ORIGINAL ARTICLE

Stability of extraction space closure

~o Gribeld
Daniela Gamba Garib,a Larissa Borges Bressane,b Guilherme Janson,c and Bruno Fraza
Bauru, S~ao Paulo, and Belo Horizonte, Minas Gerais, Brazil

Introduction: The objectives of this study were to evaluate the prevalence and long-term behavior of extraction
space reopening in patients with Class I malocclusion and to identify some associated factors. Methods: A sam-
ple of 43 patients met the inclusion criteria. Dental casts at the onset of treatment, after treatment, and 1 and
5 years after debonding were used. Initial and final cephalometric radiographs were used to measure the amount
of incisor retraction. Cochran tests were used to compare the numbers of open and closed extraction spaces
after treatment and at 1 and 5 years after debonding (P \0.05). Initial incisor crowding, amounts of anterior
retraction, and angulations between the canines and the second premolars were compared between patients
with and without space reopening with t tests. Results: Of the sample, 30.23% had extraction space reopening.
The frequency of open spaces significantly increased between the final and the 1-year posttreatment dental
casts and decreased between the casts at 1 and 5 years posttreatment. Patients with space reopening had
less initial anterior crowding and greater amounts of mandibular incisor retraction during treatment.
Conclusions: There was a high prevalence of space reopening 1 year after treatment. However, these spaces
tended to decrease by 5 years after treatment. (Am J Orthod Dentofacial Orthop 2016;149:24-30)

