Extraction in orthodontics
*Historical review. *Reasons for Extraction. *Factors determining the needs for extraction. *Analysis made to determine whether to extract or not. *Determination of space needed for alignment of teeth. *Controversy regarding the effects of extraction. *Factors considered in chosen the teeth for extraction. *Choose of tooth for extraction. *Compensating Extraction.
The role of extraction in orthodontics was recognized by John Hunter “1771” in his natural history of the teeth. Spooner “1839” advised the extraction of four premolars or first molars when defective. Pierce writing in the Dental cosmos of October “1859," advocated extraction in teeth crowding as a mean for simplifying orthodontic procedures. In “1887” Angle wrote on his new system to regulate and retain the teeth. He stated that, if the teeth were placed in their proper occlusal relationship, normal function would be developed the supporting bone to hold them in this position. In that same year, the first edition of his book, on the same subject was published. Other editions supposedly followed up to “1897” when the fifth edition, expanded in scope, came out. Farrar “1888” Considered Judicious extraction an essential request for the prevention and correction of irregularities. In “1896” Calvin case published an article regarding the need for extraction to correct facial deformities. Angle “1900” in the sixth edition of his book “Malocclusion of the teeth “describes extraction for the relief of crowding and in the treatment or various types of Malocclusion. In a “1902” article, Angle set forth his line of reasoning toward the development of his treatment philosophy. In this article, Angle states “that my
and of possible failure.belief is that if we would confer the greatest benefits upon our patients from an aesthetic standpoint 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. on the basis that if crowded teeth are aligned in correct relation to each other. In 1905 he wrote. Since then he has always been considered the leading exponent of non extraction technique . In this edition. extraction was permissible and even advisable. He claims that the writings of the “new school” (Angle) say that the causes of malocclusion are “local “. arise from the law of heredity and from other laws that govern the development of plants and animals. by this time one might almost say that the question of the hour was to extract or not? Many orthodontists were arguing that extraction is almost a crime and even a new word was coined for those who ruthlessly remove sound teeth from so called crowded arch. Case presented an article entitled the question of extraction in orthodontic. This is not the first time that Case queried this line of thinking. A cothinker and supporter of Case. In “1907” the seventh edition of Angle’s book was been published which was been completely stripped of all extraction case materials present in the sixth edition. which in turn will create adequate space for the dentition. in an article published in “1907” in items of interest. Matthew Cryer also published an article in “ 1905 “ in which he defends the use of extraction. Ottlengui in “1905” stated that. merely to satisfy a sentiment that God does not make the mistake of placing in the mouth of the human individual more teeth than is necessary for perfect harmony in
. the major concept of orthodontic in these early years was one of the expansion outward to a greater arch to eliminate individual teeth irregularities . of danger. whereas Case claims that they “partly at least. “But why enter such a field of doubt. Angel’s has been said that extraction plays no part in orthodontic treatment. and especially to laws that govern the mixture of dissimilar types. On the other hand men long counting as experts in this branch of work still argued that often either for reason of expediency or for actual benefit to the physiognomy. In the Extraction Debate of “1911. Thus . and we heard much of odontocides. the improved function of the masticatory system will result in growth of the jaws." at this “1911” meeting of the National Dental Association Calvin. In “1903” Case published an article in which he takes issue against the injudicious extraction of permanent teeth. and not resort to mutilation . In this article he discusses the causes as he believes it is intimately bound up in the discussion of extraction.
