SPECIAL ARTICLE

On the management of extraction sites

Stanley Braun, DDS, MME, a Robert C. Sjursen, Jr., DDS, b and Harry L. Legan, DDS c

Indianapolis, Ind.
Extraction sites may be needed to achieve specific orthodontic goats of positioning the dentition
within the craniofacial complex. The fundamental reality that determines the final position of the
dentition, however, is the control exercised by the clinician in closure of the extraction sites. A
specific treatment objective may require the posterior teeth to remain in a constant position
anteroposteriorly as well as vertically, while the anterior teeth occupy the entire extraction site.
Another treatment objective may require the reverse, or any number of purposeful alternatives of
extraction site closure. An appliance system developed over time, which provides this control, is
described. The system takes advantage of aspects of continuous arch therapy that provides
constant, positive orientation of the anterior and posterior groups of teeth to each other in threedimensional space across an extraction site, combined with aspects of the segmented arch
technique that permit definable and predictable force systems to be applied to these teeth.
Consequently, the clinician has the ability to forecast treatment outcomes with confidence. (Am J
Orthod Dentofac Orthop 1997;112:645-55.)

E x t r a c t i o n sites are created to achieve

one or more objectives: to improve dental occlusion,
to reconcile arch length deficiencies, to purposefully
alter the facial profile, to optimize surgical-orthodontic correction of jaw discrepancies, and to improve function, v3 The management of any extraction site must therefore be under the control of the
clinician to ensure that the teeth will ultimately reside
in predetermined positions. Toward this end, Burstone 4 has defined three types of controlled closure of
extraction sites: Type A refers to those sites where the
anterior teeth will occupy most or all of the extraction
space; type B refers to equal occupation of the extraction site by the anterior and posterior teeth; and in
type C, the extraction site is closed by the posterior
teeth occupying most or all of the extraction site.
The types of closure may not necessarily be
bilaterally identical in a given arch. For example, in
asymmetric malocclusions, one extraction site may
be identified as requiring a type C closure, whereas
the contralateral site may require a type A closure.
This may be necessary to achieve predetermined
treatment goals of the dental centerline being coincident to the facial centerline, and the dentition to
be properly positioned anteroposteriorly to support
the facial soft tissues and to satisfy the clinician's
concept of dental stability.
aClinical professor, Orthodontics, Vanderbilt University Medical Center
and University of Illinois at Chicago.
bAssistant professor, Orthodontics, Vanderbilt University Medical Center.
~Professor and Chairman, Orthodontics, Vanderhilt University Medical
Center.
Reprint requests to: Dr. Stanley Braun, 7940 Dean Rd., Indianapolis, IN
46240.
Copyright 1997 by the American Association of Orthodontists.
0889-5406/97/$5.00 + 0 8/1/75235

To achieve controlled extraction site closure, the

appliance used must deliver definable force systems
regulated by the clinician and not produce closure in
some ambiguous, indeterminate way. Only when
force systems are definable are the dental movements predictable and treatment outcomes forecastable with confidence. In addition, the force
systems should result in minimal to no tissue resorption, move teeth with optimal velocity, cause minimal patient discomfort, and have an extended range
of activation, while producing a relatively constant
force system. This latter objective results in reducing
the number of patient visits, while yielding tooth
movement with a nearly constant center of rotation.
The purpose of this article therefore is to describe
an appliance system that has been developed over
time and meets these goals.
GENERAL CONSIDERATIONS IN TOOTH
M O V E M E N T (Quantities in this manuscript are
representative)

To translate a tooth or a group of teeth, it has been

repeatedly shown that a moment-to-force ratio applied at
a bracket should be equal to the perpendicular distance
from the bracket to the center of resistance of an individual tooth or group of teeth. 5-~ Further, investigators have
recently demonstrated that translatory movement causes
the least tissue damage because the periodontal stress is
relatively uniformly distributed along the root surfaces. 9-12
In contrast, uncontrolled dental tipping results in the
greatest periodontal stress located at both the dental
apical and alveolar crestal regions. In root movement, the
greatest periodontal stress is in the apical region, whereas
in controlled tipping (center of rotation approximating the
645

