PhD Scientific Days 2025

Poster Session III. - S: Dental Research

Early Space Management through Premolar Enucleation: A Retrospective Analysis of Class I Crowding Cases

Name of the presenter

Heckenast Lili

Institute/workplace of the presenter

Department of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, Semmelweis University

Authors

Dr. Lili Heckenast¹, Domingo Martín², Bálint Nemes¹, Andreu Puigdollers³, Dorottya Frank⁴

1: Department of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, Semmelweis University
2: Private Practice Martin-Goenaga, San Sebastián, Spain
3: Department of Orthodontics and Dentofacial Orthopaedics, Faculty of Dentistry, International University of Catalunya
4: Department of Dentistry, Oral and Maxillofacial Surgery, University of Pécs

Text of the abstract

Introduction
Premolar enucleation, a less explored variant of serial extraction, aims to create early space in the dental arch to encourage spontaneous alignment. Unlike traditional serial extraction, it involves removing premolars before eruption, potentially reducing treatment complexity.

Aims
The present research investigates the effects of premolar enucleation on incisor inclination, molar position, and alignment in cases of severe crowding.

Method
This retrospective study reviewed records of 43 Class I patients (19 males, 24 females) with severe crowding, treated via a modified serial extraction protocol. The sequence involved removal of deciduous canines, deciduous first molars, and enucleation of permanent first premolars. No appliances were used during this phase; fixed multiband appliances followed later.
Plaster models were analyzed at T0 (pre-enucleation) with Moyers analysis and at T1 (before fixed appliances) using arch length discrepancy.
Cephalometric changes in incisor inclination, molar tipping, overjet, and overbite were measured digitally at T0 and T1.
All measurements were performed independently three times by two experienced orthodontists.

Results
Out of 43 patients, 23 met inclusion criteria.
Model analysis showed arch space improvement: upper from −9.07 mm to +4.07 mm, and lower from −10.83 mm to +4.17 mm.
Cephalometric analysis revealed increases in the interincisal angle (+4.73°) and overbite (+1.66 mm), and decreases in lower incisor to NB distance (−0.82 mm) and angle (−2.98°). Molar angulation changed, with L6 inclination increasing by 3.85° (p = 0.004) relative to the mandibular plane and U6 by 3.57° (p = 0.008) relative to the palatal plane. L6 mesial movement along the NB line was ≈0.78 mm (p < 0.01). Other parameters showed no significant change.

Conclusion
Premolar enucleation appears effective in addressing severe crowding in Class I cases, promoting spontaneous alignment and significant space gain without early appliance use. The procedure supports controlled incisor retrusion, mesial molar movement, and a moderate increase in overbite, contributing to favorable vertical development of the occlusion. Though promising, patient variability underscores the need for careful case selection.

Funding
This study received no external funding.