Case’s group believed otherwise.B : There are a different methods of gaining space including. Angle’s group believed that bone could be induced by mechanical means to grow beyond its inherent size. In my humble estimation it should be the highest aim of the orthodontist to remove without hesitation such portions of those naturally produced anatomical disharmonies as are within his reach. The
.Anteroposterior dental arch malrelation As in crowding it is necessary to remove teeth to give space for correction of discrepancies in dental arch relationship. On other area of controversy between Case “rational school “and Angle’s ”new school“.Crowding When the dental arch is too large to fit in the basal arch without irregularities it is necessary to decrease the size of the dental arch by reduction of the number of the teeth. “(The Apollo reference her is a very sophisticated thrust at Angle whose concept of beauty was based on this statue. unless we assume the absurdity that the same cause at the same time produced the over-development of the upper jaw. In this area Case wrote that “The correctness of the statement that the mandible will grow to a harmonizing size will depend entirely upon whether it has been stunted in normal growth development. especially the mandible. This applied particularity in the Class II D. and which characterize the principal deformity. However the subject of this review is the extraction.). N. It is more than likely that Charles Tweed was familiar with Case’s concept of extraction because Tweed was extremely unhappy with the faces he was producing. Malrelations of this character point directly to heredity.1 when the upper arch is too far forward in relation to the lower dental arch. stripping and expansion but mainly they applied for mild crowding with many limitation in its uses. which leads to the formulation of what is become known by Tweed philosophy. which is quietly improbable. The idea of treating cases again with extraction formed the basis of his further work.all physical and aesthetic relations? Why ignore the possibility and the frequent undoubted fact that inherited inharmonious in contiguous structures over which we have no control made it impossible for us to place all of the teeth in the arch without fulfilling the designs of an inherited deformity. instead of attempting to carry out in so limited a degree the original designs of the Maker when he fashioned an Apollo. 2.
Reasons for Extraction
4-Direction of jaw growth. The premolar basal arch width should equal approximately 44% of mesiodistal width of
BAL Tooth ⋅ material
should be 37% . •Howe’s analysis Howe’s considered teeth crowding to be due to deficiency in basal arch width and length “ BAL”. The due to basal arch deficiency necessitating extraction of first premolars. This analysis also show the effect of extraction on posterior occlusion. 5-Difference in the basal arches length.
Factors determining the needs for extraction
1-Gonial angle :-Incisor procumbency in relation to the FH plane is more pronounced in the presence of short ramus and an extremely obtuse gonial angle. it is useful before selecting the teeth for extraction. 6-Age of the patient. 7-Thickness and distribution of the soft tissues covering the facial bones. since Bolton’s formula do not take into account the incisors angulation. to ascertain the effect of extraction on the ratio designed by Bolton. if it less than 37% he considered that is
.backward movement of the upper anterior teeth require the removal of a teeth to provide spaces.Arch analysis
•Bolton tooth ratio analysis This analysis aimed to estimating the overjet and overbite relationship that will obtained after treatment is finished. When one is contemplating the extraction. 3-Type and degree of crowding. 2-Axial inclination of mandibular incisors.
Analysis made to determine whether to extract or not
I-Arch analysis II-Cephalometric analysis I. Care must be taken in the uses of this analysis.
. by extraction and the tooth movement necessarily to close the space. •Kesling diagnostic setup The teeth are cut from the cast at the level of A and B points then repositioned according to Tweed formula “ FMIA = 65 o ” . Lower incisors within or below the ranges must be considered favorably shaped for good
. The index equals the MD crown diameter in millimeters divided by the FL crown diameter in millimeters and multiplied by 100. . The midline of symmetrograph is superimposed over the median palatine raphe.Also it is useful in planning individual tooth movement and determination of appliance design . This permit arrangement of crowded anterior teeth in more regular manner. They also adapted numerical ranges as clinical guidelines for the maximum limit of desirable MD.The amount of the space created. . •Harvold symmetrograph The symmetrograph is a transparent plastic device with an inscribed grid . FL index values for the lower incisors : 88 . tipped and rotated teeth.Drifted.44% may require extraction of first premolar.the 12 teeth anterior to the second molar if the basal arch is sufficient large to accommodate all of the teeth. Peck and Peck construct an index using the mesiodistal and faciolingual dimensions in the form of a mesiodistal ( MD) over faciolingual ( FL )ratio. This method determine the followings:-If the case is indicated for extraction or not and aid in choosing the teeth to be extracted.92 for the mandibular central incisors and 90 . than the basal arch is sufficient to allow expansion at the premolars. •Peck and Peck analysis Many studies indicated that deviations of crown shape influence and contribute to the mandibular incisor crowding . When the premolar basal arch width is larger than the premolar width at the cuspal region. .Arch asymmetry .95 for the mandiblular lateral . moderate or maximum anchorage.It is best mathematical representation of the problem during the mixed dentition.Help in determine the type of anchorage. This quickly give us information about the followings :. either minimum. Case between 37. .