646 Braun, Sjursen, and Legan

American Journal of Orthodontics and Dentofacial Orthopedics

December 1997

a = molar auxiliary tube

b = canine auxiliary tube

I
Closure

I~ = Center of Resistance

Force System
Posterior
Anterior
FI

Mp
Ma
F ~ 12-13, " T - ~ 10, F'(d)=Mp-Ma

Type 'A'
p

Type 'B'

Type 'C'

mb,._I

~2.~Mp

] F~__.F Mp

Ma*""

MF~-~

Mp=Ma, -MP
Ma --10
g - =W--

MaF ~ T F '

Mp
Ma = 12-13, F'(d)=Ma-Mp
F = 10, --F-'---

Fig. 1. Force systems related to type A, B, and C extraction site closure.

root apex), the greatest stress is at the alveolar crestal
region.
If an extraction site is closed with a translatory force
system (M/F approximating 10) applied equally to the
posterior teeth and anterior teeth, type B closure will
occur, t3 (See Fig. 1.) In type A closure (posterior teeth
remain essentially fixed anteroposteriorly), the clinician
must increase the M/F ratio on the posterior teeth to
approximately 12 to 13. This results in a periodontal stress
distribution related to root movement, while the anterior
teeth are simultaneously subjected to a M/F approximating 10, resulting in translation. This purposeful differential
stress distribution between the posterior and anterior
teeth takes advantage of the hierarchy of relative velocities of tooth movement, namely, root movement is a
slower process than translatory movement. Because the
system is in equilibrium, vertical forces occur (see Fig. 1)
because a couple results (F' d), which is equal to the
difference in magnitude between the posterior moment
(Mp) and the anterior moment (Ma). These vertical
forces are of concern for they have the potential of
altering the occlusal plane. It is therefore important to
control the differential between the posterior and anterior
moments, so that the vertical forces are ostensibly balanced by occlusal forces.
To achieve type C closure, the previously mentioned
force system is reversed, with the larger moment applied
to the anterior teeth and the smaller moment applied to
the posterior teeth as in Fig. 1. This results in a M/F ratio
approximating translation applied to the posterior teeth

versus a M/F ratio approximating root movement applied

to the anterior teeth. Once again, vertical forces are of
concern. (The specifics of appliance activation for type A
and type C extraction site closure will be addressed
further in Treatment Procedures.) In the special case
where the mandibular anterior teeth had been intruded
earlier, one should consider the use of Class II elastics, as
seen in Fig. 2, to eliminate the couple created by the larger
anterior moment (Ma). In this case, the horizontal force
(F) in the M/F may be reduced by half (F/2). The
horizontal component of the Class II elastic is adjusted to
be approximately equal to F/2. Consequently, the M/F
ratio at the posterior teeth is approximately 10, causing
translation, while the anterior teeth will experience root
movement because of an increased M/F ratio related to
the reduction of the force (F/2). In the maxilla, type C
closure can be achieved through the use of protraction
headgear (when the anterior teeth had been previously
intruded) or alternatively, type C closure can also be
obtained through the use of Class III elastics that will
supply a horizontal component to the posterior group of
teeth equal to F/2, and thus provide the moment-to-force
ratio that will cause translation, similar to the system
described for type C closure in the mandibular arch.
From the occlusal aspect, the forces acting on the
buccal surfaces of the posterior teeth produce a moment
as seen in Fig. 3. This moment tends to alter the arch form
by decreasing the arch width in the premolar region. This
moment may be negated by an activated lingual arch ~4,~5
or by dividing the mesiodistal force buccolingually. The

Braun, Sjursen, and Legan 647

American Journal of Orthodontics and Dentofacial Orthopedics

Volume 112, No. 6

F/217

E/2

t_
Center of Resistance

Rotating Moment = F- X

Fig, 3, Rotating moments caused by buccal forces

during extraction site closure.

