J Clin Exp Dent. 2020;12(11):e1050-7.

Gingival display after teeth extraction

Journal section: Orthodontics doi:10.4317/jced.57538

Publication Types: Research https://doi.org/10.4317/jced.57538

Vertical gingival display changes associated with upper premolars

extraction orthodontic treatment: A prospective clinical trial

Michel F. Fallas 1, Elham S. Abu-Alhaija 2, Susan N. Alkhateeb 2,3, Shadi S. Samawi 4

1
Master student, Division of Orthodontics, Department of Preventive Dentistry, Faculty of Dentistry, Jordan University of Science
and Technology, P.O. Box 3030, Irbid-Jordan
2
Professor, Division of Orthodontics, Department of Preventive Dentistry, Faculty of Dentistry, Jordan University of Science and
Technology, P.O. Box 3030, Irbid-Jordan
3
Professor, Division of Orthodontics, Department of Preventive Dentistry, Faculty of Dentistry, Jordan University of Science and
Technology, P.O. Box 3030, Irbid-Jordan
4
Private orthodontic practice, Amman – Jordan

Correspondence:
Division of Orthodontics
Department of Preventive Dentistry
Faculty of Dentistry
Jordan University of Science and Technology
P.O. Box 3030, Irbid-Jordan
Fallas MF, Abu-Alhaija ES, Alkhateeb SN, Samawi SS. Vertical gingival dis-
[email protected]
play changes associated with upper premolars extraction orthodontic treat-
ment: A prospective clinical trial. J Clin Exp Dent. 2020;12(11):e1050-7.

Received: 24/06/2020
Article Number: 57538 http://www.medicinaoral.com/odo/indice.htm
Accepted: 10/08/2020
© Medicina Oral S. L. C.I.F. B 96689336 - eISSN: 1989-5488
eMail: [email protected]
Indexed in:
Pubmed
Pubmed Central® (PMC)
Scopus
DOI® System

Abstract
Background: Extraction of upper bicuspids have been anecdotally blamed to increase the vertical gingival display
(VGD) anteriorly. However, the extraction may be needed in some cases in order to correct the underlying ortho-
dontic problem. Objectives: To investigate and compare vertical gingival display (VGD) changes associated with
upper (first vs second) premolars extraction during orthodontic treatment.
Material and Methods: Design: A prospective clinical trial. Setting: Postgraduate dental teaching clinics at Jordan
University of Science and Technology (JUST). Sample population: Sixty orthodontic patients were included in the
study. They were treated with upper first or second premolars extraction according to the underlying problem and
the individualized treatment plan of each patient. Records (radiographs, study casts and clinical photographs) were
taken for all subjects pre- and post- orthodontic treatment. Outcome measures: Pre- and post-treatment VGD, lip
length in static and dynamic positions and the amount of upper teeth retractions were recorded. The paired and the
independent t- test were used to detect differences within/between groups. Factors affecting VGD were investigated
using backward stepwise linear regression analysis.
Results: In both static and dynamic captures, VGD increased after orthodontic treatment in both premolars extrac-
tion groups. Pre- and post-treatment variables differed significantly in groups 1 and 2. VGD changes were similar
in both treatment groups. A significant association was found between VGD change during orthodontic treatment
and upper canine retraction (P<0.001), pre-treatment ANB angle (P<0.01) and upper incisor retraction(P<0.05).
Conclusions: The amount of anterior VGD increases after upper premolars extraction. The increase in VGD after
first and second premolars extractions was comparable. The increase in VGD after orthodontic treatment is associa-
ted with the amount of canine retraction, pre-treatment ANB and the amount of incisor retraction.

Key words: Vertical gingival display, tooth extraction, dental esthetics.