2.When the FMA = 30o − 35o .When the FMA = 35o − 40 o . FMIA ( 1 -FH) = 65 o . however. In some cases. the lower incisors should be uprighted over the basal bone to achieve harmonious and symmetric occlusal and facial balance and to gain a stable result. It consists of the following : FMA (FH-MP) = 25 o . that reaproximation can function as an exacting procedure to correct deviations of the mandibular incisor tooth shape and to help achieve post-treatment stability. The prognosis vary from excellent for those nearest the 20 o to good for those nearest the 30 o . The minor correction require removing 2 mm.When the FMA is over 40 o the prognosis is extremely unfavorable.The FMIA should be upward of 70 o . the correct position of
vary from 85o − 80o .
The prognosis for reducing the alveodental progonathism varies from good to those nearest 30 o to fair to those nearest 35 o . it become necessary to reduce the number of the teeth to be accommodated in the arch. from each side.
. When the FMA is below 20 o the aim should not to exceed the IMPA over 92 o . 3. Any lower incisor with an MD/FL index above these ranges . * Roles of FMA in determining the need for extraction :1-When the FMA = 20 o − 30o . Tweed diagnostic facial triangle :It is the basis for diagnosis. It can be seen. therefore. possesses a crown shape deviation which may influence or contribute to the crowding phenomenon. 4.alignment. the removal of the teeth in 40 o or more FMA detracts from father than enhance facial appearance.
a) Tweed method Tweed considered that. IMPA ( 1 -Mp) = 90 o . the prognosis for reducing the alveodental progonathism varies from fair at 35 o and unfavorable at 40 o . When the teeth in the dental arch can’t be placed into regular alignment without increasing the axial procumbency of the incisors. treatment planing and prognosis. the correct position of
vary from 95 o when
FMA = 20 o to 85 o when the angle is increased to 30 o .
FMIA = 62 o or less.FMIA = 65 o or grater and sufficient arch length.Extraction .
Right + Left + 0. the discrepancy between space available and space required the amount of room for expansion and its maintenance. variance. b) Stiener analysis He relate the lower incisors to NB line and use a linear measurement of 4 mm and angular measurement of 25 o .Tweed’s formula for treatment is given as follow :1. He uses the “ rule of thumb “ that one-third of the space is lost and that every degree of distal or mesial movement of the lower incisors represents the 2.. difference. Holdaway will tolerate it . and not their value . is important . 2.In liner movement. c) Holdaway analysis He has proposed that the lower incisor and pogonion be related to each other by the reference to the line NB : both are liner measurement expressed in mm .65 o with sufficient arch length. This is calculated as follow :Difference between teeth material .Borderline .
Determination of space needed for alignment of teeth(Yamaguchi)
1.Arch length = Amount of crowding 2. Steiner bases his decision regarding extraction of teeth upon number of factors. and the space which might be gained through extraction of teeth.5 mm . On the dental cast determine the amount of space needed to align the teeth without crowding on the basal arch.Non extraction . the distance mesially of distally which he must position the lower incisor to achieve his concept of a well-balanced face. the possibility of relocation of the lower first permanent molar the possibility of utilizing any of the space left by the exfoliation of the second deciduous molars. If the ratio is off 3 mm. if there is a 4 mm. 3.5 2
= Amount of space needed for leveling the curve
. he extracts to return to the 3 mm. Anything within 2 mm. of an equal ratio is in very good facial balance.FMIA = 62 o . A combination of these factors and their net results determine whether or not extraction is indicated. Curve of spee of space. the amount of space consumed by the use of intermaxillary elastics during treatment. The ratio of this measurement to each other .