M p = M a E/2~-F/2
(__~__)

Mp
POSTERIOR - F/2 + E/2 ~ 10

Ma
ANTERIOR -

F/2

~ 1 2 - 13

Fig. 2. Force system for type C closure in mandible

with Class II elastics.

lingual force may be supplied by an elastic. The closure

force on the anterior teeth does not have an effect on the
arch width in the canine region.
In patients exhibiting anterior arch length deficiencies, the canines often need to be initially translated part
way into the extraction sites to align the incisors. In this
case, it is important to divide the closure force (F)
buccolingually to avoid first-order canine rotations, while
simultaneously preventing first-order rotation of the posterior teeth (an active lingual arch need not be used in this
case). As mentioned earlier, the lingual component of this
divided force may be obtained through the use of lingual
elastics. Problems related to patient compliance may be
reduced through the use of lingual coil springs. Elastomeric chains should be avoided because of their rapid
force decay. 16 The issue of patient compliance is addressed further in the Treatment Procedures section.

TREATMENT PROCEDURES*
After initial tooth-to-tooth alignment of the posterior
teeth, segments are established by using relatively stiff
" U s e of 0.018 slot brackets are assumed throughout. T h e 0.022 slot
brackets m a y be used with a proportional increase in wire sizes. Table 1
lists all brackets needed. Any 0.018 slot bracket m a y be used on teeth not
otherwise specified.

wire. A 0.016 0.022 stainless steel wire is used for this

purpose. The segments are tied back to maintain their
arch lengths (see Fig. 4). When the anterior teeth do not
exhibit arch length deficiencies, the treatment occlusal
plane is established by posterior dental eruption or by true
anterior dental intrusion. 13,1s,17 If, however, the anterior
teeth exhibit an arch length deficiency, the canines are
engaged and steel-tied to a 0.016 0.016 stainless steel
"track." The track originates from each auxiliary tube on
the premolars bilaterally, and bypasses the incisors, as
seen in Fig. 5. The wire track contains a step-up immediately mesial to the premolar auxiliary tube, as well as a
bend at the wire's exit. This establishes a molar-to-molar
continuous arch of variable cross-section whose arch
length is defined.
If the canines are malaligned axially, rotated, or
require intrusion or extrusion, they should be corrected
before establishing the track, is In all cases, the arch form
should be preserved. During canine root movement, canine leveling, or correcting rotations, lingual arches
should be present to enhance anchorage and to maintain
symmetry of the posterior teeth.
After the canines are translated distally on the track,
allowing access to the incisors, they are temporarily joined
to the buccal teeth by placing extended 0.016 0.022
buccal segments, while the treatment plane of occlusion is
established for the incisors at this time. Once this is
accomplished, all the anterior teeth, including the canines,
are consolidated on a stainless steel 0.016 0.016 arch
wire molar-to-molar (the buccal segments are removed).
Root alignment may be confirmed with an x-ray film at
this time. Subsequently, the arch wire size is increased to
0.016 0.022. This allows the clinician to finalize arch
form and accomplish any third-order incisor corrections
needed.
Remaining space closure is accomplished en masse by
placing a 0.017 0.025 anterior segment engaging the
premolar tubes bilaterally, as seen in Fig. 4. The occlusal

648

Braun, Sjursen, and Legan

American Journal of Orthodontics and Dentofacial Orthopedics

December 1997

Fig. 4. Buccal segments and anterior wire arrangement for en masse space closure.

Fig. 5. Track design for initial canine distal translation.

step in the wire distal to the canines bilaterally is needed
to accommodate the vertical positional difference between
the auxiliary tubes on the premolars and the slots of the
canine brackets. The anterior teeth should be ligated
together during en masse space closure. This relatively
heavy anterior segment is used to fill the slots of the
incisor brackets for torsional control during remaining
extraction site closure. The previously used buccal segments are reseated into the buccal teeth, as seen in Fig. 4.
Once again, a continuous arch of variable cross-section
has been established (0.016 0.022 posteriorly, 0.017
0.025 anteriorly). All the teeth within each of the three
segments are well-aligned to each other, and all that
remains is en masse space closure. The arch form is
maintained by the anterior wire engaging the buccal
segments at the premolar auxiliary tubes.

