Incisor and profile alterations in extraction cases treated with standard Edgewise and pre-adjusted appliances: A controlled before-and-after study

Background Even though treatment of Class II malocclusion with premolar extractions and incisor retraction might affect incisor inclination and soft tissue profile, the effects of bracket prescription on this have not been thoroughly assessed. Methods Fifty patients (mean age: 13.6 years; 34% male) receiving extraction-based treatment with either standard Edgewise or pre-adjusted appliances were included. Between-group differences in the incisor inclination assessed with lateral cephalograms were analyzed statistically with linear/logistic regression at 5%. Results Treatment-induced changes included retroclination of the upper/lower incisors (−3.0° and −2.0°, respectively), retraction of the upper/lower incisors (−3.4 mm and −1.5 mm, respectively), retraction of the upper/lower lip (−2.1 mm and −2.0 mm, respectively), and enlargement of the nasolabial angle (+1.6°). Analysis of the data adjusting for confounders indicated that the pre-adjusted group, after treatment, had larger inclination of the upper or lower incisors (+3.2° and +4.5°, respectively), more prominent upper incisors relative to the facial plane (+1.3 mm), and smaller interincisal angle (−7.3 or −7.7°). Post-treatment upper incisor inclination fell within the cephalometric norm significantly more in the pre-adjusted than in the standard Edgewise group (odds ratio 4.3; 95% confidence interval 1.1–16.6). No differences were found in lower incisor prominence, upper/lower lip prominence, or nasolabial angle. Conclusions Pre-adjusted appliances were associated with increased inclination of the upper and lower incisors, with more prominent upper incisors, and with more acute interincisal angle after retraction compared with standard Edgewise appliances. However, such differences did not translate in greater retraction of the upper/lower lips and greater nasolabial angle