
PIIS0889540604009242 EnigmaofClassIImolarfinishing
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experience, it is doubtful that patients treated with space- on osseointegrated implants: results and experiences from a
opening and prosthetic replacements will have better long- prospective study after 2-3 years. Int J Oral Maxillofac Implants
term treatment results than those treated with orthodontic 1995;11:311-21.
space closure. The question to be answered by controlled 14. Stenvik A, Zachrisson BU. Orthodontic closure and transplanta-
tion in the treatment of missing anterior teeth. An overview.
clinical studies in the future will be: what is preferable in a
Endod Dent Traumatol 1993;9:45-52.
life-long perspective for the patient, either a natural “living”
root or an ankylosed foreign body in the site of the missing
maxillary lateral incisor? Enigma of Class II molar finishing
In this letter, we have focused on the permanence of
replacements for missing maxillary lateral incisors. Treatment The orthodontic literature, from the days of Bolton,1
decisions for young people with missing incisors should be contains ample articles about correction of the anterior
based on a comprehensive assessment that includes many segment, with the molars finished in a Class II relationship.
factors.14 For many patients, the best results can be obtained Particularly noteworthy are the patients with Class II
by an interdisciplinary approach including implants or canti- malocclusions who are treated with extractions only in the
lever prosthetics. The challenge is, however, to plan treatment maxillary arch. In a well-written thesis, Kessel2 argued
according to the patient’s needs and diagnosis, and not on the that, in nongrowing patients (above 12 years) with a
assumption that implants are superior to orthodontically particular type of Class II malocclusion, single-arch ex-
positioned and reshaped natural teeth. traction is a justifiable method of treatment. Standard
Bjorn U. Zachrisson, DDS, MSD, PhD textbooks like those of Bishara3 and Proffit4 also document
Arild Stenvik, DDS, MSD, PhD cases in which the molars were left in a Class II relation-
Oslo, Norway ship at the end of the treatment. A recent article in the
0889-5406/$30.00 AJO-DO, “Class II treatment success rate in 2- and
doi:10.1016/j.ajodo.2004.10.006 4-premolar extraction protocols” (Janson G, Brambilla AC,
Henriques JFC, de Freitas MR, Neves LS. Am J Orthod
REFERENCES Dentofacial Orthop 2004;125:472-9), compares Class II
1. Turpin DL. Treatment of missing lateral incisors. Am J Orthod patients treated with single-arch and both-arch extractions
Dentofacial Orthop 2004;125:129. and concluded that the former was better.
2. Wilson TG Jr, Ding TA. Optimal therapy for missing lateral What intrigues me is that, for a century, we orthodon-
incisors? Am J Orthod Dentofacial Orthop 2004;126(3):22A- tists have made the correction of Class II molar relation-
23A. ships a top priority. Whether we used a myofunctional
3. Thilander B, Odman J, Lekholm U. Orthodontic aspects of the approach, comprehensive fixed appliances, or even surgi-
use of oral implants in adolescents: a 10-year follow-up study. cal treatment, finishing with the molars in a Class I
Eur J Orthod 2001;23:715-31.
relationship was considered almost mandatory. But were
4. Iseri H, Solow B. Continued eruption of maxillary incisors and
first molars in girls from 9 to 25 years studied by the implant
we chasing the wrong treatment goal? Was Angle wrong in
method. Eur J Orthod 1996;18:245-56. assigning a malocclusion label to the Class II molar
5. Oesterle LJ, Cronin RJ Jr. Adult growth, aging, and the single- relationship? Is the first part of Andrews’ first key to
tooth implant. Int J Oral Maxillofac Implants 2000;15:252-60. normal occlusion worth ignoring?
6. Chang M, Wennström JL, Odman P, Andersson B. Implant As a great admirer of tooth size and morphology in
supported single-tooth replacements compared to contralateral relation to malocclusion and treatment results, I find it very
natural teeth. Crown and soft tissue dimensions. Clin Oral Impl difficult to accept Class II molar finishing.
Res 1999;10:185-94. Bolton’s tooth size ratio has shown us that proper
7. Tuverson DL. Close space to treat missing lateral incisors. Am J maxillary and mandibular tooth size and proportion are
Orthod Dentofacial Orthop 2004;125(5):17A.
essential for a normal occlusal relationship. The importance
8. Rosa M, Zachrisson BU. Integrating esthetic dentistry and space
closure in patients with missing maxillary lateral incisors. J Clin
of the anterior ratio is well understood and applied clinically.
Orthod 2001;35:221-34. In essence, 3 maxillary anterior teeth occlude with 3.5
9. Weichbrodt DJ, Stenvik A, Haanæs HR. An intra-individual mandibular anterior teeth in each quadrant for a normal
evaluation of implant supported single tooth replacements for anterior relationship—ie, overjet, overbite, and midline. It can
missing maxillary incisors (abstract). 18th Congress of the Nordic also be interpreted that maxillary anterior teeth in the outer
Association of Orthodontists, Loen, Norway, September 4-7, arc have a larger mesiodistal dimension than the mandibular
2003. ones. The size of anterior teeth in normal circumstances is
10. Thordarson A, Zachrisson BU, Mjör IA. Remodeling of canines designed to give overjet, overbite, midline, and canine occlu-
to the shape of lateral incisors by grinding: a long-term clinical sion.
and radiographic evaluation. Am J Orthod Dentofacial Orthop
It is possible to extrapolate a similar posterior ratio from
1991;100:123-32.
11. Wennström J. Personal communication 2004.
the overall ratio of Bolton. From the 77% anterior ratio,
12. Esposito M, Ekestubbe A, Gröndahl K. Radiological evaluation mandibular teeth (first molar to first molar) pick up to become
of marginal bone loss at tooth surfaces facing single Brånemark 91% value in the overall ratio. Logically and factually, the
implants. Clin Oral Impl Res 1993;4:151-7. mandibular posterior teeth are larger mesiodistally than the
13. Andersson B, Odman P, Lindvall AM. Single-tooth restorations maxillary posteriors. Five maxillary posterior teeth (first
16A Readers’ forum American Journal of Orthodontics and Dentofacial Orthopedics
December 2004