ACHIEVING CANINE TRANSLATION AND

SELECTED EN MASSE CLOSURE
To control the moment-to-force ratios and related
centers of rotation, retraction springs should produce
nominally predictable moments and forces. An acceptable
spring currently available for this purpose is the 0.017
0.025 T M A T loop design by Burstone. 4 For its activations
to result in predictable moments and forces, each dimension of the T loop must be specific. Fig. 6, A may be used
as a template for this purpose. (This spring is also
available prefabricated from the Ormco Corp.)
As an example, to produce an anteroposterior force
approximating 300 gm, the spring is activated as follows
(refer to Fig. 1): The distance from the mesial aspect of
the auxiliary tube of the first molar to the center of the
vertical tube of the canine bracket (L) is measured. An

American Journal of Orthodontics and Dentofacial Orthopedics

Volume 112,No. 6
Table

Braun, Sjursen, and Legan

649

I. Required brackets and fittings

Maxilla
.
TOOTH

Left canine
Right canine
Canine-lingual
1st or 2nd premolars
First molars
Lingual sheaths

ATTACHMENT
Part no. a

'T'- Loop Template

(Scale 1:1)
A

347-3113b
347-3013b
any lingualbutton/hook
394-5607
182-4518b
671-3672b

POSTERIOR

ANTERIOR

Mandible

Left canine
Right canine
Canine-lingual
1st or 2nd premolars
First molars
Lingual sheaths

347-3313b
347-3213b
as above
as above
180-0002b
as above

1 2

34
' '

a0.018 slots are listed -0.022 substitution brackets are available.

bOrmco Corp.
CAmerican Orthodontics.
-- +1
2

activation (A) of 8 mm will produce an approximate

mesiodistal force of 300 gm (see Table II). This activation
is subtracted from (L). The resultant difference (D)
represents the sum of the anterior and posterior leg
lengths of the T-loop springs. If this dimension D is
divided by two, the posterior leg and the anterior leg of
the T-loop spring are equal and are each (D/2). The T
loop will thus be located in the center of the dimension L.
It is advantageous to locate the T 1.5 mm anterior to this
center position by having the posterior leg 1.5 mm longer
than the anterior leg. The anterior leg is bent vertically at
(D/2 - 11/2) to enter from the occlusal aspect of the canine
vertical tube. (This bend should be overdone around the
round beak of a plier and subsequently returned to the
90 position.) A small gingival bend (approximately 5) is
made to identify the posterior leg length (D/2 + 11/2). As
an example, if the posterior leg of the T loop spring is
placed into the molar auxiliary tube and the vertical
portion of the anterior leg into the tube on the canine
bracket, and the posterior leg pulled distally through the
molar auxiliary tube to the 5 bend, the distance between
the vertical legs of the T will be 8 mm, resulting in a
mesiodistal force of approximately 300 gm. The springs
should next be contoured for patient comfort and to
ensure buccolingual passivity, thereby preventing indeterminate, extraneous forces from occurring.
The moments in both the posterior and anterior
portions of the spring are obtained by placing 30 to
40 bends in each of the six positions as shown in Fig. 6, B.
These bends should be made around the round beak of a
plier and be initially overdone, then returning to the 30 to
40 activation, as T M A wire has some "memory." By
sharing these bends occlusogingivally, the moments will
have the least effect on the mesiodistal force. A fully
activated maxillary spring is shown in Fig. 7. Note the
posterior and anterior moments are approximately equal.

L=

+,4) +

+ ACTIVATION
B

Fig. 6. A, T-loop spring template (scale 1:1). Note:

Spring is universal. There are no rights or lefts or
alterations in design for maxillary or mandibular arches.
B, Locations of moment producing bends in the T-loop
spring.

