{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T15:07:41Z","timestamp":1780067261535,"version":"3.54.0"},"reference-count":56,"publisher":"The Angle Orthodontist (EH Angle Education & Research Foundation)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2015,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective:\u2002<\/jats:title>\n                    <jats:p>To evaluate the long-term effects of asymmetrical maxillary first molar (M1) extraction in Class II subdivision treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:\u2002<\/jats:title>\n                    <jats:p>Records of 20 Class II subdivision whites (7 boys, 13 girls; mean age, 13.0 years; SD, 1.7 years) consecutively treated with the Begg technique and M1 extraction, and 15 untreated asymmetrical Class II adolescents (4 boys, 11 girls; mean age, 12.2 years; SD, 1.3 years) were examined in this study. Cephalometric analysis and PAR assessment were carried out before treatment (T1), after treatment (T2), and on average 2.5 years posttreatment (T3) for the treatment group, and at similar time points and average follow-up of 1.8 years for the controls.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:\u2002<\/jats:title>\n                    <jats:p>The adjusted analysis indicated that the maxillary incisors were 2.3 mm more retracted in relation to A-Pog between T1 and T3 (\u03b2 \u200a=\u200a 2.31; 95% CI; 0.76, 3.87), whereas the mandibular incisors were 1.3 mm more protracted (\u03b2 \u200a=\u200a 1.34; 95% CI; 0.09, 2.59), and 5.9\u00b0 more proclined to the mandibular plane (\u03b2 \u200a=\u200a 5.92; 95% CI; 1.43, 10.41) compared with controls. The lower lip appeared 1.4 mm more protrusive relative to the subnasale-soft tissue-Pog line throughout the observation period in the treated adolescents (\u03b2 \u200a=\u200a 1.43; 95% CI; 0.18, 2.67). There was a significant PAR score reduction over the entire follow-up period in the molar extraction group (\u03b2 \u200a=\u200a \u22126.73; 95% CI; \u221210.7, \u22122.7). At T2, 65% of the subjects had maxillary midlines perfectly aligned with the face.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:\u2002<\/jats:title>\n                    <jats:p>Unilateral M1 extraction in asymmetrical Class II cases may lead to favorable occlusal outcomes in the long term without harming the midline esthetics and soft tissue profile.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2319\/071614-499.1","type":"journal-article","created":{"date-parts":[[2014,11,11]],"date-time":"2014-11-11T16:29:30Z","timestamp":1415723370000},"page":"757-763","source":"Crossref","is-referenced-by-count":2,"title":["Long-term evaluation of Class II subdivision treatment with unilateral maxillary first molar extraction"],"prefix":"10.2319","volume":"85","author":[{"given":"Christos","family":"Livas","sequence":"first","affiliation":[{"name":"Staff Member, Department of Orthodontics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaos","family":"Pandis","sequence":"additional","affiliation":[{"name":"Visiting Assistant Professor, Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, University of Bern, Bern, Switzerland; and Private Practice, Corfu, Greece."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johan Willem","family":"Booij","sequence":"additional","affiliation":[{"name":"Orthodontist, Private Practice, Gorinchem, The Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christos","family":"Katsaros","sequence":"additional","affiliation":[{"name":"Professor and Chair, Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, University of Bern, Bern, Switzerland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yijin","family":"Ren","sequence":"additional","affiliation":[{"name":"Professor and Chair, Department of Orthodontics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1164","reference":[{"key":"b1","series-title":"Am J Orthod","first-page":"346","article-title":"The mechanics of centric and eccentric cervical traction","volume":"44","author":"Haack\n              DC,","year":"1958","unstructured":"Haack\n              DC, \n            \n              Weinstein\n              S. \n          \n          The mechanics of centric and eccentric cervical traction. Am J Orthod. 1958;44:346\u2013357."},{"key":"b2","series-title":"Eur J Orthod","first-page":"93","article-title":"Class II subdivision treatment with tip-back moments","volume":"19","author":"Shroff\n              B,","year":"1997","unstructured":"Shroff\n              B, \n            \n              Lindauer\n              SJ, \n            \n              Burstone\n              CJ. \n          \n          Class II subdivision treatment with tip-back moments. Eur J Orthod. 