Dentofacial changes following four premolar extraction camouflage treatment in Class III malocclusions: a retrospective cohort study with gender-based evaluation

OBJECTIVES: Adult skeletal Class III malocclusions present a significant clinical challenge, particularly in borderline cases where camouflage treatment is preferred over surgical intervention. Therefore, the aim of this study was to evaluate dentofacial changes and gender differences after camouflage treatment involving four premolar extractions in adult patients with skeletal Class III malocclusion. METHODS: This retrospective cohort study included 50 adult patients (25 females; mean age: 16.34 ± 1.11 years, and 25 males; mean age: 17.61 ± 1.92 years) with skeletal Class III malocclusion (ANB < 0°) treated with the extraction of both maxillary and mandibular first premolars. These cases were diagnosed to be in the borderline surgical-orthodontic range but refused surgical treatments. Pre-treatment (T0) and post-treatment (T1) lateral cephalometric radiographs and plaster dental casts were analyzed. Skeletal, dental, and soft-tissue measurements were obtained, and treatment quality was assessed using the Peer Assessment Rating index. Intragroup comparisons were performed using the Wilcoxon signed-rank test, and intergroup comparisons were conducted with the Mann-Whitney U test (P < 0.05). RESULTS: At T0, most variables were comparable between genders; however, males exhibited significantly greater U1-Ls, L1-Li, Sn-Stm, Stm-Me', and Go-Me values (P < 0.05). Both groups demonstrated significant improvements in PAR scores and favorable dentoalveolar and soft-tissue changes (P < 0.05). Females exhibited additional significant skeletal and profile changes (SNB°, ANB°, SN/GoGn°, Pg-Pg', CmSnLs°), whereas males showed significant upper lip retrusion (Ls-S). Intergroup comparisons revealed greater mandibular incisor retrusion (L1⊥NB) in males than in females (P < 0.05). CONCLUSIONS: Four-premolar extraction camouflage treatment in Class III malocclusions produced significant dentoalveolar and soft-tissue improvements in both genders. However, females demonstrated more pronounced skeletal and profile-related changes, whereas males exhibited a greater degree of mandibular incisor retrusion, indicating a more pronounced dentoalveolar compensation pattern. These findings suggest that gender-specific differences should be considered during treatment planning to optimize esthetic and functional outcomes.