ORIGINAL ARTICLE

Cephalometric assessment of dentofacial

vertical changes in Class I subjects treated
with and without extraction
Arunachalam Sivakumara and Ashima Valiathanb
Manipal, India, and Cleveland, Ohio

Introduction: There is disagreement concerning the effect of premolar extractions on the dentofacial vertical
dimension. It has been suggested that orthodontic forward movement of the posterior teeth after first
premolar extraction leads to reduction in vertical dimension. The purpose of this study was to examine
cephalometrically the dentofacial vertical changes in Class I Indian subjects treated with and without
extractions. Methods: The extraction group included 31 normodivergent patients (26 female, 5 male;
pretreatment age, 17.19 ⫾ 3.89 years) with maxillary and mandibular first premolar extractions. The
nonextraction group included 29 patients (18 female, 11 male; pretreatment age, 18.48 ⫾ 3.61 years). A
coordinate system with the Frankfort horizontal plane and a mandibular fiduciary line was used for the
cephalometric calibration. To determine vertical dimension changes due to treatment and to compare
differences between the 2 groups, paired and unpaired t tests were performed, respectively. Results: Both
groups had increases in linear vertical dimensions (P ⬍0.05), but the change was comparatively greater in the
extraction group (P ⬍0.05). Mesial movement of the maxillary and mandibular posterior teeth was
coincidental with the extrusion to such an extent that it increased the vertical dimension, although the
mandibular plane angle remained unchanged during treatment. Conclusions: Extraction of teeth only to
increase the overbite or decrease the mandibular plane angle might not be justified. (Am J Orthod Dentofacial
Orthop 2008;133:869-75)

I
n this era of mushrooming research and technolog-
ical advances, we still have many unanswered or
debatable questions. Much research has been fo-
cused on an intriguing question: does the vertical
dimension of the face decrease with therapeutic premo-
lar extraction? Although this conundrum has been
around since the beginning of orthodontics, it has
surfaced in debates among many clinicians recently.
Thus, it is current conventional wisdom that it is
desirable to extract teeth in patients with vertical facial
patterns to help control the vertical dimension. It is
further believed that extraction should be avoided in
brachyfacial types to prevent excessive vertical clo-
sure.1,2 The dentoalveolar apparatus is assumed to take
the form of an occlusal wedge so that the bite is opened
when molars or premolars are extruded or distalized, or
From the Department of Orthodontics and Dentofacial Orthopedics, Manipal
College of Dental Sciences, Manipal, India.
a
Reader.
b
Professor and head, adjunct professor of Orthodontics, Case Western Reserve
University, Cleveland, Ohio.
Reprint requests to: Arunachalam Sivakumar, Department of Orthodontics and
Dentofacial Orthopedics, Manipal College of Dental Sciences, Manipal
576104, India; e-mail, sivlalith2004@yahoo.co.in.
Submitted, March 2006; revised and accepted, May 2006.
0889-5406/$34.00
Copyright © 2008 by the American Association of Orthodontists.
doi:10.1016/j.ajodo.2006.05.041
it is closed when the molars are moved forward after
extraction of the premolars.3,4 From a biomechanical
point of view, this belief is logical and self-explanatory.
Unlike other dental treatments, orthodontic mechano-
therapy is performed in an environment of biological
complexities and complexities associated with the treat-
ment per se. Hence, any differences of opinion regard-
ing this rule (occlusal wedge hypothesis) are not
surprising.
Recent studies evaluating the effect of first premo-
lar extractions on the vertical dimension concluded that
vertical changes after the extraction of first premolars
were not statistically different from those in nonextrac-
tion patients, and that the attempt to help control (close)
the vertical dimension with the extraction of first
premolars was not possible.5,6 A few studies demon-
strated increases in the absolute values of anterior and
posterior facial heights, even with premolar extraction
with no further change in the mandibular plane angle
(MPA).7-10 Some studies suggest that it takes special
effort, in addition to the premolar extractions, to reduce
the vertical dimension in patients with high MPAs.
Pearson11 showed a mean decrease in MPA of 3.9°
after premolar extractions, with vertical chincups used
before and during orthodontic treatment. Garlington12
attempted to reduce the vertical dimension through
869
870 Sivakumar and Valiathan American Journal of Orthodontics and Dentofacial Orthopedics
June 2008

Table I. Sample characteristics

Extraction Nonextraction
group group t* P

Initial age (y) 17.19 18.48 1.31 0.19, NS

Treatment time (y) 2.92 1.49 16.20 ⬍0.001, HS

*Student t test; NS, not significant; HS, highly significant (P ⬍0.001).

early removal of the remaining deciduous teeth and

enucleation of the second premolars; although there
was a statistically significant decrease in lower facial
height, the MPA decreased by only 0.8°.
In spite of compelling evidence, premolar extrac-
tions continue to be implicated as a cause for decreased
vertical dimensions. With this in mind, our intent in this
study was to objectively evaluate dentofacial vertical
changes in Class I Indian subjects treated with and
without extractions.