1997;19:93\u2013101."},{"key":"b3","series-title":"Am J Orthod Dentofacial Orthop","first-page":"257","article-title":"Class II subdivision treatment success rate with symmetric and asymmetrical extraction protocols","volume":"124","author":"Janson\n              G,","year":"2003","unstructured":"Janson\n              G, \n            \n              Dainesi\n              EA, \n            \n              Henriques\n              JF, \n            \n              de Freitas\n              MR, \n            \n              de Lima\n              KJ. \n          \n          Class II subdivision treatment success rate with symmetric and asymmetrical extraction protocols. Am J Orthod Dentofacial Orthop. 2003;124:257\u2013264."},{"key":"b4","series-title":"Eur J Orthod","first-page":"1","article-title":"Smile attractiveness in patients with Class II division 1 subdivision malocclusions treated with different tooth extraction protocols","volume":"36","author":"Janson\n              G,","year":"2014","unstructured":"Janson\n              G, \n            \n              Branco\n              NC, \n            \n              Morais\n              JF, \n            \n              Freitas\n              MR. \n          \n          Smile attractiveness in patients with Class II division 1 subdivision malocclusions treated with different tooth extraction protocols. Eur J Orthod. 2014;36:1\u20138."},{"key":"b5","series-title":"J Clin Orthod","first-page":"93","article-title":"Subdivision malocclusions: cracking the riddle","volume":"35","author":"Warren\n              DW.","year":"2001","unstructured":"Warren\n              DW. \n          \n          Subdivision malocclusions: cracking the riddle. J Clin Orthod. 2001;35:93\u201399."},{"key":"b6","series-title":"J Clin Orthod","first-page":"293","article-title":"Mini-implant anchorage in a unilateral Class II patient","volume":"46","author":"Livas\n              C.","year":"2012","unstructured":"Livas\n              C. \n          \n          Mini-implant anchorage in a unilateral Class II patient. J Clin Orthod. 2012;46:293\u2013298."},{"key":"b7","series-title":"Angle Orthod","first-page":"327","article-title":"Class II subdivision treatment with the Herbst appliance","volume":"83","author":"Bock\n              NC,","year":"2013","unstructured":"Bock\n              NC, \n            \n              Reiser\n              B, \n            \n              Ruf\n              S. \n          \n          Class II subdivision treatment with the Herbst appliance. Angle Orthod. 2013;83:327\u2013333."},{"key":"b8","series-title":"Am J Orthod Dentofacial Orthop","first-page":"443","article-title":"Classification and treatment of Class II subdivision malocclusions","volume":"145","author":"Cassidy\n              SE,","year":"2014","unstructured":"Cassidy\n              SE, \n            \n              Jackson\n              SR, \n            \n              Turpin\n              DL, \n            \n              Ramsay\n              DS, \n            \n              Spiekerman\n              C, \n            \n              Huang\n              GJ. \n          \n          Classification and treatment of Class II subdivision malocclusions. Am J Orthod Dentofacial Orthop. 2014;145:443\u2013445."},{"key":"b9","series-title":"Inf Orthod Kieferorthop","first-page":"63","article-title":"Correction of an Angle Class II\/Subdivision with unilateral maxillary molar extraction","volume":"42","author":"Mock\n              L,","year":"2010","unstructured":"Mock\n              L, \n            \n              Booij\n              JW. \n          \n          Correction of an Angle Class II\/Subdivision with unilateral maxillary molar extraction. Inf Orthod Kieferorthop. 2010;42:63\u201367."},{"key":"b10","series-title":"Br J Orthod","first-page":"61","article-title":"Multiple linear regression as an analytical tool in cephalometric studies","volume":"24","author":"Dibbets\n              JM,","year":"1997","unstructured":"Dibbets\n              JM, \n            \n              Trotman\n              CA, \n            \n              McNamara\n              JA\n              Jr, \n            \n              van der Weele\n              LT, \n            \n              Janosky\n              JE. \n          \n          Multiple linear regression as an analytical tool in cephalometric studies. Br J Orthod. 1997;24:61\u201366."