The B type extraction site closure will occur from this

spring configuration. To ensure the moment bends are
properly distributed within the spring, each leg should be
held with a plier and after orienting them in the same
relationship as they would be intraorally (posterior leg
horizontal, and anterior leg vertical), the vertical portions
of the T loop should touch. If they do not, the 30 to
40 bends should be rechecked. It is important that the
vertical legs do touch, for if they do not, the mesiodistal
activation of 8 mm will be affected.
The forces and moments of the spring for various
activations are representative and listed in Table II. Note
the moment-to-force ratio will change from approximately
8 initially, to approximately 13 at the end of 4 mm of
extraction site closure. This indicates that the centers of
rotation of the anterior and posterior groups of teeth are
somewhat variable. Although this is not ideal, it is the best
available at this time. This spring should not be reactivated until at least half the activation has been reduced by
extraction site closure. If extraction site closure on one
side of the arch precedes the contralateral side, the
springs should not be reactivated until both sides have
closed 4 ram.
By locating the T spring 1.5 mm anteriorly, reactivation

650 Braun, Sjursen, and Legan

American Journal of Orthodontics and Dentofacial Orthopedics

December 1997

Fig. 7. Activated T-loop spring (anterior and posterior moments are equal for type B
extraction site closure).
Table II. R e p r e s e n t a t i v e f o r c e s y s t e m v a l u e s of T M A , 0.017 0.025 c e n t e r e d T - l o o p spring
ActivaEon
(MM)

Force
(gram)

Moment
(GrMM)

M/F
RaEo

M/F Ratio
with lingual eNs~cs

0
1
2
4
6
8

0
50
100
150
250
300

1350
1550
1750
2000
2300
2400

-31
17.5
13
9
8

-10
9
8
---

can easily be accomplished by pulling the distal leg posteriorly until the vertical legs are 8 mm apart once again. The
spring can be reactivated without removal. As en masse
closure occurs, the projection of the 0.017 0.025 anterior
wire will slide through the premolar brackets bilaterally.
These projections should be clipped periodically, as they will
strike the molars and interfere with closure if this is not done.
This sliding continuous arch ensures the dental contacts of
the teeth on each side of the extraction site will be properly
positioned in all planes of space. In addition, the established
arch form is maintained throughout closure.
The reader will recall that type A closure is
achieved by increasing the moment-to-force ratio applied to the posterior teeth. This was illustrated through
the use of Class II elastics as related to the maxillary
arch, and Class III elastics in the mandibular arch. This
approach to type A closure was obtained by increasing
the M/F ratio through decreasing F. An alternative
means of increasing the moment-to-force ratio at the
posterior teeth would be to increase the moment (Mp).
This can be done by locating the T loop 3.5 mm anterior
to the center position. This lengthens the distal leg,
allowing for an additional 30 to 40 bend to be placed
in the posterior leg approximately 2 mm distal to
position 1 in Fig. 6, B. Similarly, in type C closure, the

T loop is located 3.5 mm distal to the center position.

This allows a similar additional 30 to 40 bend to be
placed in the anterior leg, increasing the moment-toforce ratio applied to the anterior teeth.
In cases requiring initial canine retraction, the closure
springs are activated in the same manner with the exception that the spring activation is 4 mm. This provides an
approximate mesiodistal force of 150 gm. A lingual force
of approximately 150 gm is provided by placing an appropriate elastic from the auxiliary lingual fitting on the first
molars to a lingual button or equivalent on the canines.
(See Fig. 8.) The presence of a passive lingual arch is
optional. If a patient does not wear the lingual elastics, the
canines will rotate a very small amount labiolingually and
seize on the wire track, stopping all motion. This is an
important fail-safe design. Failure of patient cooperation
will be evident at the following appointment as normal
canine translation occurs at a rate approximating 1 mm
per month.
FRICTIONAL CONSIDERATIONS
It is important to consider that bracket/wire relative
motion occurs in two instances: between the 0.016 0.016
track and the canine bracket when canines are individually

American Journal of Orthodontics and Dentofacial Orthopedics

Volume 112, No. 6

Braun, Sjursen, and Legan 651

Fig, 8. Occlusal view of initial canine distal translation.