also recommended extraction of premolars in patients with large anterior facial height and a steep mandibular plane. lower anterior face height) to avoid vertical overclosure. was not associated with any change in the lower
. found that extraction. recommended the extraction of teeth in dolichofacial patient (retrognathic facial type with long lower face height ) to help control the vertical dimension. soft tissue profile and TMJ.. as a result of their study. recommended a nonextraction approach in the treatment of the hypodivergent facial type and an extraction approach in the treatment of hyperdivergent facial type.8 mm space. They also believed that extraction should be avoided in brachyfacial patients (prognathic facial type with short. in the belief that mesial movement of molars may allow anterior rotation of the mandible. particularly the lower anterior face height Schudy. He also advocated extraction of teeth to close down the bite Pearson. Many orthodontists also believed that extraction permits the posterior teeth to move forward resulting in decrease in the vertical dimension of occlusion. These will be discussed as follow:-
1-Lower anterior face height and mandibular position
Many orthodontists agree that nonextraction treatment is associated with downward and backward rotation of the mandible and an increase in the lower anterior face height. Klapper et al. on treatment of class I and class II malocclusion..3. They also agree that extraction treatment is associated with upward and forward rotation of the mandible and a decrease in the lower anterior face height. On the other hand Chua et al . among other. The mandible is then allowed to overclose which in turn reduce the facial vertical dimension. even when dental and skeletal discrepancies are deemed to be mild. The Tweed formula for correction of the angulation of
denoting that for
every 1 degree retraction of the lower incisors require 0.
Controversy regarding the affects of extraction
There are a great controversy about the effect of extraction on the lower anterior face height.
Staggers. that mostly accompany the orthodontic mechanic. Division 1 malocclusion.Soft tissues
Orthodontists have long recognized that the extraction especially the premolar often is accompanied by changes in the soft tissues profile. Staggers. In class II or III cases in which a portion of extraction space is closed by forward movement of molars.in “ profile. studied the effect of extraction versus non extraction on the soft tissue profile. Lo and Hunter studied the nasolabial angel changes that occurred in the treated Class II. Looi and Mills.anterior face height ( ANS-Me). For this reason . While the nonextraction treatment is associated with downward and backward rotation of the mandible (N-Me).The mean ratio of increase was 1. the overclosure of the mandible with the subsequent reduction of the vertical height is suspected. there has been a tendency to avoid extraction of premolar wherever possible and. extraction can lead to what is sometimes called the “ Orthodontics look “ or “ dished . Following retraction of upper incisor teeth in class II. in his study on the treated class I cases found that an increase rather than decrease of the lower anterior face height either with or without extraction of premolars. to extract second rather than first premolars.6 degrees to 1 mm.Division 1 malocclusion. her considered loss of the vertical height is difficult to occur. Where the incisors are retracted excessively. At times these changes will result in improvement in the facial profile.
. will compensate for the forward movement of molars. in some cases. The average ratio of increase was 2. since the extrusion of molars . He also found a slight increase in the mandibular plane angle and extrusion of the maxillary and mandibular first molars. 3. The patients had a minimum of 3 mm. 2-There was a strong and significant correlation between the change in the nasolabial angel and the increase in lower face height.2 degrees to 1 mm.The response of the nasolabial angel from the extraction group was not significantly different from that of the nonextraction group. At other times.
2. They summarized the followings:1-The nasolabial angel increased with the increase in the maxillary incisor retraction. upper incisor retraction at treatment completion. They concludes:1. the lip do not fall back to a corresponding extent and any further dropping back may be more associated with backward movement of point A and therefore removing support from the base of the lips. the upper lip drops back to a certain extent and it’s probably desirable in most cases.