P
osttreatment stability remains a challenge in
orthodontics because long-term preservation of
the teeth in their new positions is unpredictable.
Angle1 stated that relapse would occur if normal occlu-
sion was not achieved during treatment. Studies have
demonstrated that even in patients finished with an
adequate static and functional occlusion, there is a ten-
dency for some relapse.2-5 Instability is individual and
may be associated with other aspects such as severity
and type of malocclusion, mechanics, the patient's
compliance, growth, and the adaptability of the hard
and soft tissues.2,6
An undesirable relapse expression often observed in
clinical practice is the reopening of extraction spaces.
Space reopening in extraction sites can cause peri-
odontal issues related to food impaction and overload
of occlusal forces.7 In addition, it may impair esthetics
a
Associate professor, Department of Orthodontics, Bauru Dental School, Univer-
sity of S~ao Paulo, Bauru, S~ao Paulo, Brazil.
b
Postgraduate student, Department of Orthodontics, Bauru Dental School, Uni-
versity of S~ao Paulo, Bauru, S~ao Paulo, Brazil.
c
Professor, Department of Orthodontics, Bauru Dental School, University of S~ao
Paulo, Bauru, S~ao Paulo, Brazil.
d
Private practice, Belo Horizonte, Minas Gerais, Brazil.
All authors have completed and submitted the ICMJE Form for Disclosure of
Potential Conflicts of Interest, and none were reported.
Address correspondence to: Larissa Borges Bressane, Department of Orthodon-
tics, Bauru Dental School, University of S~ao Paulo, Alameda Octavio Pinheiro
Brisolla 9-75, Bauru, SP, 17012-901, Brazil; e-mail, larissa_bressane@
hotmail.com.
Submitted, August 2014; revised and accepted, June 2015.
0889-5406/$36.00
Copyright Ó 2016 by the American Association of Orthodontists.
http://dx.doi.org/10.1016/j.ajodo.2015.06.019
24
mainly when it occurs in the maxillary arch. Surprisingly,
few studies have been dedicated to this subject, and no
data on its prevalence were found. The search in Medline
for “extraction space reopening” showed only 6 articles
up to October 2013. Even in the most successfully
treated extraction patients, whose teeth were tightly
approximated, teeth adjacent to the old extraction area
can separate.7 The opened spaces at the extraction sites
may vary from a fraction of a millimeter to several milli-
meters.7 On the other hand, residual extraction spaces
can demonstrate spontaneous closure in the long term
after treatment.8-12 Oftedal and Wisth9 evaluated
extraction spaces that were not completely closed and
observed that 35% of maxillary residual spaces and
46% of mandibular residual spaces totally closed in
the postretention period.
Some etiologic factors that were previously related to
extraction space reopening are gingival invagination on
the extraction site and root parallelism.7,13-20 Gingival
invaginations may occur because of the approximating
movement of neighboring teeth and are more frequent
in the mandibular arch than in the maxillary arch.19,21
The explanation is the occurrence of gingival fiber
displacement instead of remodeling, resulting in tissue
accumulation.21 Because of the assumption that this
local factor could predispose a patient to relapse of the
extraction site closure, some authors have suggested
periodontal surgery to remove the excessive gingival
tissues.7,13,16-19 However, there is no evidence
associating gingival invagination and extraction space
reopening so far.21,22
Garib et al
Additionally, root parallelism between the canines
and the second premolars in patients having first premo-
lar extractions has been considered an important factor
for the stability of space closure.14,23-26 Hatasaka14
observed that parallel roots are more stable during the
posttreatment period and also more favorable for tooth
interdigitation. More recently, Chiqueto et al27 found no
differences for neighboring tooth angulation in patients
with and without extraction space reopening.
The prevalence of extraction space reopening after
orthodontic treatment as well as its predisposing factors
must be better elucidated, because extractions are often
required in orthodontic treatment. In this study, we
aimed to verify the frequency of extraction space re-
opening in patients with Class I malocclusions treated
with extractions of the 4 first premolars and to evaluate
the long-term behavior of these spaces. Additionally,
possible associated factors such as initial tooth crowd-
ing, angulation between canine and second premolar
crowns, and the amount of mandibular incisor retraction
were investigated.
MATERIAL AND METHODS
This study was approved by the ethics committee at
the University of S~ao Paulo in Brazil. To detect a 20%
difference in space reopening with a 5 5% and
b 5 80%, the sample should comprise at least 37 sub-
jects. The sample was obtained from the files of the
Department of Orthodontics at the University of S~ao
Paulo. The inclusion criteria were Class I malocclusion
treated with 4 first premolar extractions, complete per-
manent dentition at the pretreatment stage, standard
edgewise appliances used, no dental anomalies of num-
ber (agenesis or supernumerary teeth), no history of peri-
odontal surgery in the extraction area, and availability of
dental casts obtained at the end of treatment and at 1
and 5 years after treatment.
After applying these criteria, 43 patients were selected.
The sample initial age ranged from 11.3 to 16.2 years
(mean, 13.6 years; standard deviation [SD], 1.4 years).
The age at the end of comprehensive orthodontic treat-
ment ranged from 13.1 to 20.7 years (mean, 16.1 years;
SD, 2.0 years). All patients had the same retention proto-
col, including a modified Hawley retainer for the maxillary
arch and a canine-to-canine fixed bonded retainer for the
mandibular arch. The Hawley retainer was recommended
to be used full time for 6 months, followed by nights-
only use for 6 months. The mandibular fixed bonded
retainer was used for a mean period of 3 years.
On the final, 1-year, and 5-year dental casts from
these patients, the numbers of open and closed extrac-
tion sites were calculated at each stage and compared
American Journal of Orthodontics and Dentofacial Orthopedics
25
to evaluate the frequency of extraction space reopening
in patients with Class I malocclusions. Only the quad-
rants that were fully closed at the end of treatment
were considered: 124 quadrants. To evaluate whether
initial tooth crowding, angulations between the canine
and second premolar crowns in each quadrant, and
amounts of mandibular incisor retraction were predis-
posing factors for extraction space reopening, the 43 pa-
tients were divided into 2 groups: group 1, with 13
patients with at least 1 extraction space reopening,
and group 2, with 30 patients without space reopening
in the posttreatment periods of 1 and 5 years.
To measure the dental cast variables, the initial, final,
1-year, and 5-years posttreatment dental casts were
digitized using a 3-dimensional scanner (R700; 3Shape,
Copenhagen, Denmark). The following variables were
measured with the OrthoAnalyzer 3-dimensional soft-
ware (3Shape) (Fig 1).
1. Initial mandibular crowding measured with Little's
irregularity index.28 After identifying points on the
proximal aspects of the anterior teeth, the software
automatically calculated the irregularity index
value.
2. Angulation between the canines and the second
premolars. The angulation of the crown long axis
was measured relative to the occlusal plane. The
occlusal plane was obtained by marking 3 points:
bilaterally on the mesiobuccal cusp tips of the first
molars and one point on the incisors. The long
axis of the clinical crown was constructed according
to the method of Andrews.29 The digital model was
rotated to position the occlusal plane parallel to the
horizontal plane. The angulation measurements
were performed on the perspective of a buccal
segment plane by rotating the model on the vertical
axis from the lateral view so that the operator could
see the entire mesiodistal width of the contralateral
central incisor (Fig 1, C). The angulation between
the canine and the second premolar was calculated.
Negative values meant convergence between the
crowns' long axes, and positive values meant diver-
gence between the crowns' axes.
To measure the amount of mandibular incisor retrac-
tion, the initial and final cephalometric radiographs were
digitized with a scanner (i800; Microtek ScanMaker,
Santa Fe Springs, Calif) and analyzed with imaging soft-
ware (version 11.5; Dolphin Imaging & Managent Solu-
tions, Chatsworth, Calif). The magnification factors were
corrected by the software. To measure the amount
of mandibular incisor retraction during orthodontic
treatment, the distance from the labial aspect of the
mandibular central incisor crown to the line from nasion
January 2016  Vol 149  Issue 1
26 Garib et al