!,

,,.'
Fig. 9. Couple at wire/bracket interface caused by
dental tipping.

translated, and secondly, between the 0.017 0.025

anterior wire and the auxiliary tube of the premolar
bracket during en masse space closure. Frictional effects
must be considered at these two locations.
Because teeth undergoing orthodontics move at relatively low velocities, the law of static friction applies, F =
b~N, where F represents the frictional force resisting
motion, IX the coefficient of friction at adjoining bracket/
wire interfaces, and N the perpendicular force that exists
at the bracket/wire interface in all planes. 19 Because all
teeth are essentially supported by springs (the periodontal
ligament), when they occlude, engage food, are touched
by the tongue, they each move a minute amount. This
motion is essentially random in all planes of space and
results in the normal force N, becoming zero in excess of
590 times each day. 2-22 Consequently, the frictional forces

Fig. 10. Pretreatment cephalogram tracing of patient

with Class II malocclusion.
approach zero as well, thus not resisting motion at the
wire/bracket interfaces. This has been shown in experiments conducted by Liew 23 and is supported by anecdotal
evidence that similar extraction site closure velocities
occur whether a wire joining the posterior and anterior
teeth is present or not. It should be noted, however, when
relative motion is attempted at the wire/bracket interfaces
at two or more adjacent bracketed teeth, frictional forces
cannot become zero for this requires that random dental
motions occur in synchrony--a virtual impossibility. It is
important to emphasize that there must be relative linear
motion (related to translation) at the bracket/wire interface. If this is not the case, as in dental tipping, a couple

652 Braun, Sjursen, and Legan

American Journal of Orthodontics and Dent@cial Orthopedics

December 1997

Fig. 11. Appliances in place for type A maxillary closure.

B
A
Fig. 12. A, Posttreatment cephalogram tracing of patient with Class II malocclusion. B, Maxillary superimposition of treated patient with Class II malocclusion.

would result at the interface (see Fig. 9), and no amount

of relative random bracket/wire motion would result in
the normal forces of the couple approaching zero simultaneously. It is therefore important that translatory motion occur for efficient tooth movement.
CLINICAL EXAMPLES OF EXTRACTION SITE
CLOSURE

The cephalogram tracing shown in Fig. 10 is of a

patient with Class II malocclusion. No additional significant skeletal growth was anticipated. The treatment plan
required removal of the maxillary first premolars with the
anterior segment retracted fully into the extraction site (A

Fig. 13. Pretreatment cephalogram tracing of patient

with Class Ill malocclusion.

anchorage). Posterior anchorage was planned through

extraoral appliance wear during site closure. Mandibular
extractions were not planned. It became obvious early in
treatment that patient compliance, as had been promised,
would not be forthcoming. Consequently, maxillary type A
closure was introduced, using a moment-to-force ratio
approximating 13 posteriorly, with a moment-to-force
ratio of approximately 10 anteriorly. Fig. 11 illustrates the
appliances in place, and Fig. 12, A is a cephalogram
tracing after extraction site closure. Fig. 12, B is a maxil-

American Journal of Orthodontics and Dentofacial Orthopedics

Volume 112,No. 6

Braun, Sjursen, and Legan

653

Fig. 14. Intraoral view of patient with Class III malocclusion during extraction site closure.

lary superimposition of this patient, indicating that type A

closure was achieved.
The cephalogram tracing in Fig. 13 is of a patient with
Class III malocclusion. No additional skeletal growth was
anticipated. Correction of the malocclusion was planned
through dental movement alone. Four first premolars
were removed with type B extraction site closure in the
mandible and type C extraction site closure in the maxilla.
Fig. 14 illustrates the appliances in place during closure of
the extraction sites. Fig. 15, A is a tracing of a cephalogram after closure, and Fig. 15, B is the related maxillary
and mandibular superimpositions. The planned closure
was readily achieved based on the predictability of the
force systems (M/F ratios).