MATERIAL AND METHODS

The sample consisted of 120 lateral cephalograms Fig 1. Linear measurements with overall and mandibu-
lar coordinate systems.
obtained from 60 Class I normodivergent malocclusion
patients (SN-GoGn, 32° ⫾ 1°). They did not have
severe anteroposterior (0° ⬍ ANB ⬍ 5°) and vertical
discrepancies (0 mm ⬍ overbite ⬍ 6 mm). The extrac-
tion group included 31 patients (26 female, 5 male;
pretreatment age, 17.19 ⫾ 3.89 years) with maxillary
and mandibular first premolar extractions. The nonex-
traction group inlcuded 29 patients (18 female, 11
male; pretreatment age, 18.48 ⫾ 3.61 years). Detailed
characteristics of the groups are shown in Table I. All
subjects had Class I malocclusion and were treated by
using standard edgewise appliances and frictionless
mechanics. Space closure was carried out with .019 ⫻
.025-in stainless steel wire. The subjects were selected
on the basis of following criteria: Class I malocclusion,
defined according to clinical files and study casts; age
between 13 and 22 years (both sexes); all permanent
maxillary and mandibular teeth, up to the first perma-
nent molars; treatment with standard edgewise appli-
ance; and balanced growth pattern.
The pretreatment and posttreatment lateral cepha-
lograms were taken on the same radiographic unit
(Planmeca 2002 Proline PAN oblique cephalometric
machine; Planmeca Co, Helsinki, Finland). The lateral Fig 2. Lateral cephalometric landmarks and measurements.
films were hand traced by 1 investigator (A.S.). The
magnification was set at 1.09 in the scale. The reference
lines used were the Frankfort horizontal (FH) plane and
the mandibular fiduciary line (FL). The FL was drawn thus facilitate local superimpositioning of mandibles.
between 2 fiduciary points. Fiduciary points are fixed We used the method described by Dibbets13 for struc-
references for comparison or measurement. These fidu- tural mandibular superimpositioning. The fiduciary
ciary points replace the images of metallic implants and points were arbitrarily located below the lower border
American Journal of Orthodontics and Dentofacial Orthopedics Sivakumar and Valiathan 871
Volume 133, Number 6

Table II. Definitions of linear and angular measurements

Anterior facial height (AFH) Linear distance between nasion and menton (Me)
Lower anterior facial height (LAFH) Linear distance between the anterior nasal spine and Me
Posterior facial height (PFH) Linear distance between sella (S) and gonion (Go)
Facial height index (FHI) Ramus height divided by the distance from Me measured to the palatal plane.
FH-U1 Perpendicular distance from the Frankfort horizontal (FH) plane to the incisal edge of the
maxillary incisor
FH-U6 Perpendicular distance from FH plane to the mesiobuccal cusp tip of the maxillary first molar
FL-L1 Perpendicular distance from the fiduciary line (FL) to the incisal edge of the mandibular incisor
FL-L6 Perpendicular distance from the FL to the mesiobuccal cusp tip of the mandibular first molar
SVertical-U1 Perpendicular distance from S vertical to the incisal edge of the maxillary incisor
SVertical-U6 Perpendicular distance from S vertical to the mesial convex point of the maxillary first molar
PogVertical-L1 Perpendicular distance from pogonion (Pog) vertical to the incisal edge of the mandibular incisor
PogVertical-L6 Perpendicular distance from Pog vertical to the mesial convex point of the mandibular first molars
MPA Angle formed by the mandibular plane (Go-Me) and FH plane

Table III. Comparison of pretreatment and posttreatment measurements between groups

