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.

Historical review
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
1

In the Extraction Debate of “1911. Case presented an article entitled the question of extraction in orthodontic." at this “1911” meeting of the National Dental Association Calvin. Thus . arise from the law of heredity and from other laws that govern the development of plants and animals. A cothinker and supporter of Case. in an article published in “1907” in items of interest. 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. and especially to laws that govern the mixture of dissimilar types. on the basis that if crowded teeth are aligned in correct relation to each other. In “1903” Case published an article in which he takes issue against the injudicious extraction of permanent teeth. Angel’s has been said that extraction plays no part in orthodontic treatment. In this edition. 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. and we heard much of odontocides. Matthew Cryer also published an article in “ 1905 “ in which he defends the use of extraction. 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 2 . which in turn will create adequate space for the dentition. “But why enter such a field of doubt. He claims that the writings of the “new school” (Angle) say that the causes of malocclusion are “local “. whereas Case claims that they “partly at least.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. and of possible failure. of danger. In 1905 he wrote. 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. Ottlengui in “1905” stated that. In this article he discusses the causes as he believes it is intimately bound up in the discussion of extraction. This is not the first time that Case queried this line of thinking. extraction was permissible and even advisable. the improved function of the masticatory system will result in growth of the jaws. Since then he has always been considered the leading exponent of non extraction technique . and not resort to mutilation . the major concept of orthodontic in these early years was one of the expansion outward to a greater arch to eliminate individual teeth irregularities .

Case’s group believed otherwise. 2. 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. 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. Angle’s group believed that bone could be induced by mechanical means to grow beyond its inherent size. which is quietly improbable. 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.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. instead of attempting to carry out in so limited a degree the original designs of the Maker when he fashioned an Apollo. unless we assume the absurdity that the same cause at the same time produced the over-development of the upper jaw. This applied particularity in the Class II D. Reasons for Extraction 1. especially the mandible. and which characterize the principal deformity.B : There are a different methods of gaining space including. which leads to the formulation of what is become known by Tweed philosophy.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. N. The 3 . “(The Apollo reference her is a very sophisticated thrust at Angle whose concept of beauty was based on this statue. However the subject of this review is the extraction. On other area of controversy between Case “rational school “and Angle’s ”new school“.).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. The idea of treating cases again with extraction formed the basis of his further work.Anteroposterior dental arch malrelation As in crowding it is necessary to remove teeth to give space for correction of discrepancies in dental arch relationship. Malrelations of this character point directly to heredity.

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. if it less than 37% he considered that is due to basal arch deficiency necessitating extraction of first premolars. 7-Thickness and distribution of the soft tissues covering the facial bones. 6-Age of the patient. 4-Direction of jaw growth. This analysis also show the effect of extraction on posterior occlusion.backward movement of the upper anterior teeth require the removal of a teeth to provide spaces. 3-Type and degree of crowding. to ascertain the effect of extraction on the ratio designed by Bolton. The premolar basal arch width should equal approximately 44% of mesiodistal width of 4 . The BAL Tooth ⋅ material should be 37% . it is useful before selecting the teeth for extraction. since Bolton’s formula do not take into account the incisors angulation. •Howe’s analysis Howe’s considered teeth crowding to be due to deficiency in basal arch width and length “ BAL”. 5-Difference in the basal arches length. When one is contemplating the extraction. 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.Arch analysis •Bolton tooth ratio analysis This analysis aimed to estimating the overjet and overbite relationship that will obtained after treatment is finished.