},{"key":"b11","series-title":"Am J Orthod Dentofacial Orthop","first-page":"196","article-title":"Effect of magnification on lateral cephalometric studies","volume":"122","author":"Dibbets\n              JM,","year":"2002","unstructured":"Dibbets\n              JM, \n            \n              Nolte\n              K. \n          \n          Effect of magnification on lateral cephalometric studies. Am J Orthod Dentofacial Orthop. 2002;122:196\u2013201."},{"key":"b12","series-title":"J Orofac Orthop","first-page":"265","article-title":"Comparison of linear measurements in cephalometric studies","volume":"64","author":"Nolte\n              K,","year":"2003","unstructured":"Nolte\n              K, \n            \n              M\u00fcller\n              B, \n            \n              Dibbets\n              J. \n          \n          Comparison of linear measurements in cephalometric studies. J Orofac Orthop. 2003;64:265\u2013274."},{"key":"b13","series-title":"Am J Orthod Dentofacial Orthop","first-page":"28","article-title":"Cephalometric evaluation of symmetric and asymmetrical extraction treatment for patients with Class II subdivision malocclusions","volume":"132","author":"Janson\n              G,","year":"2007","unstructured":"Janson\n              G, \n            \n              Carvalho\n              PE, \n            \n              Can\u00e7ado\n              RH, \n            \n              de Freitas\n              MR, \n            \n              Henriques\n              JF. \n          \n          Cephalometric evaluation of symmetric and asymmetrical extraction treatment for patients with Class II subdivision malocclusions. Am J Orthod Dentofacial Orthop. 2007;132:28\u201335."},{"key":"b14","series-title":"Am J Orthod Dentofacial Orthop","first-page":"316","article-title":"Extraction of maxillary first permanent molars in patients with Class II Division 1 malocclusion","volume":"132","author":"Stalpers\n              MJ,","year":"2007","unstructured":"Stalpers\n              MJ, \n            \n              Booij\n              JW, \n            \n              Bronkhorst\n              EM, \n            \n              Kuijpers-Jagtman\n              AM, \n            \n              Katsaros\n              C. \n          \n          Extraction of maxillary first permanent molars in patients with Class II Division 1 malocclusion. Am J Orthod Dentofacial Orthop. 2007;132:316\u2013323."},{"key":"b15","series-title":"J Orofac Orthop","first-page":"128","article-title":"The effect of premolar extractions on incisor position and soft tissue profile in patients with Class II, Division 1 malocclusion","volume":"70","author":"Weyrich\n              C,","year":"2009","unstructured":"Weyrich\n              C, \n            \n              Lisson\n              JA. \n          \n          The effect of premolar extractions on incisor position and soft tissue profile in patients with Class II, Division 1 malocclusion. J Orofac Orthop. 2009;70:128\u2013138."},{"key":"b16","series-title":"Angle Orthod","first-page":"59","article-title":"Soft tissue changes after upper premolar extraction in Class II camouflage therapy","volume":"76","author":"Scott Conley\n              R,","year":"2006","unstructured":"Scott Conley\n              R, \n            \n              Jernigan\n              C. \n          \n          Soft tissue changes after upper premolar extraction in Class II camouflage therapy. Angle Orthod. 2006;76:59\u201365."},{"key":"b17","series-title":"J Orofac Orthop","first-page":"56","article-title":"Profile changes following extraction vs. nonextraction orthodontic treatment in a pair of identical twins","volume":"57","author":"Katsaros\n              C.","year":"1996","unstructured":"Katsaros\n              C. \n          \n          Profile changes following extraction vs. nonextraction orthodontic treatment in a pair of identical twins. J Orofac Orthop. 1996;57:56\u201359."},{"key":"b18","series-title":"J Orofac Orthop","first-page":"354","article-title":"The influence of extraction versus non-extraction orthodontic treatment on the soft tissue profile","volume":"57","author":"Katsaros\n              C,","year":"1996","unstructured":"Katsaros\n              C, \n            \n              Ripplinger\n              B, \n            \n              H\u00f6gel\n              A, \n            \n              Berg\n              R. \n          \n          The influence of extraction versus non-extraction orthodontic treatment on the soft tissue profile. J Orofac Orthop. 1996;57:354\u2013365."