Comparative Assessment of Relapse Following Fixed Orthodontic Treatment in Patients Treated With and Without Extraction: A Systematic Review and Meta-Analysis.

Abstract

The present systematic review aimed to evaluate and compare the post-treatment relapse of overjet, overbite, and mandibular incisor crowding in patients treated with extraction and non-extraction orthodontic approaches and to assess the influence of treatment modality on long-term stability. The review was conducted following PRISMA guidelines. Data were extracted from 10 studies, including retrospective and longitudinal designs, with a total of 720 participants. The primary outcome measures included overjet, overbite, and Little's Irregularity Index. Standardized mean difference (SMD) was used as the summary statistic to compare extraction and non-extraction groups. The risk of bias was assessed using the ROBINS-I tool. The meta-analysis revealed no statistically significant differences in relapse between extraction and non-extraction groups for overjet (SMD: 0.52, 95% CI: -0.18 to 1.23, p>0.05), overbite (SMD: 0.41, 95% CI: -0.11 to 0.93, p>0.05), and incisor irregularity index (SMD: 0.71, 95% CI: -0 to 1.23, p>0.05). Funnel plots indicated no significant publication bias. Risk of bias assessment showed moderate concerns in confounding and participant selection across several studies, while bias due to missing data was notable in longer follow-up studies. The findings suggest that both extraction and non-extraction treatment approaches exhibit similar post-treatment relapse rates for overjet, overbite, and incisor irregularity. The choice of treatment should be based on clinical considerations along with concerns of long-term stability. Further high-quality randomized controlled trials are required to strengthen the evidence.