4 mm . analyzed the soft tissue profile change that result from retraction of maxillary incisors at minimum of 3 mm either with or without extraction. Drobocky and Smith examined the change in the facial profile during orthodontic treatment with extraction of four first premolars. Retraction of the lower incisors has more effect on the lower lip. 3. They considered three measurements that were of clinical significance . Increased nasolabial angle by mean of 10 . the magnitude of the mean difference between extraction and nonextraction patients being approximately 6 o in the nasolabial angle. The upper lips were retracted “ mean 3. 6. Although in some cases this may be desirable.5⋅• 4. Increase upper lip thickness by mean of 2. up to 60 o for angular measurements of lip position and 11 to 13 mm for liner measurements of lip protrusion. Young and Smith . Talass etal. the lower lip length and the increase in the labiomental angle . 5.3 mm . 2. Decrease of interlabial gap by about 2. Increase the soft tissue lower face height. 2.2.7 “ . compare the soft tissues profile changes of extraction and nonextraction treated patients.4 mm . Furthermore. in many cases it is not and retraction of the lower incisors should be avoided. 1 to 2 mm in upper lip protrusion. the range of response by individual patients is very large. 4. Clearly the great majority of patient exhibit controlled amount of profile change that produce improvement in facial esthetics.
. They also observed that there is a great individual variability in the effect of treatment on the soft tissue profile. 7. The reduction of overjet has the effect of “ uncurling “ both lips. The Anteroposterior position of the lower lip seem to be unchanged. Although average changes are less in nonextraction patients. it is not possible to predict the effect on the lips of a given movement of the teeth. They concluded the following :1. They concluded that the negative effect of extraction on the facial profile are false. this enables them to be held together without undue effort. The result of this study summarized as following:1. the range of individual changes in facial profile is almost as great for nonextraction cases as for extraction cases. this measurements are the upper lip retraction. and 2 to 3 mm in lower lip protrusion. There is a wide individual response in the reaction of the soft tissues to change in the underlying hard tissues. nonextraction patients had less facial changes as a result of orthodontic treatment than a similar group of extraction patients. 3. On average. which seems to follow the incisors closely. Increased lower lip length by mean of 3.
First premolar extraction is considered by many to be an etiologic factor in TMJ disorders. among others. believed that extraction of premolars during the course of orthodontic therapy are considered to be a predisposing factor in TMJ anterior disk displacement and TMJ disordered for the following reasons :1. 4. Concerning the forward rotation of the mandible. no controlled study has published results supporting this hypothesis.). Posterior condylar displacement has long been associated with TMJ disorders. Another theory that has been proposed is that first premolar extractions lead to overretraction of the anterior teeth.
. this theory has not been substantiated by research. Reilly et al. The facial appearance should be judged on an overall basis rather than as a series of individual features. This overretraction of anterior teeth is thought to displace the mandible an the condyles posteriorly. As a result of their study. were measured the anterior and posterior condylar space through the corrected axial tomogram. and the muscles of mastication become foreshortened. Farrar and McCarthy. It would seem that nonextraction cases should offer much less of an opportunity for the clinician to alter the profile. They had shown that.in “ look. as an etiologic factor in the TMJ disorders. Although this theory is popular. the extraction of premolars did not affect the so called condylar positions of extraction treated subjects. As result. It has been vigorously argued ( and assumed ) by some that nonextraction treatment is the solution to undesirable facial changes ( and particularly the “ dished. TMJ problems are likely go occur. The consequences of esthetics cannot be judged by comparing numbers
3 . The mandible is then allowed to overclose. among others. As with the previous hypothesis. 2.. they support the hypothesis that orthodontic treatment is not costive of TMJ disorders. The difference in the nasolabial angel versus the protrusion of the lips illustrates that improvements in one measurement may result in unfavorable changes in another measurement. examined clinically the TMJ in extraction orthodontic patient before and after orthodontic treatment for the presence of the sings or symptoms of TMJ disorders. Extraction of premolars permits the posterior teeth to move forward resulting in a decrease in the vertical dimension of occlusion.either in their cross sectional or longitudinal studies. particularly the maxillary anterior. it was mentioned previously. Kundinge. particularly among general practitioners.
it is the tooth most commonly removed for relief of crowding. 2 malocclusion.1 malocclusion particularly where there is a considerable overjet. are the teeth of choice for extraction. Severely malposed teeth and which are difficult to align. They found no difference between the extraction and the nonextraction cases. In this cases the extraction of lower first premolar will causes further collapse to the lower incisor teeth and deep bite become traumatic to the lower anterior and palatal soft tissue.In treatment of class II D. grossly carious teeth and teeth with large restorations are the teeth of choice for extraction in orthodontics. must be considered before extraction.Beattie et al. For this reason..Lower first premolars should not be extracted in class II except where the lower crowding is very sever.