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Introduction 5% level of significance) and Z1-β is the normal deviate at

There is general consensus regarding an attractive smile, 1-β% power with β% of type II error (1.28 at 90% statis-
which occurs when little gingiva is displayed upon smi- tical power), r= n1/n2 is the ratio of sample size required
ling (1-3). A gummy smile (GS) is diagnosed when there for 2 groups, generally it is one for keeping equal sample
is excessive vertical gingival display (VGD) between size for 2 groups, δ(0.92) is obtained from a previous
the lower border of the upper lip and the free gingival study (3) and is the expected difference between the 2
margin of the upper anterior teeth (4). It has been con- groups (1mm).
firmed that the teeth size, amount of incisal show and Sixty orthodontic patients were included in the study.
the position of upper lip are important characteristics They were treated with extraction of upper first or se-
in self-recognition of smile attractiveness and more im- cond premolars according to the underlying problem and
portantly, the VGD (1). Studies have indicated different the individualized treatment plan of each patient. The
threshold levels of VGD that can be perceived as accep- pretreatment baseline cephalometric measurements for
table (1-3), beyond these levels, the VGD will adversely the investigated groups are presented in Table 1.
affects the perceived beauty of a smile. At the time of final records taking and analysis, 6 pa-
Kokich et al. (2) found that VGD during smiling was not tients from group 1 and 4 patients from group 2 were
generally noticeable by general dental practitioners or excluded (missing appointments and poor oral hygiene)
laypeople unless it was 4mm at least and Van der Geld (Fig. 1).
et al. (1) suggested that patients with 2mm to 4mm of Subjects were allocated into one of 2 groups as follows: -
VGD were considered esthetically acceptable while Abu Group 1: - Upper first premolars extraction
Alhaija et al. (3) reported that general dental practitio- Included 24 patients (7 males,17 females) with a mean
ners, orthodontists and laypeople considered a VGD of age of 21.56±3.19yrs who were treated with fixed ortho-
2mm or more as unattractive. dontic appliance for 2.22±0.3yrs.
Anecdotally, extraction of teeth has been attributed to in- Group 2: - Upper second premolars extraction
crease the VGD. However, extraction of upper premolar Included 26 patients (8 males,18 females) with a mean
may be needed in some patients with mild gummy smile age of 22.16±3.59yrs who were treated with fixed ortho-
in order to correct the underlying orthodontic problem. To dontic appliance for 2.25±0.30yrs.
our knowledge, no study to investigate the effect of upper Pre- and post- treatment records (orthopantomogram,
first or second premolar extraction on VGD in orthodonti- lateral cephalogram, study casts, clinical photographs,
cally treated subjects is said to exist. The objectives of this digital video recording) were taken for all subjects.
study were to record and compare changes in the VGD in All patients were treated using pre-adjusted edgewi-
subjects treated with fixed appliance with upper premo- se fixed appliance (3M-Gemini-Uniteks, 0.022-inch
lars (first and second) extraction treatment plan. MBT-prescription brackets) by the same orthodontic
postgraduate student (M.F.). Brackets were placed at the
Material and Methods same height (midfacial-axis) for the upper anterior teeth
-Trial desing in all subjects. Patients were followed-up monthly. Ini-
This study was a parallel group prospective clinical trial tial dental alignment started with 0.014-inch Nickle Tita-
-Subjects and Methods nium (NiTi) archwire then with a sequence of 0.016-inch,
Ethical approval for this study was obtained from the 0.018-inch, 0.016X0.022-inch, 0.019X0.025-inch NiTi
Institutional review board (IRB)/ Jordan University of archwires before 0.019X0.025-inch stainless steel (SS)
Science and Technology /JUST(IRB No. 86/117/2018). rectangular archwires were inserted. Upper space closure
The participants for this study were recruited from pa- was carried out using elastic power chain for all patients.
tients attending postgraduate orthodontic clinics/ JUST No upper arch extrusive or intrusive mechanics were used
The inclusion criteria were as follows: age 17 years or throughout the study (intermaxillary elastics, curve of
more, skeletal class I or class II malocclusion, upper Spee, utility arch and miniscrews in the upper arch).
premolars extraction treatment plan, no previous ortho- -Clinical photographs and video recording
dontic treatment. The exclusion criteria were poor oral The clinical photographs and video records were taken
hygiene, lower arch extraction and smoking. A written with a digital video camera (Canon EOS-70D). Five se-
informed consent was attained from all participants be- conds of video, yielding 150 frames was taken for each
fore orthodontic treatment. patient. The frontal photographs and videos were recor-
-Sample size calculation revealed that for a 90% power ded in standardized fashion with the camera at a fixed
and 5% precision and assuming an overall attrition rate distance from the patient (1.5m). The patient’s head was
of 10%, initial recruitment should target a total of 20 placed in a cephalometric head holder to obtain natural
patients per group. Sample size was calculated (5) as head position and the patient was asked to rehearse the
follows: N=((r+1)(Zα/2+Z1-ß)2 δ2)/rd2 Where Zα/2 is the phrase “Chelsea eats cheesecake on the Chesapeake”
normal deviate at a level of significance (Zα/2 is 1.96 for and then to smile. The video was downloaded to the