Pretreatment Posttreatment

Extraction Nonextraction Extraction Nonextraction

Parameter Mean SD Mean SD Significance* Mean SD Mean SD Significance*

MPA (°) 23.35 3.61 24.34 3.05 NS 23.90 3.99 24.47 3.59 NS
AFH (mm) 106.30 7.15 109.66 5.83 NS 108.65 7.19 110.56 5.72 NS
LAFH (mm) 60.90 5.60 61.77 4.56 NS 62.63 5.72 62.36 4.39 NS
PFH (mm) 71.20 6.46 72.69 5.92 NS 72.16 6.99 73.18 5.96 NS
LAFH/AFH (%) 57.20 2.08 56.29 2.20 NS 57.54 2.56 56.37 2.04 NS
PFH/AFH (%) 66.98 3.99 66.26 4.32 NS 66.37 4.63 66.25 5.16 NS
FHI 61.17 8.06 59.40 9.15 NS 60.58 9.47 59.82 8.41 NS
FH-U1 (mm) 46.99 4.36 48.96 3.97 NS 47.39 4.02 48.98 4.40 NS
FH-U6 (mm) 43.01 4.22 45.18 4.24 NS 44.58 3.64 45.25 3.46 NS
FL-L1 (mm) 43.00 3.92 42.24 3.07 NS 43.41 3.38 42.58 3.02 NS
FL-L6 (mm) 42.46 3.73 42.12 2.59 NS 42.74 3.57 42.84 2.59 NS
SVertical-U1 (mm) 71.93 5.42 72.98 5.92 NS 68.25 3.68 71.40 5.41 S
SVertical-U6 (mm) 40.78 4.15 42.51 4.62 NS 42.74 4.26 41.91 4.62 NS
PogVerticalL1 (mm) 4.26 3.78 2.54 2.99 NS 1.31 3.42 2.29 2.96 NS
PogVertical L6 (mm) ⫺20.59 3.97 ⫺21.56 2.95 NS ⫺17.50 4.43 ⫺21.44 2.64 S

*Unpaired t test; S, significant (P ⬍0.05); NS, not significant (P ⬎0.05).

of the mandible and approximately parallel to the
occlusal plane.
A coordinate system with the FH plane and a
perpendicular line through sella (Svertical) was used for
measuring maxillary molar and incisor positions. Man-
dibular molar and incisor positions were measured from
a perpendicular to the FL line tangent to pogonion:
Pogvertical (Fig 1). The overall superimposition with
structural landmarks of the anterior and middle cranial
fossa allowed transfer of the FH plane from pretreat-
ment to posttreatment tracings.14
Mandibular superimposition according to Bjork’s
structural method15 was used to transfer the FL. Figure
2 shows the location of the landmarks and other
measurements on a tracing. The cephalometric mea-
surements used in this study (from previous reports) are
described in Table II.16-18 All linear measurements
from the radiograph were divided by the magnification
factor to obtain the actual dimension.
To guarantee greater sample homogeneity, only
Class I patients with a balanced facial growth pattern
were selected. To select patients with a balanced
growth pattern, Steiner’s norm for SN-GoGn angle of
32° was used.19 Therefore, the subjects had values
within the mean of ⫾ 1 SD.
For error testing, pretreatment and posttreatment
cephalograms were traced at the same time, and all
radiographs were traced by the same operator (A.S).
Ten patients were selected and pretreatment and post-
treatment radiographs were traced and retraced by the
872 Sivakumar and Valiathan American Journal of Orthodontics and Dentofacial Orthopedics
June 2008