. and the discrepancy in arch relationship is not very marked. . Tooth condition must be balanced with other considerations of tooth position in deciding an extractions. c) The position of crowding : pleasing final appearance. b) The position of teeth : The position of the tooth apex must be considered.
Factors considered in chosen the teeth for extraction
a) The condition of the teeth : Fractured. as it is more difficult to move the apex than to move the crown.The upper first premolars extraction is indicated for treating a class II C. .
Choose of tooth for extraction
First premolar “ Tulley “
-This tooth is positioned near the center of each quadrant of the dental arch. . the extraction of the upper first molar is practiced but tend to leave some residual spaces. occlusal balance. and is therefor near the sit of crowding. recall 65 extraction and nonextraction border line cases to examine clinically the long term effect of orthodontic treatment on the TMJ.Extraction of the first premolar is indicated in bimaxillary protrusion case and the case of marked crowding. . The mean posttreatment interval was 14 years. So they concluded that extraction decision should not be distorted by unwarranted assumptions about the long-term functional superiority of one strategy or the other. hypoplastic. the final tooth position and interdental contacts.
When less maxillary incisor retraction are needed.5 mm or less “ premolar unit “ and no indication for incisor retraction “ Mild arch length deficiency “. 5. 4. When the arch length discrepancies is 7. The third molars must be present in x-ray film in normal size and good position. 3. as a result of the tongue action on the lower incisors and the growth of the mandible.. 2. Always.
* Consideration for the first permanent molar :1. It maintain the height of the bite. When it is badly decayed. 4. the extraction of upper first premolars should be avoided . Create space for the second permanent molar. it is at right position in the arch. Open bite closure in class I cases. 7.In class III cases. * Indication :When the extraction of 4 first premolars with the enaculation of the third molars does not sufficient to relief the crowding and correct the dental basal arch discrepancies. If mesial movement of fist permanent molar is required. •Decrease anterior torque problem. leads to presence of residual spacing.
First permanent molar “ Tully . 6. Extraction of the mandibular first molar in these cases.
Second premolar “ Tulley and logan “
* Indications :1. •Decrease the uses of class II elastics. When the facial contour are in good balance and proportion * Advantage :• Less complicated mechanics . in the absence of the crowding. Due to the previously mentioned considerations. It is essential tooth in orthodontic treatment . 2. 3. this tooth bas been esteemed as untouchable from the every beginning of the history of orthodontics. * Requirement for first permanent molar extraction :1. Considered the cornerstone of the dentition. beyond the limit of orthodontic tooth movements or take too much orthodontic procedures. •Decrease maxillary incisors retraction.
Removal of weak. Reduce the amount and duration of orthodontic treatment. The extraction of the only occluding cheek teeth may allow a postural prenormal occlusion to developed. The extraction of first permanent molar will allow the second permanent molar to drifled mesially and occupy much of the extraction space without improving in incisal relationship. 6. * Contraindication 1. Patient appearance is natural and so difficult to discover that the patient has orthodontic and extraction treatment. Provide only amount of space needed . No problem of extraction space and anterior diastema. The first permanent molar should extracted before the eruption of the second permanent molars. 2. Less surgical trauma and decrease the possibility of precoronitis. No problem in borderline cases . More stability → reduce the probability of relapse. This allow the second permanent molar to erupt in mesial direction. 4. and the same is true for the third molar. 5. 2. In case of premature loss of deciduous molars with the tendency of class III arch relationship.