moderate or maximum anchorage. This quickly give us information about the followings :. They also adapted numerical ranges as clinical guidelines for the maximum limit of desirable MD. Peck and Peck construct an index using the mesiodistal and faciolingual dimensions in the form of a mesiodistal ( MD) over faciolingual ( FL )ratio. •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 ” . This permit arrangement of crowded anterior teeth in more regular manner. FL index values for the lower incisors : 88 . . by extraction and the tooth movement necessarily to close the space. .95 for the mandiblular lateral .92 for the mandibular central incisors and 90 . Case between 37.Also it is useful in planning individual tooth movement and determination of appliance design . The midline of symmetrograph is superimposed over the median palatine raphe. •Peck and Peck analysis Many studies indicated that deviations of crown shape influence and contribute to the mandibular incisor crowding .It is best mathematical representation of the problem during the mixed dentition. •Harvold symmetrograph The symmetrograph is a transparent plastic device with an inscribed grid . tipped and rotated teeth. Lower incisors within or below the ranges must be considered favorably shaped for good 5 . When the premolar basal arch width is larger than the premolar width at the cuspal region. . .44% may require extraction of first premolar.Help in determine the type of anchorage.Arch asymmetry . This method determine the followings:-If the case is indicated for extraction or not and aid in choosing the teeth to be extracted. either minimum.Drifted.The amount of the space created. . than the basal arch is sufficient to allow expansion at the premolars. The index equals the MD crown diameter in millimeters divided by the FL crown diameter in millimeters and multiplied by 100.the 12 teeth anterior to the second molar if the basal arch is sufficient large to accommodate all of the teeth.

In some cases. * Roles of FMA in determining the need for extraction :1-When the FMA = 20 o − 30o . II-Cephalometric analysis a) Tweed method Tweed considered that. from each side. It consists of the following : FMA (FH-MP) = 25 o . therefore.When the FMA is over 40 o the prognosis is extremely unfavorable. 4. that reaproximation can function as an exacting procedure to correct deviations of the mandibular incisor tooth shape and to help achieve post-treatment stability.When the FMA = 30o − 35o .The FMIA should be upward of 70 o . however. the removal of the teeth in 40 o or more FMA detracts from father than enhance facial appearance. When the FMA is below 20 o the aim should not to exceed the IMPA over 92 o . treatment planing and prognosis. 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. Any lower incisor with an MD/FL index above these ranges . FMIA ( 1 -FH) = 65 o . The prognosis vary from excellent for those nearest the 20 o to good for those nearest the 30 o . IMPA ( 1 -Mp) = 90 o . the correct position of 1 vary from 85o − 80o .alignment. 6 . 3. possesses a crown shape deviation which may influence or contribute to the crowding phenomenon. the prognosis for reducing the alveodental progonathism varies from fair at 35 o and unfavorable at 40 o . it become necessary to reduce the number of the teeth to be accommodated in the arch. The prognosis for reducing the alveodental progonathism varies from good to those nearest 30 o to fair to those nearest 35 o . When the teeth in the dental arch can’t be placed into regular alignment without increasing the axial procumbency of the incisors. The minor correction require removing 2 mm. the correct position of 1 vary from 95 o when FMA = 20 o to 85 o when the angle is increased to 30 o . 2. Tweed diagnostic facial triangle :It is the basis for diagnosis.When the FMA = 35o − 40 o . It can be seen.

The ratio of this measurement to each other . 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 . Holdaway will tolerate it .In liner movement. difference.Tweed’s formula for treatment is given as follow :1. 7 .FMIA = 65 o or grater and sufficient arch length. Steiner bases his decision regarding extraction of teeth upon number of factors. the discrepancy between space available and space required the amount of room for expansion and its maintenance.Borderline . If the ratio is off 3 mm.Non extraction . 3.FMIA = 62 o . variance. is important . Curve of spee Right + Left + 0. 2. the amount of space consumed by the use of intermaxillary elastics during treatment. and not their value . of an equal ratio is in very good facial balance. he extracts to return to the 3 mm. 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 . and the space which might be gained through extraction of teeth. 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. the distance mesially of distally which he must position the lower incisor to achieve his concept of a well-balanced face. This is calculated as follow :Difference between teeth material . if there is a 4 mm. Determination of space needed for alignment of teeth(Yamaguchi) 1.FMIA = 62 o or less. 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. Anything within 2 mm.5 2 = Amount of space needed for leveling the curve of space. A combination of these factors and their net results determine whether or not extraction is indicated. On the dental cast determine the amount of space needed to align the teeth without crowding on the basal arch.Arch length = Amount of crowding 2.Extraction .65 o with sufficient arch length..5 mm .