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J Clin Exp Dent. 2020;12(11):e1050-7. Gingival display after teeth extraction

Table 1: Means, SD for the baseline cephalometric measurements, difference between means and SE between the 2 studied
groups.

Cephalometric Measurements Pretreatment Pretreatment Mean Difference

Mean(SD) Mean(SD) (SE)
Group 1 Group 2
SNA° 80.89(3.27) 82.97(5.91) 2.08(1.58)
SNB° 76.11(3.69) 78.08(5.28) 1.97(1.51)
ANB° 4.78(1.48) 4.68(2.81) 0.09(0.74)
Max-Mand-plane-angle° 30.89(3.39) 33.21(4.71) 2.32(1.36)
Upper-incisor/Maxillary-plane (UI/Max)° 119.28(5.23) 118.63(5.31) 0.65(1.74)
Lower-incisor/Mandibular-plane (LI/Mn)° 102.50(9.85) 100.95(6.47) 1.55(2.73)
Interincisal-angle° 112.17(11.57) 115.53(15.17) 3.36(4.45)
Overjet(mm) 5.39(1.04) 4.16(1.01) 1.23(0.33)***
Overbite(mm) 4.00(1.08) 2.63(2.89) 1.37(0.72)
Li/A-pog(mm) 6.22(2.51) 5.95(2.32) 0.29(0.79)
LFH% 55.54(3.26) 55.94(3.18) 0.40(1.05)
***P<0.001.

Fig. 1: Flowchart showing patient flow during the trial.

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computer and the frame that best represents the patient’s post-treatment model (S1) to determine the amount of
natural unstrained social smile was selected. Table 2 retraction of anterior teeth and the amount of molar pro-
shows definition of the measurements calculated using traction. The reference landmark used was the rugae
the static and video captures. area as recommended by previous researchers (6-8).
-Cephalometric superimposition (Table 2) -Primary outcome
The pre-treatment maxillary incisors tracing was placed • VGD:- It was measured from the lower edge of the
on the graphic tablet of the digitizing system over a mi- upper lip to the gingival margins of the incisors and
llimeter graded sheet. Post-treatment maxillary incisors canines. This was measured pre- and post-orthodontic
were traced on the pre-treatment cephalogram. The di- treatment for both static and dynamic lip positions.
fference between every related point was measured by • Upper lip length: - It was measured from subnasale to
calculating the number of squares (each square on the lower border of upper lip. This was measured pre- and
graded sheet equal 1 mm). post-orthodontic treatment for both static and dynamic
-Dental cast measurements (Table 2) lip position.

Table 2: Definition of measurements used in the study.

Measurement (mm) Definition

Clinical photography
Pre-St-VGD The amount of pre- and post-treatment vertical gingival display in static
Post-St-VGD position.
Pre-St-Nose-U-lip-length Post- The pre- and post-treatment length of the upper lip in the static position
St-Nose-U-lip-length from subnasale to lower border of upper lip.
Pre-dyn-VGD The amount of pre- and post-treatment gingival exposure in dynamic
Post-dyn-VGD position.
Pre-dyn-Nose-U-lip-length The pre- and post-treatment length of the upper lip in the dynamic
Post-dyn-Nose-U-lip-length position from subnasale to lower border of upper lip.
Cephalometric superimposition
UIE-retraction The amount of upper incisor edge retraction on cephalometric
superimposition
UIA-retraction The amount of upper incisor root apex retraction on cephalometric
superimposition
UI-extrusion The amount of upper incisor edge vertical displacement on cephalometric
superimposition
Dental Cast
UIE-retraction The amount of retraction of upper incisors measured from the incisal edge
in the baseline model (S0) to the incisal edge of the transposed
transparent model (S1).
UC-retraction The amount of retraction of upper canines measured from the mesial
contact point of the canine in the baseline model (S0) to the mesial contact
of the transposed transparent model(S1).