Fig 1. Variables measured on the digital models with the OrthoAnalyzer software: A, space dimen-
sions; B, Little's irregularity index; C, angulation between the canine and second premolar crowns in
relation to the occlusal plane.

through point B of the mandible was measured. The dif-
ference between the initial and final measurements was
calculated.
Thirty patients were randomly selected, and all
variables were remeasured after 30 days. Random and
systematic errors were calculated with Dahlberg's for-
mula30 and dependent t tests, respectively, at a signifi-
cance level of 5%.
a normal distribution. Therefore, t tests were used to
compare groups 1 and 2 regarding the initial and final
ages, initial mandibular crowding, angulations between
the canine and second premolar crowns in each quad-
rant, and the amounts of mandibular incisor retraction.
The significance level considered was 5%. All statistical
analyses were performed with software (Statistica for
Windows version 11.0; StatSoft, Tulsa, Okla).

Statistical analysis RESULTS

The percentage of patients with at least 1 site that
was fully closed at the end of treatment and reopened
in the posttreatment stage was calculated in the whole
sample. Also, the percentages of space reopening in
the maxillary and mandibular arches were calculated.
To compare the numbers of open and closed extrac-
tion spaces between the posttreatment and the 1-year
and 5-years posttreatment dental casts, Cochran tests
were used. To evaluate space reopening after treatment,
only fully closed spaces at the end of treatment were
considered for this analysis.
All quantitative variables were tested for normality
using Shapiro-Wilk tests, which showed that they had
The random errors were within acceptable limits,
varying from 0.03 to 1.51, and there were no statistically
significant systematic errors (Table I).
The results showed that 30.23% of the patients had
at least 1 site that was fully closed at the end of treat-
ment and reopened in the 1-year posttreatment period
(Fig 2). Nine patients had only 1 quadrant with reopen-
ing. Considering the number of quadrants, 13.7% of the
closed sites reopened in the posttreatment period (17 of
124 quadrants). From these, 9.67% (12 of 124) were in
the maxillary arch, and 4.03% (5 of 124) were in the
mandibular arch. Therefore, extraction space reopening
was more frequent in the maxillary arch (Fig 3).

