Analisi dello spazio in ortognatodonzia: evoluzione di pensiero con l'evoluzione delle tecniche

Objectives The purpose of our work was to evaluate changes in the concept of space over the years and to explore how techniques for resolving dentobasal discrepancies have evolved. The results of this assessment should allow us to choose the most appropriate operative approach and estimate the possibilities and limits of arch expansion, as well as the indications and contraindications for extraction, always considering the concept of the guide arch. Materials and methods Proper treatment planning requires space analysis of the arches to resolve any dentobasal discrepancies. We conducted a review of the literature to identify the best methods for conducting a space analysis and the indications for extraction and expansion used by different authors. Results The review showed that modern orthodontic techniques can markedly reduce the need for extraction and achieve substantial expansion of the arches, including the lower arch, which has long been considered off-limits because of the high relapse rate associated with its expansion. Conclusions Although the new self-ligating appliances have revolutionized thinking in orthodontics, extreme caution should be used in treatment planning. In fact, more data are needed on the neoformation of bone induced by the interaction between brackets and light forces and on the stability of treatments performed with expansion that has until recently been considered excessive. Therefore, one of the most frequent orthodontic problems, dental crowding, is still being approached with solutions that are often antithetical.