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Why to extract ?
In orthodontics, there are two major reasons behind extraction :
1.To provide space to align the remaining teeth in the presence of severe crowding
Treatment objectives
Type of malocclusion
Esthetics (large chin button, prominent nose)
Growth pattern.
Conditions of teeth.(caries, multifilled teeth, impacted, ectopic, severe rotation)
Health of supporting tissues.
Every person had potential for an ideal relationship of all 32 teeth. Extraction
never needed.
1902 article-
“My belief is that if we would confer the greatest benefits upon our patients
from an esthetic stand point, we must work hand in hand with nature and
assist her to establish the relations of the teeth as the Creator intended they
should be,& not resort to mutilation”.
Charles Tweed:
Retreated 100 of his patients with extraction of first four premolars and found
stability of occlusion. It led to widespread reintroduction of extraction in
orthodonticsby the late 1940s.
Margolis :
- Popularized the view that the most effective extraction strategy to relieve crowding is to extract the
premolar teeth closest to the site of crowding.
- Showed the evidence for benefit of extracting second premolars or even first molars to
alleviate crowding but at the same time to reduce the degree of retraction of the anterior
teeth. More recently , extraction of second molars also advocated for the same reason.
Tweed:
“It is my opinion that it is necessary to remove dental units in all those cases where there exists a
discrepancy b/w tooth structure and basal bone.”
Raymond Begg:
Later criticized
Prefer fuller and more prominent lips than std of 1950s and 1960s.
Litigation: 1980s
TMD problems.
Witzig and Spahl- critical of bicuspid Xn.
• Distalization of mandible;
The controversy continues and these range from an absolute rejection of the possibility of
a need for extraction to a rejection of the possibility of arch expansion and growth
guidance along with a continued high percentage of extraction.
• 10mm/more-
Extraction almost always.
What to extract ?
Extraction of Ist premolars.
ADVANTAGES :
8. Open bite.
ADVANTAGES :
INDICATIONS :-
Class II div 1 with perfect lower arch alignment but growth expectation inadequate.
Class II div 1 with good lower arch over basal bone, with some growth expectation.
U 4 occlude with L4
8s erupt normally.
Stable results.
Profile maintained.
2nd MOLAR EXTRACTION:
10-12mm of space :Satisfies arch length problem, not apparent when patient smiles.
Overbite reduction.
INDICATIONS:
Chipman:
DISADVANTAGES:
Too much tooth substance removed in Cl I mal occlusion with mild crowding.
Unacceptable positions of erupted 3rd molars –second, late stage of fixed therapy.
Contraindications:
Incisor Extraction:
INCISOR EXTRACTION:
Advantages:
Disadvantages :
1 incisor extraction causes deepbite if normal tooth size relationship is present before Xn.
Incisor extraction is –
Rarely indicated.
Bu/Li blocked out lateral, with good contact b/w central and canine.
Dilacerated tooth.
Gardiner et al:
Extraction of Canines:
Relation b/w root surface area and extraction site selection upon incisor
retraction.
Diagnostic line.
CONCLUSION:
Orthodontic treatment may include extractions of any tooth in the arch based
on sound diagnosis, treatment objectives.
REFERENCES
Contemporary Orthodontics, 4th edn; William R. Proffit