Alginate impressions were taken before and after treat- -Secondary outcome
ment and study casts were fabricated and scanned with • Upper Anterior teeth retraction: It was calculated as
a Ceramill Map 400- scanner with accuracy of 0.02 mm the horizontal distance between pre-t and post-treatment
(AmannGirrbach, Koblach, Austria) to obtain a 3-di- incisal edges.
mensional (3D) model. By using Ceramill Mind design • Upper incisors extrusion: It was calculated as the ver-
(CAD; computer-aided design) software of AmannGirr- tical distance between pre- and post- treatment incisal
bach Company, 3D model measurements were obtained. edges
The accuracy of measurements was performed by cali- The records of 10 subjects were randomly selected and
bration of the program each week. measurements were done twice with 2-week interval.
The baseline model (S0) was superimposed to the The Dahlberg formula was used to calculate the stan-

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dard error of the method. Dahlberg errors ranged from Discussion

0.01mm for St-VGD to 0.32mm for Li/A-Pog and from This study aimed to record the changes in the VGD as-
0.30° for ANB to 1.03° for Ui/Max. sociated with upper premolars extraction as part of or-
-Statistical analysis thodontic treatment plan. If upper premolars extraction
Statistical analysis was performed using the Statisti- is associated increased VGD, then upper teeth intrusion
cal Package for the Social Sciences computer software mechanics should be initiated as early as possible du-
(SPSS 22, SPSS Inc., IL, USA). Intention to treat (ITT) ring orthodontic treatment. To our knowledge, this study
analysis was applied. Paired t-test was conducted to was the first to investigate such changes in orthodontic
examine and define the differences between the studied subjects.
variables at the different time intervals before and after The age of included subjects ranged from 17 to 26 years
orthodontic treatment. Independent t-test was carried out to preclude growth changes; as growth of the upper lip
to detect the differences between the 2 studied groups. could affect the gingival exposure measurements. Nanda
Backward stepwise linear regression analysis was used et al. (9) reported that growth of the upper lip is usua-
to determine the effects of the studied variables on the lly completed by the age of 15 years in both males and
amount of VGD after extraction treatment. females.
Although both genders were included in the study, there
Results was a lower number of male subjects in all groups. This
In group 1, 9 patients presented with Class I malocclu- was in agreement with previous studies that reported hi-
sion and 15 subjects presented with Class II malocclu- gher demand for orthodontic treatment in females than
sion. In group 2, Class I and Class II malocclusions were in males (10). Additionally, smile patterns show sexual
evenly distributed with 13 patients each. Upper arch den- dimorphism. Previous findings agreed that GS is pri-
tal crowding averaged 4.14±0.63mm and 3.03±1.02mm marily a female characteristic and a higher smile line is
in groups 1 and 2; respectively (P<0.001). more common in females than males (1).
Means, standard deviations (SD), mean differences, Patients were treated with fixed appliance with extrac-
standard error (SE) and P values for the studied variables tion of either upper first or second premolars according
are shown in Tables 3-5. to the underlying orthodontic problem. Subjects who
In both bicuspid extraction groups, the differences be- needed more space were treated with upper first bicuspid
tween the pre- and post-treatment means for anterior VGD extraction, while patients who needed less space becau-
in the static and dynamic positions ranged from 0.61mm se they had moderate crowding were treated with upper
to 1.57mm which was statistically significant (P<0.05). second bicuspid extractions (11). The proper selection
The length of the upper lip increased after orthodontic of teeth extraction based on the needed space resulted in
treatment in both static and dynamic positions (P<0.05). comparable amount of anterior teeth retraction for both
Significant changes were detected in the following extraction groups. This would explain the comparable
cephalometric variables in both treatment groups; retro- increase of VGD in both extraction groups after ortho-
clined upper incisors (P<0.001), increased interincisal dontic treatment.
angle (P≤0.001), reduced overjet (P<0.001) and overbi- Space closure was carried on with elastic power chains
te corrected (P<0.01). on a rigid rectangular SS 0.019X0.025-inch archwire
In both bicuspid extraction groups, the VGD increased for all patients in order to achieve the maximum amount
in the static and dynamic positions. However, differen- of bodily movement retraction of anterior teeth rather
ce between the 2 groups was not statistically significant than tipping of the anterior teeth (12). However, tipping
(P>0.05). There were no statistical differences detected in of teeth during retraction was evident as upper incisors
the amount of upper incisors edge and root retraction be- inclination to maxillary plane was reduced significantly.
tween the two extraction groups (P>0.05). In both bicus- This was likely due to the play between the archwire and
pid extraction groups, the amount of upper incisor extru- bracket slot.
sion during treatment was approximately 2mm (P>0.05). The amount of VGD was increased on the upper anterior
Regression analysis showed that there were three predic- teeth in both static and dynamic positions after premo-
tors associated with the increase in the amount of VGD lars extraction. This increase in VGD may have resul-
after upper premolars extraction (R=0.677); the amount ted from anterior teeth extrusion during their retraction.
of canine retraction (R2=0.498;P=0.001), the pretreat- This was in agreement with Sarver (13) who reported
ment ANB angle (R2=0.377;P=0.009) and the amount that space closure by uprighting the incisors through re-
of upper incisor retraction (R2=0.301;P=0.030). traction would elongate the crowns of teeth which would
-Harms in turn increase the amount of incisal show at rest and
No negative outcomes were reported by any subject du- on smile.
ring the trial. Gingival hyperplasia was observed in 2 Upper incisors retraction (≈3mm) and extrusion (≈2mm)
cases and were excluded from the trial. after premolars extraction resulted in up to 1.5mm in-