Table IV. Comparison of treatment changes between groups

Extraction

Pretreatment Posttreatment Difference t* P

Parameter Mean SD Mean SD

MPA (°) 23.35 3.60 23.90 4.00 0.55 1.83 0.08, NS

AFH (mm) 106.30 7.15 108.65 7.20 2.35 4.37 ⬍0.001, HS
LAFH (mm) 60.90 5.60 62.63 5.70 1.33 5.58 ⬍0.001, HS
PFH (mm) 71.20 6.50 72.16 7.00 0.96 1.59 0.12, NS
LAFH/AFH (%) 57.20 2.10 57.54 2.60 0.35 1.18 0.25, NS
PFH/AFH (%) 66.98 4.00 66.37 4.60 ⫺0.61 1.14 0.26, NS
FHI 61.17 8.10 60.58 9.50 ⫺0.59 0.64 0.53, NS
FH-U1 (mm) 46.99 4.40 47.39 4.00 0.40 1.19 0.24, NS
FH-U6 (mm) 43.01 4.20 44.58 3.60 1.57 4.87 ⬍0.001, HS
FL-L1 (mm) 43.00 3.90 43.41 3.40 0.40 1.22 0.23, NS
FL-L6 (mm) 42.46 3.70 42.74 3.60 0.28 0.86 0.00, NS
SVertical-U1 (mm) 71.93 5.40 68.35 3.70 ⫺3.67 5.06 ⬍0.001, HS
SVertical-U6 (mm) 40.78 4.20 42.74 4.30 1.97 4.50 ⬍0.001, HS
PogVertical-L1 (mm) 4.26 3.80 1.31 3.40 ⫺2.95 6.73 ⬍0.001, HS
PogVertical-L6 (mm) ⫺20.59 3.97 ⫺17.50 4.40 3.09 5.62 ⬍0.001, HS

*Paired t test; †unpaired t test; NS, not significant; S, significant; HS, highly significant.

same operator (A.S) a minimum of a month later. The
tracings were analyzed, and the differences in measure-
ments between the 2 tracings of the same radiograph
were calculated. Paired t tests were performed to
determine significant differences between the 2 trac-
ings.
Statistical analysis
Standard descriptive statistical calculations were
computed for each group. The skeletal and dental
parameters were analyzed separately in each group.
Intragroup comparisons were made by paired t tests.
Intergroup comparisons of changes between the groups
were done by unpaired t tests. When nonnormality was
observed, the results were ascertained by nonparamet-
ric tests such as the Mann-Whitney test (for unpaired)
and the Wilcoxon test (paired). Pretreatment (between
both groups) and posttreatment (between both groups)
values were also compared for possible nonsignificant
differences. The initial ages and treatment times of the
groups were compared with the Student t test.
RESULTS
No significant difference was found between any
measurement on the 10 cephalograms traced at 2 times
for error testing.
There were no significant differences between the
variables in the pretreatment stage between the extrac-
tion and nonextraction groups (Table III). In the post-
treatment stage, only 2 variables (SVertical-U1 and
PogVertical-L6) had significant differences between the
groups (Table III). The treatment changes of the fol-
lowing parameters were significantly different between
the groups: AFH, LAFH, FH-U6, SVertical-U1, SVertical-
U6, PogVertical-L1, and PogVertical-L6 (Table IV).
The mean changes resulting from either treatment
reflected little or no increase in the MPA. Only 10 of
the 60 patients (4 in the extraction group, 6 in the
nonextraction group) had a decrease in AFH. These
decreases ranged from 0.9 to 1.8 mm in the extraction
sample and 0.9 to 2.5 mm in the nonextraction sample.
DISCUSSION
The stimulus for this investigation was the assertion
that extraction treatment is tantamount to reduction in
facial vertical dimension and subsequent increase in
depth of the bite, particularly when compared with
nonextraction treatment.2,20 In clinical practice, orth-
odontists sometimes decide to extract premolars based
on the theory that reducing tooth mass will lead to bite
closure by accelerating the normal forward growth
rotation of the mandible. Such rotation, would, in
theory, reduce the anterior facial height and carry the
chin forward. Our data indicate that this belief might be
grossly exaggerated. These data are more consistent
with the inference that closing extraction spaces might
cause collateral extrusive effects that tend to increase
the vertical dimension.21,22 The results of the study
along with previous reports appear to clarify the appro-
priateness for the rationale of extraction treatment.
The reason for including a nonextraction group in
this study was that the treatment changes from extrac-
American Journal of Orthodontics and Dentofacial Orthopedics Sivakumar and Valiathan 873
Volume 133, Number 6