January 2016  Vol 149  Issue 1 American Journal of Orthodontics and Dentofacial Orthopedics
Garib et al 27

Table I. Random and systematic errors between the

first and second measurements
Measurement Measurement
1 (n 5 30) 2 (n 5 30)

Variable Mean SD Mean SD Dahlberg P

Mandibular crowding 9.96 4.08 10.16 4.03 0.55 0.16
Right maxilla 0.19 0.41 0.20 0.43 0.04 0.49
Left maxilla 0.15 0.31 0.16 0.33 0.04 0.62
Right mandible 0.17 0.31 0.17 0.31 0.03 0.38
Left mandible 0.19 0.33 0.23 0.37 0.12 0.20
Right maxillary angle 1.42 5.86 1.43 5.52 1.36 0.98
Left maxillary angle 2.77 4.56 2.05 5.11 1.51 0.06
Fig 3. Prevalence of extraction spaces reopening in the
Right mandibular 0.68 4.08 0.63 4.12 1.12 0.88
angle maxilla and mandible.
Left mandibular 2.82 4.46 2.31 4.45 1.03 0.06
angle
Amount of 1.75 1.62 1.76 1.58 0.13 0.77 Table II. Comparison of the amount of closed and re-
mandibular opened spaces at the end of treatment and 1 year and
incisor retraction
5 years posttreatment (Cochran tests)
Final 1 year 5 years

Site Open Closed Open Closed Open Closed P

Right maxilla 0 34 5 29 2 32 0.02*
Left maxilla 0 30 7 23 4 26 0.00*
Right mandible 0 3 1 30 1 30 0.36
Left mandible 0 29 4 25 0 29 0.01*
Total 0 124 17 107 7 117 0.00*

*Statistically significant at P \0.05.

(Table II). These data have considerable value for clinical

Fig 2. Prevalence of extraction spaces reopening in the
total sample.
The frequency of open spaces significantly increased
between the final and the 1-year posttreatment dental
casts (except for the mandibular right site). However,
the frequency of open spaces significantly decreased be-
tween the casts at 1 year and 5 years for the mandibular
left site and for all sites (Table II).
Patients with extraction spaces that reopened had
significantly less initial anterior crowding and greater
amounts of mandibular incisor retraction during treat-
ment (Table III).
DISCUSSION
From the 43 subjects who were selected for this
study, 13 had reopening of at least 1 extraction site, re-
sulting in a prevalence of 30.23% (Fig 2). This frequency
was also confirmed by the longitudinal evaluation of
closed and reopened spaces, where the frequency of
space reopening increased within 1 year after treatment
practice and are a red flag for orthodontists to apply
preventive procedures. Although many studies have re-
ported extraction space reopening, none has determined
the actual prevalence of this problem.7,9-11,14,20-23,31 It is
relevant to emphasize that space reopening occurred in
the first year after treatment. This finding agrees with
previous studies showing that most orthodontic
relapse occurs within 2 years after appliance
removal.5,32,33 Although no differences in the overall
quality of orthodontic treatments between patients
treated in university programs and private practices
has been found, a specific investigation of space
reopening in private practices would help to clarify this
issue.34
Curiously, no patient had space reopening in both
arches. Among all the investigated quadrants, 9.67%
of the quadrants with space reopening were in the
maxillary arch, and 4.03% were in the mandibular
arch. The greater prevalence of space reopening in the
maxillary arch may be due to morphologic and func-
tional conditions. The mandibular arch is naturally con-
tained by the maxillary arch in a normal occlusion, which
limits the mandibular teeth to move labially and

American Journal of Orthodontics and Dentofacial Orthopedics January 2016  Vol 149  Issue 1
28 Garib et al

Table III. Comparison between patients with and without space reopening at initial and final ages, amounts of initial
mandibular crowding, angulations between the canine and second premolar crowns, and amounts of mandibular
incisor retraction (t tests)
Group 1 (with space reopening), n 5 13 Group 2 (without space reopening), n 5 30

