Extraction of premolars in orthodontic treatment does not negatively affect upper airway volume and minimum cross-sectional area : a systematic review with meta-analysis

Article Article scientifique Méta-analyse Extraction of premolars in orthodontic treatment does not negatively affect upper airway volume and minimum cross-sectional area : a systematic review with meta-analysis eng 2025-03-10 2025-04 author Papageorgiou Spyridon N 0000-0003-1968-3326 Clinic of Orthodontics and Pediatric Dentistry, Center for Dental Medicine, University of Zurich, Plattenstrasse 11, 8032 Zurich, Switzerland. author Zyli Maria 0009-0007-4738-0150 Division of Orthodontics, University Clinics of Dental Medicine, Faculty of Medicine, University of Geneva, Rue Miche-Servet 1, 1211 Geneva, Switzerland. 429776 author Papadopoulou Alexandra 0000-0001-5981-0479 Division of Orthodontics, University Clinics of Dental Medicine, Faculty of Medicine, University of Geneva, Rue Miche-Servet 1, 1211 Geneva, Switzerland.,Discipline of Orthodontics, Sydney Dental School, Faculty of Medicine and Health, The University of Sydney, 2 Chalmers Str, NSW 2010 Sydney, Australia. 974834 CUMD - Clinique d'orthodontie (CORT) cjaf012 10.1093/ejo/cjaf012 40062590 0141-5387 PMC11891658 https://academic.oup.com/ejo/article/47/2/cjaf012/8068404 Background: Extraction of premolars is usually prescribed for the orthodontic treatment of cases with inadequate space within the dental arch or when anterior teeth retraction is indicated; however, it has been advocated that this treatment approach could negatively influence the airways. Objective: To identify and critically appraise studies of premolar extractions during orthodontic treatment on upper airway dimensions. Search methods: Electronic unrestricted searches in nine databases until October 2024. Selection criteria: Clinical studies on humans comparing comprehensive orthodontic treatment with versus without the extraction of premolars using cone-beam computed tomography to assess upper airway volume or minimum cross-sectional area (minCSA). Data collection and analysis: After duplicate study selection, data extraction, and risk-of-bias assessment according to Cochrane, random-effects meta-analyses of Mean Differences (MD) with their 95% confidence intervals (CI) were performed, followed by subgroup/meta-regression analyses and assessment of the quality of evidence. Results: Twelve papers corresponding to 11 unique retrospective non-randomized studies were included, covering 891 patients (35.8% male; 20.0 years-old on average). No statistically significant differences in the effect of orthodontic treatment on the volume of the nasopharynx, palatopharynx, glossopharynx, oropharynx or oral cavity were seen between patients treated with versus without premolar extractions (P > .05). Similarly, no significant differences were seen between extraction and non-extraction patients in terms of minCSA of the nasopharynx, palatopharynx, or glossopharynx (P > .05). On the contrary, patients treated with premolar extractions showed increased minCSA of the oropharynx compared to those treated without premolar extractions (4 studies; MD = 23.00 mm2; 95% CI = 10.74-35.26 mm2; P = .009). No significant effects from patient age, sex, or equivalence of the extraction/non-extraction groups were found, while the strength of evidence was moderate in all cases due to the inclusion of non-randomized studies with high risk of bias. Conclusions: Limited evidence of moderate strength indicates that, on average, premolar extractions during comprehensive orthodontic treatment have little to no effect on the volume and minCSA of the airways. Registration: CRD42024621355. Airways Meta-analysis Orthodontic treatment Systematic review Tooth extraction Humans Bicuspid / surgery Bicuspid / diagnostic imaging Tooth Extraction / methods Orthodontics, Corrective / methods Cone-Beam Computed Tomography / methods Respiratory System / diagnostic imaging Dewey 617.6 209 Division d'orthodontie 24Q1 false 1448 Orthodontie 1065 https://zenodo.org/records/14558019 European journal of orthodontics 47 2 933bc759-07c0-4494-9157-42e67a517661 Article (Published version) Public Papageorgiou_EJO_2025_(exo_air)_as_.pdf 1879093 application/pdf CC BY-NC-ND-4.0 4c7c25a48c483522a6babeb9fc6a601729b9e21fd18692ff3fbbd0b537f55513 e5eb5e4b-aa99-48c5-9dab-679802b9bfed Supplemental data Public cjaf012_suppl_supplementary_appendi.pdf 1407535 application/pdf 3c9fcc74cf82bc6876ca8586a42eecce49af8034b9fa10c7c4169194c64b8b4c openAccess Faculté de médecine / Section de médecine dentaire / Département de réhabilitation oro-faciale / Division d'orthodontie

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Extraction of premolars in orthodontic treatment does not negatively affect upper airway volume and minimum cross-sectional area : a systematic review with meta-analysis	European journal of orthodontics			2025	60	9,354

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Zyli, Maria