o
B

SECOND PREMOLAR EXTRACTION SITES

When there is a significant anterior arch length deficiency,
requiring that canines and first premolars be initially
translated distally, they are first joined together on a 0.016
0.022 wire as seen in Fig. 16, and translated as one large
tooth, bilaterally. The incisors are bypassed with a vertical
offset. To prevent the wire from striking the incisors as the
canines and first premolars translate distally, the vertical
offsets mesial to the canines may be altered symmetrically
and bilaterally. Note the arch form and contact relationships across the extraction sites are continuously maintained in all planes of space.
The appliance configuration after consolidation with
the incisors is shown in Fig. 17. The T-spring closure loop
is activated in the same fashion as described earlier. Relative
motion occurs between the anterior and posterior teeth at
the premolar bracket slot. Excessive wire protruding mesially
is bent gingivally to avoid striking the canines as the extraction site closes. It is important to ligate the first and second
molars together. Failure to do this would allow the first

Fig. 15. A, Posttreatment cephalogram tracing of patient with Class Ill malocclusion. B, Maxillary and mandibular superpositions of treated patient with Class III
malocclusions.

molars to translate anteriorly, because the T spring is attached to these teeth. If an active lingual arch is used, the T
spring is activated 8 mm. Alternatively, if lingual elastics are
used, the T spring is activated 4 mm. Type A, B, or C closure
is achieved as described earlier.

CONCLUSION
It is important for treatment results to be under the
control of the clinician. This can only be achieved by the
application of predictable, controlled force systems. A
fail-safe and user-friendly system for doing this has been
described that has the added advantage of ensuring the

654

Braun, Sjursen, and Legan

American Journal of Orthodontics and Dent@cial Orthopedics

December 1997

Fig. 16. Preliminary retraction of canine and first premolar (second premolar extraction
case).

Fig. 17. En masse second premolar extraction site closure.

teeth will maintain alignment throughout extraction site

closure. The patient need only be seen each 6 weeks
because of the long ranges of activations. In the event of
patient noncompliance, the system seizes and essentially
stops without deleterious side effects. The clinician may
easily discover noncompliance at the next appointment.
After extraction site closure, minimal finishing procedures
are required because the alignment of dental contacts and
axial inclinations are maintained throughout treatment
and extraction site closure (A, B, or C) has been controlled so that the targeted occlusion is attained at completion of extraction site closure.

REFERENCES

1. Peck S, Peck H. Frequency of tooth extraction in orthodontic treatment. Am J

Orthod 1979;76:491-6.
2. Shields TE, Little RM, Chapko MK. Stability and relapse of mandibular anterior
alignment: a cephalometric appraisal of first premolar extraction cases treated by
traditional edgewise orthodontics. Am J Orthod 1985;87:27-38.
3. deCastro N. Second premolar extraction in clinical practice. Am J Orthod
1974;65:115-37.
4. Burstone CJ. The segmented approach to space closure. Am J Orthod 1982;82:
361-78.
5. Smith RJ, Burstone CJ. Mechanics of tooth movement. Am J Orthod 1985;82:294307.
5. Tanne K, Sakuda M, Burstone CJ. Three dimensional finite element analysis for
stress in the periodontal tissue by orthodontic forces. Am J Orthod Dentofae
Orthop 1987;92:499-505.

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American Journal of Orthodontics and Dentofacial Orthopedics

Volume 112, No. 6
7. Burstone CJ. The biophysics of bone remodeling during orthodontics--optimal
force considerations In: Norton LA, Burstone CJ. The biology of tooth movement.
Boca Raton: CRC Press, 1989.
8. Braun S, Winzler J, Johnson BE. An analysis of orthodontic force systems applied
to the dentition with diminished alveolar support. Eur J Orthod 1993; 15:73-7.
9. Wehrbein H, Fuhrmann RAW, Diedrich PR. Human histologic tissue response
after long-term orthodontic tooth movement. Am J Orthod Dentofac Orthop
1995;107:360-71.
10. Wehrbein H, Furhmann RAW, Diedrich PR. Periodontal conditions after facial
root tipping and palatal root torque of incisors. Am J Orthod Dentofac Orthop
1994;106:455-62.
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