Second molar extraction “Magness”
* Indication :1. restored. 3. 2. Better esthetic → reduce the probability of dished-in . When the first permanent molars are extracted.1 malocclusion and before eruption of the second permanent molar.5 % of the teeth are lost. 8. Elimination of the third molar as a possible cause of relapse . endodontically treated molar is much more better then the removal of intact premolar. 3. 7. * Advantage of the first permanent molar extraction :1. * Contraindication :14
. In class II D. Extraction of 4 first premolars and 4 third molars causes loss of 25 % of the teeth and also the space of third molars is more or less wasted .2. 4. where the third molar is present and of normal size and position 2. In cases of open bite by temporarily reducing the molar functional area * Advantages :1. Anchorage problems are minimal because mesial movement of the second permanent molars are desirable and necessary to allow the normal eruption of the third molar. all of it’s space can be used and only 12.
correction thus becomes more circumscribed to a specific dentition zone. 4. 2. * Advantages :One way of preventing relapse is to extract an incisor with extreme malpositioning. 2.
Upper and lower canines
Extracted only when it beyond restoration . Removal of an incisors cause the canine to displace mesially.g. 2. which moreover limits the sometimes unnecessary movement of many teeth. Sever bimaxiallry protrusion . Moderate class III malocclusions. the space either fails to close or else opens up with ease. 3. Lateral incisor : Extracted only when it severely malformed or severely malposed e.
When one permanent teeth are lost early or are congenitally missing in one side.1. visible diastema thus results in an area of considerable aesthetic and periodontal importance. and particularly among adults. Diagnostic setup of final occlusal status must be evaluated. Sever anterior space deficiency . Tooth size anomalies. 3. 3. Ectopic eruption of incisors . Anomalies in the number of anterior teeth. In certain cases. 4. The loss of gingival tissue of the disappearance of the external alveolar lamina constitutes an additional indication for extraction of the affected incisor. Missed third molar or bicuspid .
Upper Incisors teeth
Central incisor : Extracted only when it beyond restoration . palataly positioned apex .
* Indication :1. * Clinical implication :1. An accentuated overjet is contraindication to removed of single lower incisors. the remaining teeth may move toward the extraction space and sometimes the
1973. : The functional impact of extraction and nonextraction treatment :A long term comparison in patients with “borderline. J. . B. 1996. E. Orthod. Canut. A. Case : Extraction versus nonextraction. Orthop. (2)Where the overbite is excessive and there is a class II tendency. Am. L.Paquette. D. References
Bernstein. L. 1991. : Mandibular incisor extraction : indications and long-term evaluation. The following general principles are applied when considering compensation extractions : (1) In a class I malocclusion where there is crowding but a normal overbite and overjet. a balanced extraction should be made in which teeth in the other side as removed. 18 : 485 . J. E and Johnston. W. . J. Am. Quoted from Kundinger. Orthop. Dentofac . Y. . I. European Journal of orthodontics. J. J. J. Angle versus Clavin S . and Lubit. Orthod. Am. Am. Christensen.489 . The aim of compensating extraction is to avoid lateral asymmetry. Orthop. S. .” equally susceptible Class II malocclusions. Dentofac . O. Holdaway. 104 : 361 .460 . Donegan. 1993. and McCarthy. E. 1992. : Walker Publishing . : Changes in facial profile during orthodontic treatment with extraction of four firs premolars. : Edward H . Orthod. Lim. 84 : 1-28 . A. D. Am. 84 . 1994. Am. 105 :444-449. 95 : 220 -230 . (3)Where there is a class II tendency. 73 : 459 . : A soft-issue Cephalometric analysis and its use in orthodontic treatment planning .anterior teeth may across the midline with the subsequent asymmetry. unavoidable extractions or missing teeth in the upper arch require compensating extractions in the lower arch but not vice versa. B. Part I. J. 64 : 115 -136 . 100 : 110 . 102 : 464 . Beattie. Jensen. : An evaluation of temporomandibular joints and jaw muscles after orthodontic treatment involving premolar extractions. V. 1983. Am. : Extraction of first molars in discrepancy cases. Am. W. Drobocky.369 . unavoidable extractions or missing teeth in the lower arch will require a compensating extraction in the upper arch but not vice versa. Orthod. A. L. Montgomery. J. : A clinical outline of temporomandibular joint diagnosis and treatment. Orthod. It is not necessarily to extract the same tooth in the other side. Orthod. J. R. Dentofac . L. Ala .470 . Orthop. J. To avoid this. Editorial section : On second-premolar extraction and the moderate borderline malocclusion.115 . midline and to establish normal occlusion. C. a compensating extraction should be made in the opposing arch to reduce the movement of the center line and to maintain the overbite.8 . Part I . unavoidable extraction or missing teeth in one buccal segment. Chua. D. : The effects of extraction versus nonextracton orthodontic treatment on the growth of the lower anterior face height. Dentofac . J. Historical revisionism. 1983 . J. 64 : 115-136. K. Orthod. Orthod. : Extraction of first molars in discrepancy cases. Orthop. K. S. and Smith. R. and Ferguson. J. Orthod. 1973.