},{"key":"b19","series-title":"J Orofac Orthop","first-page":"196","article-title":"Overjet correction and space closure mechanisms for Class II treatment by extracting the maxillary first molars","volume":"72","author":"Booij\n              JW,","year":"2011","unstructured":"Booij\n              JW, \n            \n              Goeke\n              J, \n            \n              Bronkhorst\n              EM, \n            \n              Pancherz\n              H, \n            \n              Ruf\n              S, \n            \n              Katsaros\n              C. \n          \n          Overjet correction and space closure mechanisms for Class II treatment by extracting the maxillary first molars. J Orofac Orthop. 2011;72:196\u2013203."},{"key":"b20","series-title":"Eur J Orthod","first-page":"524","article-title":"Effects of camouflage treatment on dentofacial structures in Class II division 1 mandibular retrognathic patients","volume":"27","author":"Demir\n              A,","year":"2005","unstructured":"Demir\n              A, \n            \n              Uysal\n              T, \n            \n              Sari\n              Z, \n            \n              Basciftci\n              FA. \n          \n          Effects of camouflage treatment on dentofacial structures in Class II division 1 mandibular retrognathic patients. Eur J Orthod. 2005;27:524\u2013531."},{"key":"b21","series-title":"Am J Orthod Dentofacial Orthop","first-page":"698","article-title":"Soft tissue profile changes from 5 to 45 years of age","volume":"114","author":"Bishara\n              SE,","year":"1998","unstructured":"Bishara\n              SE, \n            \n              Jakobsen\n              JR, \n            \n              Hession\n              TJ, \n            \n              Treder\n              JE. \n          \n          Soft tissue profile changes from 5 to 45 years of age. Am J Orthod Dentofacial Orthop. 1998;114:698\u2013706."},{"key":"b22","series-title":"Eur J Orthod","first-page":"180","article-title":"The PAR Index (Peer Assessment Rating): methods to determine outcome of orthodontic treatment in terms of improvement and standards","volume":"14","author":"Richmond\n              S,","year":"1992","unstructured":"Richmond\n              S, \n            \n              Shaw\n              WC, \n            \n              Roberts\n              CT, \n            \n              Andrews\n              M. \n          \n          The PAR Index (Peer Assessment Rating): methods to determine outcome of orthodontic treatment in terms of improvement and standards. Eur J Orthod. 1992;14:180\u2013187."},{"key":"b23","series-title":"Am J Orthod Dentofacial Orthop","first-page":"443","article-title":"Classification and treatment of Class II subdivision malocclusions","volume":"145","author":"Cassidy\n              SE,","year":"2014","unstructured":"Cassidy\n              SE, \n            \n              Jackson\n              SR, \n            \n              Turpin\n              DL, \n            \n              Ramsay\n              DS, \n            \n              Spiekerman\n              C, \n            \n              Huang\n              GJ. \n          \n          Classification and treatment of Class II subdivision malocclusions. Am J Orthod Dentofacial Orthop. 2014;145:443\u2013451."},{"key":"b24","series-title":"J Am Dent Assoc","first-page":"1318","article-title":"Esthetics and smile characteristics from the layperson's perspective: a computer-based survey study","volume":"139","author":"Ker\n              AJ,","year":"2008","unstructured":"Ker\n              AJ, \n            \n              Chan\n              R, \n            \n              Fields\n              HW, \n            \n              Beck\n              M, \n            \n              Rosenstiel\n              S. \n          \n          Esthetics and smile characteristics from the layperson's perspective: a computer-based survey study. J Am Dent Assoc. 2008;139:1318\u20131327."},{"key":"b25","series-title":"Am J Orthod Dentofacial Orthop","first-page":"e171","article-title":"Smile esthetics from patients' perspectives for faces of varying attractiveness","volume":"140","author":"Chang\n              CA,","year":"2011","unstructured":"Chang\n              CA, \n            \n              Fields\n              HW\n              Jr, \n            \n              Beck\n              FM, \n            et al\n          . Smile esthetics from patients' perspectives for faces of varying attractiveness. 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Am J Orthod. 1958;44:346\u2013357."},{"key":"b2","series-title":"Eur J Orthod","first-page":"93","article-title":"Class II subdivision treatment with tip-back moments","volume":"19","author":"Shroff\n              B,","year":"1997","unstructured":"Shroff\n              B, \n            \n              Lindauer\n              SJ, \n            \n              Burstone\n              CJ. \n          \n          Class II subdivision treatment with tip-back moments. 