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 Table 3: Means, standard deviations (SD), mean differences, standard error (SE), 95% confidence interval (C.I.) and P values for pre- and post- treatment VGD and lip length in static and dynamic
J Clin Exp Dent. 2020;12(11):e1050-7.

photograph in the 2 studied groups.

Variable (mm) Group 1 Group 2 Group 1 & 2

Pre-treatment Post-treatment Mean Diff (SE) Pre-treatment Post-treatment Mean Diff (SE) Mean diff (SE) 95% C.I. P-value
Mean (SD) Mean (SD) Mean (SD) Mean (SD)
St-VGD 21 3.03 (1.14) 4.77 (1.47) 1.48 (0.21)*** 3.19 (1.06) 4.47 (1.64) 1.28 (0.27)*** 0.20 (0.28) -0.51 – 0.90 NS
St-VGD 11 3.38 (0.99) 4.94 (1.26) 1.56 (0.20)*** 3.20 (1.15) 4.56 (1.49) 1.37 (0.25)*** 0.19 (0.26) -0.46 – 0.85 NS
St-VGD 22 4.76 (1.40) 5.65 (1.52) 0.89 (0.21)*** 4.84 (1.35) 6.09 (1.70) 1.25 (0.25)*** -0.36 (0.26) -1.03 – 0.30 NS
St-VGD 12 5.11 (1.53) 6.08 (1.44) 0.97 (0.24)*** 5.17 (1.36) 6.19 (1.54) 1.02 (0.36)** -0.50 (0.30) -0.81 – 0.70 NS
St-VGD 23 4.16 (2.09) 4.65 (2.11) 0.49 (0.31) 4.22 (1.29) 5.19 (1.72) 0.94 (0.4)*** -0.49 (0.30) -1.24 – 0.27 NS
St-VGD 13 4.25 (1.74) 5.11 (2.02) 0.86 (0.38)* 4.06 (1.43) 5.09 (1.57) 1.02 (0.36)** -0.16 (0.42) -1.22 – 0.90 NS

