We would like to thank Dr Doshi for his useful comments and the opportunity to discuss our article. We contrasted 2 treatment strategies and named them “intrusive” and “extrusive” based on their intent and how they are customarily perceived by clinicians. The aims were to test the combined effect of all appliances and interventions of each strategy and to evaluate their effectiveness on vertical control. Thus, we did not ask whether intrusion is, in principle, feasible, but, rather, whether vertical control is different between these specific, commonly applied treatments.
Concerning molar position, the origin of our reference system was sella, so part of the molar displacement was attributed to facial growth. In the mandibular arch, both groups showed anterior molar displacement, which was larger in the extraction group by 3 mm, due to anchorage loss during retraction. Almost 1 mm of distalization of the maxillary molars was achieved in the nonextraction group through regular use of low-pull headgear and Class II elastics, but this did not affect the vertical dimension differently from the other group, where mesial molar movement was evident. In the extraction group, spaces were closed through intra-arch mechanics (power chains). The influence of low-pull headgear on the vertical dimension has been examined in previous studies, and similar results were obtained (see the “Discussion” section in our article).
The results imply that conventional orthodontic strategies are limited in their ability to alter skeletal vertical dimensions, despite common beliefs, thus highlighting the importance of neuromuscular balance and function in the establishment of vertical dimensions. We share Dr Doshi’s interest in a comparison between conventional mechanics and newer approaches—eg, temporary anchorage devices—and look forward to such future studies.