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Am J Orthod Dentofacial Orthop. 2003;124:257\u2013264."},{"key":"b4","series-title":"Eur J Orthod","first-page":"1","article-title":"Smile attractiveness in patients with Class II division 1 subdivision malocclusions treated with different tooth extraction protocols","volume":"36","author":"Janson\n              G,","year":"2014","unstructured":"Janson\n              G, \n            \n              Branco\n              NC, \n            \n              Morais\n              JF, \n            \n              Freitas\n              MR. \n          \n          Smile attractiveness in patients with Class II division 1 subdivision malocclusions treated with different tooth extraction protocols. Eur J Orthod. 2014;36:1\u20138."},{"key":"b5","series-title":"J Clin Orthod","first-page":"93","article-title":"Subdivision malocclusions: cracking the riddle","volume":"35","author":"Warren\n              DW.","year":"2001","unstructured":"Warren\n              DW. \n          \n          Subdivision malocclusions: cracking the riddle. J Clin Orthod. 2001;35:93\u201399."},{"key":"b6","series-title":"J Clin Orthod","first-page":"293","article-title":"Mini-implant anchorage in a unilateral Class II patient","volume":"46","author":"Livas\n              C.","year":"2012","unstructured":"Livas\n              C. \n          \n          Mini-implant anchorage in a unilateral Class II patient. J Clin Orthod. 2012;46:293\u2013298."},{"key":"b7","series-title":"Angle Orthod","first-page":"327","article-title":"Class II subdivision treatment with the Herbst appliance","volume":"83","author":"Bock\n              NC,","year":"2013","unstructured":"Bock\n              NC, \n            \n              Reiser\n              B, \n            \n              Ruf\n              S. \n          \n          Class II subdivision treatment with the Herbst appliance. Angle Orthod. 2013;83:327\u2013333."},{"key":"b8","series-title":"Am J Orthod Dentofacial Orthop","first-page":"443","article-title":"Classification and treatment of Class II subdivision malocclusions","volume":"145","author":"Cassidy\n              SE,","year":"2014","unstructured":"Cassidy\n              SE, \n            \n              Jackson\n              SR, \n            \n              Turpin\n              DL, \n            \n              Ramsay\n              DS, \n            \n              Spiekerman\n              C, \n            \n              Huang\n              GJ. \n          \n          Classification and treatment of Class II subdivision malocclusions. Am J Orthod Dentofacial Orthop. 2014;145:443\u2013445."},{"key":"b9","series-title":"Inf Orthod Kieferorthop","first-page":"63","article-title":"Correction of an Angle Class II\/Subdivision with unilateral maxillary molar extraction","volume":"42","author":"Mock\n              L,","year":"2010","unstructured":"Mock\n              L, \n            \n              Booij\n              JW. \n          \n          Correction of an Angle Class II\/Subdivision with unilateral maxillary molar extraction. 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Am J Orthod Dentofacial Orthop. 2007;132:28\u201335."},{"key":"b14","series-title":"Am J Orthod Dentofacial Orthop","first-page":"316","article-title":"Extraction of maxillary first permanent molars in patients with Class II Division 1 malocclusion","volume":"132","author":"Stalpers\n              MJ,","year":"2007","unstructured":"Stalpers\n              MJ, \n            \n              Booij\n              JW, \n            \n              Bronkhorst\n              EM, \n            \n              Kuijpers-Jagtman\n              AM, \n            \n              Katsaros\n              C. \n          \n          Extraction of maxillary first permanent molars in patients with Class II Division 1 malocclusion. Am J Orthod Dentofacial Orthop. 2007;132:316\u2013323."},{"key":"b15","series-title":"J Orofac Orthop","first-page":"128","article-title":"The effect of premolar extractions on incisor position and soft tissue profile in patients with Class II, Division 1 malocclusion","volume":"70","author":"Weyrich\n              C,","year":"2009","unstructured":"Weyrich\n              C, \n            \n              Lisson\n              JA. \n          \n          The effect of premolar extractions on incisor position and soft tissue profile in patients with Class II, Division 1 malocclusion. 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