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St-Nose-U- Lip 12.42 (2.59) 12.50 (2.59) 0.74 (0.04) 13.17 (1.77) 13.29 (1.73) 0.12 (0.06)* -0.5 (0.06) -0.19 – 0.10 NS
Length
Dyn-VGD 21 3.41 (1.25) 4.93 (1.57) 1.52 (0.21)*** 3.45 (1.44) 4.68 (1.73) 1.24 (0.26)*** 0.28 (0.27) -0.40 – 0.97 NS
Dyn-VGD 11 3.50 (1.31) 5.07 (1.44) 1.57 (0.26)*** 3.52 (1.40) 4.89 (1.69) 1.37 (0.29)*** 0.20 (0.31) -0.59 – 0.99 NS
Dyn-VGD 22 4.75 (1.68) 5.67 (1.95) 0.92 (0.28)** 5.08 (1.49) 6.28 (1.81) 1.20 (0.26)*** -0.28 (0.31) -1.06 – 0.49 NS
Dyn-VGD 12 5.20 (1.53) 6.17 (1.76) 0.97 (0.23)*** 5.54 (1.54) 6.46 (1.62) 0.92 (0.27)** 0.55 (0.30) -0.67 – 0.78 NS
Dyn-VGD 23 4.15 (2.02) 4.76 (2.20) 0.61 (0.41)* 4.48 (1.71) 5.37 (1.91) 0.88 (0.32)** -0.27 (0.42) -1.32 – 0.79 NS
Dyn-VGD 13 4.40 (1.87) 5.30 (2.33) 0.90 (0.39)* 4.56 (1.40) 5.44 (1.65) 0.88 (0.28)** 0.01 (0.39) -0.96 – 0.99 NS
Dyn-Nose-U- 12.40 (2.57) 12.49 (2.56) 0.90 (0.04)* 13.17 (1.80) 13.31 (1.72) 0.14 (0.04)** -0.05 (0.06) -0.17 – 0.07 NS
Lip Length
*P<0.05, **P<0.01, ***P<0.001
Gingival display after teeth extraction
 J Clin Exp Dent. 2020;12(11):e1050-7. Gingival display after teeth extraction

crease in VGD anteriorly. It has been suggested that be-

cause the gingiva and alveolus are attached to teeth roots
by the periodontal ligament, the gingiva follows vertical
movement of the root during extrusion forces (14). This
explains the increase in VGD associated with upper an-
Mean Diff (SE)

-4.11 (3.26)***
terior teeth retraction.

2.05 (0.18)***
9.63 (1.20)***

0.11 (0.59)**
4.89 (1.84)*
-0.79 (0.90)
-0.45 (0.49)
-0.16 (0.56)

-0.62 (0.72)
1.02 (0.94)

1.74 (0.54)
Lip length slightly increased after upper first and second
bicuspid extraction which is in agreement with Janson et
Table 4: Means, standard deviations (SD), mean differences, standard error (SE) and P values for pre- and post- treatment cephalometric analysis in treated groups.

al. (15). Upper lip support may have been affected by

the retraction of the upper anterior teeth which allowed
the lip to achieve a lower position and thus increased
the lip length (16). This finding may allow us to think
Post-treatment

that the increase in the VGD was slightly masked by the

119.63 (9.05)

56.55 (2.58)
78.87 (4.58)

33.37 (4.52)
81.95 (5.08)

89.05 (5.76)
Mean (SD)

4.21 (1.46)
2.11 (0.94)
2.53 (1.12)
5.13 (2.18)

109 (6.26)
Group 2

small increase in lip height.

The average anteroposterior changes in the position of
the maxillary incisors found in this study were higher
than those reported in previous studies (11-17). In this
study, there was a mean maxillary incisor retraction of
3mm in both first and second bicuspid extraction groups.
Pre-treatment

Ong and Wood (11) reported a mean maxillary incisor

115.53 (15.17)

55.94% (3.18)
100.95 (6.47)
118.63 (5.31)
78.08 (5.28)
82.97 (5.91)
Mean (SD)

33.21 (4.71)

2.63 (2.89)
5.95 (2.32)
4.68 (2.81)