found that extraction. even when dental and skeletal discrepancies are deemed to be mild.. Klapper et al.3. was not associated with any change in the lower 8 . Many orthodontists also believed that extraction permits the posterior teeth to move forward resulting in decrease in the vertical dimension of occlusion. among other. also recommended extraction of premolars in patients with large anterior facial height and a steep mandibular plane. in the belief that mesial movement of molars may allow anterior rotation of the mandible. The Tweed formula for correction of the angulation of 1 denoting that for every 1 degree retraction of the lower incisors require 0. recommended a nonextraction approach in the treatment of the hypodivergent facial type and an extraction approach in the treatment of hyperdivergent facial type. 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. as a result of their study. The mandible is then allowed to overclose which in turn reduce the facial vertical dimension.. recommended the extraction of teeth in dolichofacial patient (retrognathic facial type with long lower face height ) to help control the vertical dimension. Controversy regarding the affects of extraction There are a great controversy about the effect of extraction on the lower anterior face height. particularly the lower anterior face height Schudy. on treatment of class I and class II malocclusion. He also advocated extraction of teeth to close down the bite Pearson. On the other hand Chua et al . soft tissue profile and TMJ. 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. lower anterior face height) to avoid vertical overclosure.8 mm space. They also believed that extraction should be avoided in brachyfacial patients (prognathic facial type with short.

The mean ratio of increase was 1. Staggers. The patients had a minimum of 3 mm. They summarized the followings:1-The nasolabial angel increased with the increase in the maxillary incisor retraction. her considered loss of the vertical height is difficult to occur. Looi and Mills. there has been a tendency to avoid extraction of premolar wherever possible and. upper incisor retraction at treatment completion. He also found a slight increase in the mandibular plane angle and extrusion of the maxillary and mandibular first molars.6 degrees to 1 mm.Soft tissues Orthodontists have long recognized that the extraction especially the premolar often is accompanied by changes in the soft tissues profile. 2-There was a strong and significant correlation between the change in the nasolabial angel and the increase in lower face height. While the nonextraction treatment is associated with downward and backward rotation of the mandible (N-Me). They concludes:1. the overclosure of the mandible with the subsequent reduction of the vertical height is suspected. the upper lip drops back to a certain extent and it’s probably desirable in most cases.in “ profile. since the extrusion of molars . Division 1 malocclusion. studied the effect of extraction versus non extraction on the soft tissue profile. extraction can lead to what is sometimes called the “ Orthodontics look “ or “ dished . For this reason . Where the incisors are retracted excessively.Division 1 malocclusion. Staggers. will compensate for the forward movement of molars. to extract second rather than first premolars. In class II or III cases in which a portion of extraction space is closed by forward movement of molars. in some cases. Following retraction of upper incisor teeth in class II. At times these changes will result in improvement in the facial profile. 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. 2.anterior face height ( ANS-Me). 3. Lo and Hunter studied the nasolabial angel changes that occurred in the treated Class II.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. The average ratio of increase was 2. At other times. 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. that mostly accompany the orthodontic mechanic. 9 .

and 2 to 3 mm in lower lip protrusion. The reduction of overjet has the effect of “ uncurling “ both lips. 2. Increased lower lip length by mean of 3. They concluded that the negative effect of extraction on the facial profile are false. Decrease of interlabial gap by about 2. the lower lip length and the increase in the labiomental angle . Although average changes are less in nonextraction patients.7 “ . compare the soft tissues profile changes of extraction and nonextraction treated patients. Although in some cases this may be desirable. nonextraction patients had less facial changes as a result of orthodontic treatment than a similar group of extraction patients. in many cases it is not and retraction of the lower incisors should be avoided. 1 to 2 mm in upper lip protrusion. it is not possible to predict the effect on the lips of a given movement of the teeth. the range of individual changes in facial profile is almost as great for nonextraction cases as for extraction cases. Young and Smith . Drobocky and Smith examined the change in the facial profile during orthodontic treatment with extraction of four first premolars. Talass etal. Increase the soft tissue lower face height. 2. Clearly the great majority of patient exhibit controlled amount of profile change that produce improvement in facial esthetics. the magnitude of the mean difference between extraction and nonextraction patients being approximately 6 o in the nasolabial angle. They concluded the following :1.4 mm . Increased nasolabial angle by mean of 10 . They considered three measurements that were of clinical significance .2. The Anteroposterior position of the lower lip seem to be unchanged. 3. up to 60 o for angular measurements of lip position and 11 to 13 mm for liner measurements of lip protrusion.3 mm . which seems to follow the incisors closely. the range of response by individual patients is very large. 4. 3. 10 . There is a wide individual response in the reaction of the soft tissues to change in the underlying hard tissues. Retraction of the lower incisors has more effect on the lower lip.5⋅• 4. this enables them to be held together without undue effort. Furthermore. The upper lips were retracted “ mean 3. 6. Increase upper lip thickness by mean of 2. analyzed the soft tissue profile change that result from retraction of maxillary incisors at minimum of 3 mm either with or without extraction. On average. They also observed that there is a great individual variability in the effect of treatment on the soft tissue profile. 5. this measurements are the upper lip retraction.4 mm . 7. The result of this study summarized as following:1.