Table IV. Continued

Extraction vs
Nonextraction nonextraction

Pretreatment Posttreatment Difference t* P t† P

Mean SD Mean SD

24.34 3.1 24.47 3.6 0.12 0.32 0.75, NS 0.89 0.98, NS

109.66 5.8 110.56 5.7 0.90 2.30 ⬍0.05, S 2.16 ⬍0.05, S
61.77 4.6 62.36 4.4 0.60 1.77 0.09, NS 2.48 ⬍0.05, S
72.69 5.9 73.18 6.0 0.49 0.96 0.34, NS 0.59 0.56, NS
56.29 2.2 56.33 2.0 0.08 0.24 0.81, NS 0.60 0.55, NS
66.26 4.3 66.25 5.2 ⫺0.01 0.02 0.98, NS 0.82 0.42, NS
59.40 9.15 59.82 8.4 0.42 0.51 0.61, NS 0.81 0.42, NS
48.96 4.0 48.98 4.4 0.02 0.06 0.95, NS 0.82 0.42, NS
45.18 4.2 45.25 3.5 0.31 0.61 0.55, NS 2.08 ⬍0.05, S
42.24 3.1 42.58 3.0 0.33 1.15 0.26, NS 0.15 0.88, NS
42.12 2.6 42.84 2.6 0.85 2.56 ⬍0.05, S 1.22 0.23, NS
72.98 5.9 71.40 5.4 ⫺1.66 2.52 ⬍0.05, S 2.17 ⬍0.05, S
42.51 4.6 41.91 4.6 ⫺0.41 0.92 0.37, NS 3.80 ⬍0.001, HS
2.54 3.0 2.29 3.0 ⫺0.25 0.64 0.53, NS 4.55 ⬍0.001, HS
⫺21.56 2.9 ⫺21.44 2.6 ⫺0.12 0.27 0.79, NS 4.19 ⬍0.001, HS