Variable Mean SD Mean SD P

Initial age (y) 14.16 1.41 13.36 1.32 0.09
Final age (y) 16.87 1.93 15.68 2.05 0.08
Mandibular crowding (mm) 8.29 3.60 11.63 3.95 0.01*
Right maxillary angle ( ) 3.00 4.12 2.47 5.42 0.75
Left maxillary angle ( ) 2.91 2.69 1.84 4.86 0.46
Right mandibular angle ( ) 0.87 4.79 0.68 3.62 0.88
Left mandibular angle ( ) 3.30 4.09 3.26 4.90 0.98
Amount of mandibular incisor retraction (mm) 2.60 1.15 1.53 1.54 0.04*

*Statistically significant at P \0.05.

buccally. On the other hand, the maxillary arch has no
restriction to come forward except for upper lip resis-
tance. In addition, mandibular protrusion with incisal
guidance generates labial and lingual force vectors on
the maxillary and mandibular anterior teeth, respec-
tively. The labial component of force may contribute
to extraction space reopening in the maxillary arch.
Finally, if effective occlusal contact is left between the
maxillary and mandibular incisors in maximum intercus-
pation, opening of diastemas in the maxillary arch may
occur after treatment.35
The prevalence of reopened spaces tended to
decrease between 1 year and 5 years after treatment.
This means that approximately 41.17% of the reopened
spaces closed spontaneously after the fifth posttreat-
ment year (Table II). These results corroborate previous
studies that describe a tendency for teeth to move mesi-
ally as the patient's age increases.5,36,37 Also, there is
spontaneous improvement of the occlusion over
time.38 Persson et al39 suggested that the posttreatment
improvement of the occlusion is even greater in those
with a Class I malocclusion because growth of the apical
bases is favorable.
Patients with space reopening had less mandibular
tooth crowding and greater mandibular incisor retrac-
tion during treatment than did patients without space
reopening (Table III). This is consistent with the principle
that original arch dimensions, including length, should
be preserved to accomplish posttreatment stabil-
ity.33,40,41 Many authors have prescribed uprighting of
the mandibular incisors on the apical base as the major
requirement for stability.42-46 Gorman43 stated that
several studies that have shown low stability indexes
did not appropriately upright the mandibular incisors,
as recommended by Tweed.46 He included mandibular
incisor uprighting as one of the “12 keys for stability.”
However, this procedure is commonly related to post-
treatment stability. When teeth are moved beyond the
position determined by muscle forces in the stomatog-
nathic system, they tend to return to their original posi-
tions.33,40,41 The greater the incisor crowding, the lower
the frequency of space reopening. This negative
association can be explained because less incisor
retraction will be necessary to close the residual spaces
in patients with accentuated crowding.10
Although previous studies have reported the impor-
tance of root parallelism for stability, in our study, pa-
tients with and without space reopening were similar
regarding the final crown angulations of the canines
and the second premolars.14,20,25 These results agree
with those of Chiqueto et al,27 who found no differences
in the final angulations between the canines and the sec-
ond premolars in patients with and without extraction
space reopening. Since both groups in this study had
crown angulations between the canines and the premo-
lars from 8 to 4 , these results are probably due to the
satisfactory root parallelism of the complete sample
(Table III).
Because of the high prevalence of patients with
extraction space reopening (30.23%) and its association
with anterior crowding and the amount of mandibular
incisor retraction, preventive measures should be applied
to ensure posttreatment stability. A premolar-to-premo-
lar fixed bonded retainer should be used in the mandib-
ular arch. In the maxillary arch, a fixed retainer should be
used associated with the removable retainer. At 1 year
posttreatment, a canine-to-canine retainer could
replace the premolar-to-premolar fixed retainer, and
the fixed retainer in the maxillary arch could be removed.
In patients with greater amounts of retraction, fixed re-
tainers are even more important to prevent extraction
space reopening.