the extraction of premolars did not affect the so called condylar positions of extraction treated subjects. This overretraction of anterior teeth is thought to displace the mandible an the condyles posteriorly.). Extraction of premolars permits the posterior teeth to move forward resulting in a decrease in the vertical dimension of occlusion. and the muscles of mastication become foreshortened. this theory has not been substantiated by research. It would seem that nonextraction cases should offer much less of an opportunity for the clinician to alter the profile. Another theory that has been proposed is that first premolar extractions lead to overretraction of the anterior teeth. Although this theory is popular. Reilly et al. Farrar and McCarthy. 4.TMJ First premolar extraction is considered by many to be an etiologic factor in TMJ disorders. 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. it was mentioned previously. It has been vigorously argued ( and assumed ) by some that nonextraction treatment is the solution to undesirable facial changes ( and particularly the “ dished. As result. 2. among others. As a result of their study.in “ look. The facial appearance should be judged on an overall basis rather than as a series of individual features. The mandible is then allowed to overclose. were measured the anterior and posterior condylar space through the corrected axial tomogram. TMJ problems are likely go occur. The consequences of esthetics cannot be judged by comparing numbers 3 . particularly the maxillary anterior. examined clinically the TMJ in extraction orthodontic patient before and after orthodontic treatment for the presence of the sings or symptoms of TMJ disorders.either in their cross sectional or longitudinal studies. Concerning the forward rotation of the mandible. 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. 11 . among others. particularly among general practitioners. They had shown that. as an etiologic factor in the TMJ disorders. As with the previous hypothesis.. Kundinge. no controlled study has published results supporting this hypothesis. Posterior condylar displacement has long been associated with TMJ disorders. they support the hypothesis that orthodontic treatment is not costive of TMJ disorders.3.

must be considered before extraction.Lower first premolars should not be extracted in class II except where the lower crowding is very sever. 2 malocclusion. Severely malposed teeth and which are difficult to align. 12 . Tooth condition must be balanced with other considerations of tooth position in deciding an extractions. Choose of tooth for extraction First premolar “ Tulley “ -This tooth is positioned near the center of each quadrant of the dental arch. Factors considered in chosen the teeth for extraction a) The condition of the teeth : Fractured.The upper first premolars extraction is indicated for treating a class II C.Beattie et al. . . c) The position of crowding : pleasing final appearance. the extraction of the upper first molar is practiced but tend to leave some residual spaces.1 malocclusion particularly where there is a considerable overjet. They found no difference between the extraction and the nonextraction cases. grossly carious teeth and teeth with large restorations are the teeth of choice for extraction in orthodontics. b) The position of teeth : The position of the tooth apex must be considered. . . and the discrepancy in arch relationship is not very marked. the final tooth position and interdental contacts. as it is more difficult to move the apex than to move the crown. are the teeth of choice for extraction. it is the tooth most commonly removed for relief of crowding. occlusal balance. For this reason.. 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.In treatment of class II D. hypoplastic. 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. 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.Extraction of the first premolar is indicated in bimaxillary protrusion case and the case of marked crowding. The mean posttreatment interval was 14 years.