4.16 (1.01)

retraction of 2.5mm and 1.6mm in the maxillary first

and maxillary second premolars extraction groups, res-
pectively. Saelens and De Smit (17) reported an average
2.1mm and 1.9mm retraction in their 4 first bicuspids
and 4 second bicuspids extraction groups, respectively.
Predictors of the increase in the amount of VGD after
Mean Diff (SE)

12.28 (1.70)***

-9.33 (2.05)***
3.22 (0.17)***

upper premolars extraction are the amount of canine and

1.78 (0.13)***
1.53 (0.60)*
-0.78 (0.39)

0.035(0.76)
1.25 (0.69)

0.72 (0.94)

3.22 (1.75)
0.47 (0.74)

upper incisors retraction. This is of note to orthodontists

where the greater the incisors and canine are retracted,
the more the increase in the VGD. The pre-treatment
ANB was also detected as a predictor to develop an in-
crease in the amount of VGD after bicuspid extraction.
The interpretation is that patients with a Class II maloc-
Post-treatment

121.50 (11.23)

clusion have a higher tendency to develop an increase in

80.42 (3.20)

99.28 (6.09)
30.17 (4.46)
74.86 (4.01)
Mean (SD)

55.51(2.33)
2.22 (0.88)
4.69 (2.31)
5.56 (1.82)

2.17 (0.79)
Group 1

107 (8.88)

the VGD compared to a Class I malocclusion.

The limitations of this study include small male-to-fe-
male ratio. More males should be included in future stu-
dies. Also, the allocation of subjects in each group (first
or second premolars) was not randomized and was based
on the characteristics of the patients. In addition, skele-
Pre-treatment

112.17 (11.57)
102.50 (9.85)
119.28 (5.23)

tal Class I and Class II malocclusion was mixed in each

80.89 (3.27)

30.89 (3.39)
76.11 (3.69)
Mean (SD)

55.54(3.26)
6.22 (2.51)
4.00 (1.08)
5.39 (1.04)
4.78 (1.48)

group which might affected the outcome.

Conclusions
- Extraction of both upper first and second premolars in-
creases the amounts of the VGD in orthodontic patients
Interincisal Angle°

- The increase in VGD following first and second pre-

**P<0.01, ***P<0.001

molars extraction was similar.

Li/A-pog mm
Overbite mm
Overjet mm

- The increase in VGD after orthodontic treatment is as-

UI/Max°
Variable

sociated with the amount of canine retraction, pre-treat-

LI/Mn°

LFH%
ANB°
SNB°

ment ANB and the amount of incisor retraction.

SNA°

MM°

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J Clin Exp Dent. 2020;12(11):e1050-7. Gingival display after teeth extraction

Table 5: Means, standard deviations (SD), differences between the means of cephalometric and dental casts superim-
position measurements, standard error (SE) and P-values in the studied groups.

Measurement (mm) Group 1 Group 2 Mean Diff. 95% C.I. P-value

mean (SD) mean (SD) (SE)
Cephalometric superimposition
UIE Retraction 2.94 (1.21) 3.10 (0.93) 0.16 (0.35) -0.90 – 0.53 0.34
UIA Retraction 1.97 (0.96) 2.15 (0.82) 0.18 (0.29) -0.78 – 0.41 0.33
UIE Extrusion 2.08 (0.51) 2.03 (0.70) 0.05 (0.20) -0.35– 0.46 0.26
Dental cast superimposition
Upper 12Edge retraction 2.98 (1.39) 3.59 (1.86) -0.61 (0.54) -1.71 – 0.49 0.27
Upper11Edge Retraction 3.70 (1.39) 3.53 (1.58) 0.17 (0.49) -0.82 – 1.16 0.73
Upper21Edge Retraction 3.71 (1.23) 3.33 (1.40) 0.38 (0.44) -0.51 – 1.26 0.40
Upper22Edge Retraction 3.59 (1.38) 3.15 (1.11) 0.44 (0.41) -0.39 – 1.27 0.29
Upper13 Retraction 3.00 (1.450) 3.66 (1.66) -0.65 (0.51) -1.70 – 0.39 0.21
Upper23 Retraction 3.28 (0.92) 3.58 (1.44) -0.30 (0.40) -1.11 – 0.51 0.45

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