January 2016  Vol 149  Issue 1 American Journal of Orthodontics and Dentofacial Orthopedics
Garib et al
CONCLUSIONS
1. One third of the patients treated with 4 premolar ex-
tractions had extraction spaces that reopened.
2. We found that 13.7% of the extraction sites reop-
ened. Extraction space reopening was more
frequent in the maxillary arch (9.67%) than in the
mandibular arch (4.03%).
3. The prevalence of reopened spaces tended to
decrease by 5 years after treatment.
4. Patients with space reopening had less initial
mandibular crowding and greater amounts of
mandibular incisor retraction during treatment.
REFERENCES
1. Angle EH. Treatment of malocclusion of the teeth. Angle's system.
Philadelphia: S. S. White Dental Manufacturing; 1907. p. 14-7.
479-89, 502-5.
2. Al Yami EA, Kuijpers-Jagtman AM, van't Hof MA. Stability of or-
thodontic treatment outcome: follow-up until 10 years postreten-
tion. Am J Orthod Dentofacial Orthop 1999;115:300-4.
3. Erdinc AE, Nanda RS, Isiksal E. Relapse of anterior crowding in pa-
tients treated with extraction and nonextraction of premolars. Am
J Orthod Dentofacial Orthop 2006;129:775-84.
4. Little RM, Riedel RA, Engst ED. Serial extraction of first premolars—
postretention evaluation of stability and relapse. Angle Orthod
1990;60:255-62.
5. Vaden JL, Harris EF, Gardner RL. Relapse revisited. Am J Orthod
Dentofacial Orthop 1997;111:543-53.
6. Nanda RS, Nanda SK. Considerations of dentofacial growth in
long-term retention and stability: is active retention needed? Am
J Orthod Dentofacial Orthop 1992;101:297-302.
7. Edwards JG. The prevention of relapse in extraction cases. Am J
Orthod 1971;60:128-44.
8. Crossman IG, Reed RT. Long term results of premolar extractions in
orthodontic treatment. Br J Orthod 1978;5:61-6.
9. Oftedal B, Wisth J. Residual extraction sites after orthodontic
treatment. Part I. At debanding. Eur J Orthod 1982;4:11-9.
10. Oftedal B, Wisth PJ. Residual extraction sites after orthodontic
treatment. Part III. Changes in the post-retention period. Eur J Or-
thod 1982;4:203-10.
11. Valarelli DP. Reabertura dos espaços de extraç~oes nos diferentes
protocolos de tratamento ortod^ ontico [dissertation]. Bauru, S~ao
Paulo, Brazil: University of S~ao Paulo; 2010.
12. Wisth PJ, Oftedal B. Residual extraction sites after orthodontic
treatment. Part II. At the end of retention. Eur J Orthod 1982;4:
99-104.
13. Erikson BE, Kaplan H, Aisenberg MS. Orthodontics and transeptal
fibers. Am J Orthod 1945;31:1-20.
14. Hatasaka HH. A radiographic study of roots in extraction sites.
Angle Orthod 1976;46:64-8.
15. McCollum AG, Preston CB. Maxillary canine retraction, peri-
odontal surgery, and relapse. Am J Orthod 1980;78:610-22.
16. Parker GR. Transseptal fibers and relapse following bodily retration
of teeth: a histologic study. Am J Orthod 1972;61:331-44.
17. Redlich M, Shoshan S, Palmon A. Gingival response to orthodontic
force. Am J Orthod Dentofacial Orthop 1999;116:152-8.
18. Reitan K. Principles of retention and avoidance of posttreatment
relapse. Am J Orthod 1969;55:776-90.
American Journal of Orthodontics and Dentofacial Orthopedics
29
19. Robertson PB, Schultz LD, Levy BM. Occurrence and distribution
of interdental gingival clefts following orthodontic movement
into bicuspid extraction sites. J Periodontol 1977;48:232-5.
20. Vecere JW. Extraction space closure stability following canine
retraction and periodontal surgery [thesis]. Philadelphia: Temple
University; 1982.
21. Rivera Circuns AL, Tulloch JF. Gingival invagination in extraction
sites of orthodontic patients: their incidence, effects on periodontal