6. •Decrease anterior torque problem. It maintain the height of the bite. It is essential tooth in orthodontic treatment . •Decrease the uses of class II elastics. When the facial contour are in good balance and proportion * Advantage :• Less complicated mechanics . Due to the previously mentioned considerations.Jensen “ * Consideration for the first permanent molar :1. 4. Open bite closure in class I cases. When less maxillary incisor retraction are needed.5 mm or less “ premolar unit “ and no indication for incisor retraction “ Mild arch length deficiency “. If mesial movement of fist permanent molar is required. Extraction of the mandibular first molar in these cases. Second premolar “ Tulley and logan “ * Indications :1. 4. When it is badly decayed. 3.In class III cases. 13 . First permanent molar “ Tully . Create space for the second permanent molar. leads to presence of residual spacing. * Requirement for first permanent molar extraction :1. in the absence of the crowding. Considered the cornerstone of the dentition. it is at right position in the arch. Always. 7. The third molars must be present in x-ray film in normal size and good position. beyond the limit of orthodontic tooth movements or take too much orthodontic procedures. * 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. When the arch length discrepancies is 7. 2. 5. •Decrease maxillary incisors retraction. as a result of the tongue action on the lower incisors and the growth of the mandible. 2.. this tooth bas been esteemed as untouchable from the every beginning of the history of orthodontics. 3. the extraction of upper first premolars should be avoided .

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 . In case of premature loss of deciduous molars with the tendency of class III arch relationship. 2. 4. 3. Removal of weak. When the first permanent molars are extracted. 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. 2.2. 2. where the third molar is present and of normal size and position 2. Provide only amount of space needed . * Contraindication 1. 3. 5. More stability → reduce the probability of relapse. The first permanent molar should extracted before the eruption of the second permanent molars. The extraction of the only occluding cheek teeth may allow a postural prenormal occlusion to developed. all of it’s space can be used and only 12. No problem of extraction space and anterior diastema. 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. 7. and the same is true for the third molar. 6. Better esthetic → reduce the probability of dished-in . restored. No problem in borderline cases . 8. * Contraindication :14 .1 malocclusion and before eruption of the second permanent molar. This allow the second permanent molar to erupt in mesial direction. Patient appearance is natural and so difficult to discover that the patient has orthodontic and extraction treatment. 4. Reduce the amount and duration of orthodontic treatment. endodontically treated molar is much more better then the removal of intact premolar. In cases of open bite by temporarily reducing the molar functional area * Advantages :1.5 % of the teeth are lost. Elimination of the third molar as a possible cause of relapse . Second molar extraction “Magness” * Indication :1. * Advantage of the first permanent molar extraction :1. Less surgical trauma and decrease the possibility of precoronitis. In class II D.

palataly positioned apex . Diagnostic setup of final occlusal status must be evaluated. In certain cases. 2. the remaining teeth may move toward the extraction space and sometimes the 15 .g. correction thus becomes more circumscribed to a specific dentition zone. Upper and lower canines Extracted only when it beyond restoration .1. * Clinical implication :1. 4. 3. An accentuated overjet is contraindication to removed of single lower incisors. The loss of gingival tissue of the disappearance of the external alveolar lamina constitutes an additional indication for extraction of the affected incisor. Sever anterior space deficiency . the space either fails to close or else opens up with ease. 3. 4. Anomalies in the number of anterior teeth. Upper Incisors teeth Central incisor : Extracted only when it beyond restoration . Ectopic eruption of incisors . 2. * Advantages :One way of preventing relapse is to extract an incisor with extreme malpositioning. Lower incisor”Canut” * Indication :1. Tooth size anomalies. Compensating Extraction When one permanent teeth are lost early or are congenitally missing in one side. 2. Lateral incisor : Extracted only when it severely malformed or severely malposed e. and particularly among adults. 3. Sever bimaxiallry protrusion . Moderate class III malocclusions. visible diastema thus results in an area of considerable aesthetic and periodontal importance. Missed third molar or bicuspid . which moreover limits the sometimes unnecessary movement of many teeth. Removal of an incisors cause the canine to displace mesially.

