Serial extraction: 20 years of follow-up
An eight-year-and-two-month-old Caucasian female patient had a chief complaint of an\nupper inter-incisor diastema. In the facial analysis, the patient showed a harmonious\nface and a normal labial posture. In the intraoral clinical examination, the presence of\na large diastema was observed, together with several early extractions of primary teeth,\nwith great space loss, and, consequently, a reduction of upper and lower arch length\n().\nIn the panoramic radiograph, presence of multiple extractions of primary teeth was\nverified, with consequent lack of space due to retroclination of the permanent teeth,\nas was the presence of all permanent teeth, which had either erupted or were at\nseveral developmental stages, except for the third molars ().\nThe treatment protocol was composed of two stages: one interceptive and one\ncomprehensive. In the interceptive phase, a serial extraction program was performed,\nwhich aimed especially at correcting the discrepancies of the dental arch, fostering\nfavorable conditions for a normal development of the occlusion. Due to the great lack\nof space, initial planning comprised anchorage preparation: a) an extraoral appliance\nin the upper arch (cervical headgear) to obtain upper molar distalization; b) an\nactive lip bumper, on the lower arch; c) bracket installation on the upper incisors\nto close the diastema, and to provide space for lateral incisor eruption. Still in\nthis stage, primary first molar extractions were indicated to accelerate eruption of\nfirst premolars, which were to be extracted sequentially to create space for the\npermanent canine teeth ().\nAfter the eruption of all permanent teeth, at the end of interceptive phase, new\nradiographs were obtained to plan the comprehensive phase (). In this phase, a fixed appliance was installed aiming\nto align, level, and correct the axial inclinations, and small diastemas (). shows the treatment finalization, when the patient was oriented regarding\nthe use of retainers: an upper Hawley appliance, and a lower 3x3 retainer.\nTwenty years after the end of the interceptive treatment, a new follow-up appointment\nwas scheduled. It could be noted that the facial proportion balance was preserved,\nwith only a small relapse at the upper arch, and lower anterior crowding ().