. 1978. R. L . J. Am. Farrar. 1989. J. Dentofac . Daugaard-Jensen.
T. F. Orthod. D. Am. S. Dentofac . 1993. 48 : 132-140 .430 . S. Kundinger. 1994. 82 : 384-391 . L. Am. J. Dentofac . W. T. 107 : 199 . Orthop.517 . and Lubit. J. Yamaguchi. F. Dentofac . W. : Soft-tissue profile changes resulting from retraction of maxillary incisors. Am. Orthod. Orthod. Young. :Extraction of second molars. Am. E. J. 89 : 507 . J. Orthod. : Effects of orthodontics on the facial profile: A comparison of changes during nonextraction and four premolar extraction treatment. Am. 104 : 361 . Dentofac .Klapper. Angel Orthod. Am. E. 91: 385-394. and Pawlowski B. 1991. F. M. Priewe. : The effects of extraction and nonextraction treatment on the mandibular position. L. 100 : 443-452 . :Changes in nasolabial angle related to maxillary incisor retraction. 1991. 103 : 452 -458 . J. Orthop. August : 519-522. L. C. Am. : Class II elastics and extractions and temporomandibulr disorders : A longitudinal prospective study. Orthop. 1962. J. J. : The effect of extraction and nonextraction treatment on the mandibular position. British Dental Journal. . 1987. Orthop. F. Pearson L. Tulley. K. 34: 75-93 . Orthop. Orthop. J. 1959. 1992. 1993
. : The influence of extraction and nonextraction orthodontic treatment on brachyfacial and dolichofacial growth patterns. J. Quoted from Yamaguchi Y. O’Reilly. and Smith. J. C. Am. S. Orthop. Lim. J. J. Orthod. D. Talass. J. J. K..24.115 . R. Dentofac . M. J. D. Am. Schudy. Talass. Dentofac . R. Orthop. W. : Vertical growth versus anteroposterior growth as related to function and treatment. 103 : 459 . D.1982. A. S. Orthod. Angel Orthod. J. Orthod.369 . Dentofac . Staggers. and Baker. 105 : 19 . J. . B. 100 : 443-452 . Orthod. . : The effect of two contrasting forms of orthodontic treatment on the facial profile. Orthod. Christensen. S. 1964. : Vertical changes following first premolar extractions. and Nada. J. Magness. : The effects of extraction versus nonextracton orthodontic treatment on the growth of the lower anterior face height. 1993. Donegan. and Mills. Orthop. Quoted from Chua. J. Rinchuse. 1986. E. : An evaluation of Cephalometric analysis and extraction formulas for orthodontic treatment planning. Y. R. : The role of extractions in orthodontic treatment. M.209 . . : Vertical control in treatment of patients having backward -rotational growth tendencies. Am. S. : An evaluation of temporomandibular joints and jaw muscles after orthodontic treatment involving premolar extractions. Dentofac . 1991. V. and. Orthod. and Ferguson. E. K. Dentofac . A. Lo. 1986. 100 : 110 . J.1978.463 . Navarro S. F.428 . and Hunter. Close. R. Am. and Nanda R. L. Orthod. 101 : 425 . . 48 : 414 . Am. Bowman. . K. J. Looi. Orthod.