health, and orthodontic treatment. Am J Orthod 1983;83:469-76.
22. Ribeiro GU. A invaginaç~ao gengival e o fechamento ortod^ ontico de
espaços de extraç~oes: conduta clınica. R Dental Press Ortodon Or-
top Facial 2004;9:77-82.
23. Braun S, Sjursen RC Jr, Legan HL. On the management of extrac-
tion sites. Am J Orthod Dentofacial Orthop 1997;112:645-55.
24. Buchner HJ. Closing spaces in orthodontic cases. Angle Orthod
1953;23:158-65.
25. Mayoral G. Treatment results with light wires studied by pano-
ramic radiography. Am J Orthod 1982;81:489-97.
26. Strang RH. Axial inclination of teeth in extraction cases. Angle Or-
thod 1957;27:11-3.
27. Chiqueto K, Janson G, de Almeida CT, Storniolo JM, Barros SE,
Henriques JF. Influence of root parallelism on the stability of
extraction-site closures. Am J Orthod Dentofacial Orthop 2011;
139:e505-10.
28. Little RM. The irregularity index: a quantitative score of mandib-
ular anterior alignment. Am J Orthod 1975;68:554-63.
29. Andrews LF. Straight wire: the concept and appliance. San Diego,
Calif: L. A. Wells; 1989:159.
30. Dahlberg G. Statistical methods for medical and biological stu-
dents. New York: Interscience Publications; 1940.
31. Atherton JD. The gingival response to orthodontic tooth move-
ment. Am J Orthod 1970;58:179-86.
32. Harris EF, Vaden JL. Posttreatment stability in adult and adoles-
cent orthodontic patients: a cast analysis. Int J Adult Orthod Or-
thognath Surg 1994;9:19-29.
33. Zachrisson BU. Important aspects of long-term stability. J Clin Or-
thod 1997;31:562-83.
34. Cook DR, Harris EF, Vaden JL. Comparison of university and
private-practice orthodontic treatment outcomes with the Amer-
ican Board of Orthodontics objective grading system. Am J Orthod
Dentofacial Orthop 2005;127:707-12.
35. Janson WA, Pandolfo RF, Vale AL. Introduç~ao a oclus~ao: ajuste
oclusal. 1st ed. S~ao Paulo, Brazil: University of S~ao Paulo; 1982.
36. Bishara SE, Jakobsen JR. Profile changes in patients treated with
and without extractions: assessments by lay people. Am J Orthod
Dentofacial Orthop 1997;112:639-44.
37. Shapiro PA. Mandibular dental arch form and dimension. Treat-
ment and postretention changes. Am J Orthod 1974;66:58-70.
38. Sadowsky C, Sakols EI. Long-term assessment of orthodontic
relapse. Am J Orthod 1982;82:456-63.
39. Persson M, Persson EC, Skagius S. Long-term spontaneous
changes following removal of all first premolars in Class I cases
with crowding. Eur J Orthod 1989;11:271-82.
40. Riedel RA. A review of the retention problem. Angle Orthod 1960;
30:179-99.
41. Felton JM, Sinclair PM, Jones DL, Alexander RG. A computerized
analysis of the shape and stability of mandibular arch form. Am
J Orthod Dentofacial Orthop 1987;92:478-83.
42. Boley JC, Mark JA, Sachdeva RC, Buschang PH. Long-term stability
of Class I premolar extraction treatment. Am J Orthod Dentofacial
Orthop 2003;124:277-87.
43. Gorman JC. The effects of premolar extractions on the long-
term stability of the mandibular incisors. Retention and
January 2016  Vol 149  Issue 1
30 Garib et al

stability in orthodontics. Philadelphia: W. B. Saunders; 1993.
p. 81-95.
44. Grieve GW. Anatomical and clinical problems involved where
extraction is indicated in orthodontic treatment. Am J Orthod
Oral Surg 1944;42:54-60.
45. Tweed CH. Indications for the extraction of teeth in orthodontic
procedure. Am J Orthod Oral Surg 1944;42:22-45.
46. Tweed CH. Frankfort mandibular incisor angle (FMIA) in ortho-
dontic diagnosis, treatment planning and prognosis. Angle Orthod
1954;24:121-69.

January 2016  Vol 149  Issue 1 American Journal of Orthodontics and Dentofacial Orthopedics