tion protocol could be compared and the interpretation
of the results might be valid. Moreover, the 2 groups
were matched by age and facial divergence. Of course,
the subjects in the nonextraction group had less severe
dental deviations than the extraction group.
Table III shows that the extraction and nonextrac-
tion groups were similar at pretreatment; the variables
had no significant differences. This ensured high com-
patibility between the studied groups.
The extraction and nonextraction groups had sta-
tistically significant differences for the variables
PogVertical-L6 and SVertical-U1 at posttreatment. This was
consequent to greater decreases in these variables in the
extraction group because of mesial movement of the
mandibular first molars in patients for whom some
anchorage loss was allowed and retraction of maxillary
incisors, respectively. The absolute measurements of
growth pattern, vertical face height, the ratio LAFH/
AFH, and molar and incisor vertical heights did not
show significant differences between the extraction and
nonextraction patients at posttreatment; this suggests
that treatment approach (extraction or nonextraction)
does not affect the vertical proportions of the face and
the dentition.
There were statistically significant differences in
the amount of change in the variables for AFH and
LAFH between the 2 groups (Table IV). This could be
due to the more pronounced increase in the absolute
value of AFH and LAFH in the extraction group than in
the nonextraction group. Nevertheless, the absolute
increase in vertical dimension was less than in the
studies of Kocadereli5 and Staggers.6
Kocadereli5 and Staggers6 showed that there was no
statistically significant difference in vertical dimension
changes between first premolar extraction and nonex-
traction groups, and orthodontic treatment produced
increases in cephalometric vertical dimension in both
groups (extraction greater than nonextraction) and cor-
roborates our findings. Chua et al7 examined the effects
of extraction and nonextraction on LAFH and reported
a significant increase in the nonextraction group and no
significant change in the extraction group. Cusimano et
al22 found no difference in facial height of hyperdiver-
gent patients with first premolar extraction treatment
when pretreatment and posttreatment results were com-
pared.
Baumrind23 reported that the mean increase in
anterior total face height was significantly greater in the
Class II extraction subgroup than in the Class II
nonextraction group; this agrees with our results. Kim
et al24 tested the occlusal wedge hypothesis by com-
paring the mesial movement of molars and the changes
in facial vertical dimension between first premolar and
second premolar extraction groups and concluded that
there was no decrease in facial vertical dimension
regardless of maxillary and mandibular first premolar
and second premolar extraction. Hayasaki et al25 re-
ported that the changes in the absolute magnitude of
posterior and anterior facial heights were similar be-
tween extraction and nonextraction treatments in both
874 Sivakumar and Valiathan
Class I and Class II malocclusion patients. Al-Nimri26
compared the changes in facial vertical dimension in
patients with Class II Division 1 malocclusion after
extraction of either the mandibular first premolars or
the mandibular second premolars and concluded that
mandibular premolar extraction, whether first or sec-
ond, was not associated with mandibular overclosure or
reduction in facial vertical dimension, despite a more
forward movement of the mandibular molars in the
second premolar extraction group.
The analysis of the variables at pretreatment and
posttreatment in Table III suggests that there was some
extrusion of the maxillary and mandibular molars in
both groups; this could have been consequent to the
mechanotherapy6,11,22 or residual growth.24 However,
the maxillary molar extrusion was statistically signifi-
cant when both groups were compared. The role of
residual growth must be considered because it can
influence facial height. In girls, growth is nearly com-
plete at 14 years. The average ages of the extraction and
nonextraction groups were 17.19 ⫾ 3.89 years and
18.48 ⫾ 3.61 years, respectively, so we can say little
about the influence of residual growth because it is
limited at these ages. However, in this study, all linear
measurements increased after treatment. This result
suggests that some residual growth as well as treatment
effects took place. This finding is similar to the studies
of Kim et al24 and Harris et al27 with subjects in the late
teens. Because the mean ages of the 2 groups were
similar in this study (Table I), the effect of growth on
facial heights between the groups could be expected to
be similar. Thus, the effect of growth on facial heights
in this study can be eliminated.
The maxillary and mandibular molars showed me-
sial movement in relation to SVertical and PogVertical,
respectively (Table IV). This movement can be conse-
quent to mechanotherapy or residual growth.6,22 This
finding is similar to the studies of Gardner et al28 and
West and McNamara29 with subjects in the late teens.
Gardner et al28 reported that the horizontal distance of
the maxillary first molar measured in relation to ptery-
gomaxillary vertical continued to increase (mesial
movement) an average of 2.6 mm from posttreatment
(age, 16.16 years) to the first recall examination (age,
21.64 years).28 West and McNamara29 reported the
same with the molars in males and females with mean
ages of 17 years 2 months and 17 years 6 months,
respectively, erupted and moved mesially during adult-
hood.29 In addition to the normal mesial displacement
of the maxillary and mandibular molars, mesial move-
ment in the extraction group might be allowed, depend-
ing on the severity of the anterior discrepancies.6,21 The
changes in the nonextraction subjects reflect primarily
American Journal of Orthodontics and Dentofacial Orthopedics
June 2008
normal residual growth, displacing these teeth forward
in relation to the reference lines.22 However, the
changes in extraction and nonextraction subjects were
statistically significant. This could be due to minimal
molar mesial movement in the nonextraction group. As
noted earlier, in the extraction group, the mesial move-
ment of the maxillary and mandibular molars was
coincident with extrusion to such an extent that it
increased the linear vertical dimension, although the
MPA remained unchanged during treatment.
The less pronounced treatment changes in the
nonextraction group for variables of facial vertical
dimension and molar extrusion could be explained by
many factors. It is conceivable that the effects of the
treatment are more pronounced with a longer duration
of treatment. Despite considerable homogeneity in
sample selection, the extraction treatment was associ-
ated with longer treatment times than the nonextraction
treatment (Table I). Even a greater space closure is
extrusive and not just because of the use of elastics.6,22
The question remains of how far clinicians are
willing to formulate sound treatment plans based on
current scientific knowledge pertaining to vertical di-
mension changes. This might not be a new phenome-
non, but certainly our generation has witnessed in-
creased accessibility and credibility of the scientific
foundations of the ongoing studies. A serious limitation
of our study (and others also) was that we could not
analyze in depth the response differences of different
patients. For example, the statistical evaluation totally
masked the effects seen in the 10 patients who had
reductions in vertical dimension. It is strongly recom-
mended that an in-depth evaluation of vertical dimen-
sion changes in each stage of the treatment of the
samples, and the results should be contemplated with
concomitant evaluation of the biomechanics of the
temporomandibular joints, since they do not function as
simple hinges. Another possible limitation of the study
could be the lack of importance given to growth and sex
differences. Although there was no significant differ-
ence in the ages of the subjects between the groups,
there is always a possibility (by chance) of comparing
the data of a growing male subject with a female after
the growth spurt. This is always a difficulty with
retrospective study groups; future studies should match
the groups according to their chronologic and skeletal
ages.
CONCLUSIONS
The intent of this cephalometric investigation was
to examine the popular theory that the vertical dimen-
sion collapses after first premolar extractions. Our
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 133, Number 6
findings do not support this, and we conclude the
following.
1. Linear vertical dimensions increased in both the
extraction and the nonextraction groups. The
changes in vertical dimension were comparatively
greater in the extraction group.
2. Extraction of teeth solely to increase the overbite or
decrease the MPA might not be justified.
The authors thank Dr Ravinder of Manipal Hospi-
tal, Bangalore, India for his valuable inputs in study
protocol and conduct.
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