Orthod. Angle versus Clavin S . : Extraction of first molars in discrepancy cases. J. 1991. E.115 . Orthod. 1996. 1994. J. Dentofac . . : Mandibular incisor extraction : indications and long-term evaluation. J. a balanced extraction should be made in which teeth in the other side as removed. European Journal of orthodontics. V. It is not necessarily to extract the same tooth in the other side. 64 : 115 -136 . Part I . : Walker Publishing . : Extraction of first molars in discrepancy cases.489 . 73 : 459 . S. Orthop. E. (2)Where the overbite is excessive and there is a class II tendency. 1983. R. I. 18 : 485 . Farrar. Case : Extraction versus nonextraction. Dentofac . Holdaway. Historical revisionism. 95 : 220 -230 . : Edward H . A. Orthop. W. J. Am.369 . Orthop. D. J. L . J. and Lubit.470 . L. 100 : 110 . 1983 . Ala . 1992. : Changes in facial profile during orthodontic treatment with extraction of four firs premolars. unavoidable extraction or missing teeth in one buccal segment. . J. . 1978. Am. Am. Dentofac . 1973. Am. Editorial section : On second-premolar extraction and the moderate borderline malocclusion. 1989. E and Johnston. 84 . Orthod. Part I. : A clinical outline of temporomandibular joint diagnosis and treatment. O.Paquette. S. : An evaluation of temporomandibular joints and jaw muscles after orthodontic treatment involving premolar extractions. Drobocky. Dentofac . J. K. 64 : 115-136. Dentofac . 105 :444-449. Orthop. Daugaard-Jensen. (3)Where there is a class II tendency. References Bernstein.8 . Quoted from Kundinger. Am. Am. L. Orthod. L. B. J. and McCarthy. Beattie. : The effects of extraction versus nonextracton orthodontic treatment on the growth of the lower anterior face height. R. W. midline and to establish normal occlusion. J. A. 104 : 361 . The aim of compensating extraction is to avoid lateral asymmetry. Orthod. and Ferguson. D. : A soft-issue Cephalometric analysis and its use in orthodontic treatment planning . J. unavoidable extractions or missing teeth in the lower arch will require a compensating extraction in the upper arch but not vice versa. J. Christensen.anterior teeth may across the midline with the subsequent asymmetry. Orthod. unavoidable extractions or missing teeth in the upper arch require compensating extractions in the lower arch but not vice versa. . 1993. and Smith. Orthod. Lim. To avoid this. Orthod. : The functional impact of extraction and nonextraction treatment :A long term comparison in patients with “borderline. K. Orthod. Am. J. Orthop. 1973. Montgomery. B. Chua. L. Jensen. 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. 102 : 464 . Am.” equally susceptible Class II malocclusions. 16 . Donegan. A.460 . Am. Canut. J. 84 : 1-28 . J. Y. R. D. C. a compensating extraction should be made in the opposing arch to reduce the movement of the center line and to maintain the overbite.

Dentofac . W. 1994. : Class II elastics and extractions and temporomandibulr disorders : A longitudinal prospective study. 1991. Orthod. : The role of extractions in orthodontic treatment. :Changes in nasolabial angle related to maxillary incisor retraction. Orthop. J. 101 : 425 . 103 : 452 -458 . British Dental Journal. R. J. C.369 . Quoted from Yamaguchi Y. Orthod. 1986. 1993. Am. S. L. M. J. Orthod. . Angel Orthod. and Hunter. Tulley. Am. : The influence of extraction and nonextraction orthodontic treatment on brachyfacial and dolichofacial growth patterns.517 . Kundinger. Orthop. Orthop. Am. S. : Effects of orthodontics on the facial profile: A comparison of changes during nonextraction and four premolar extraction treatment. Orthod. Orthod. Orthop. : The effects of extraction and nonextraction treatment on the mandibular position. 100 : 443-452 . J. 1986. : Soft-tissue profile changes resulting from retraction of maxillary incisors. Close. Orthod. K. Dentofac . and Lubit. : An evaluation of temporomandibular joints and jaw muscles after orthodontic treatment involving premolar extractions.1978. J. 107 : 199 . E. Am. F. and Nanda R. V. Navarro S. Priewe. Looi. J. Talass. Y. 48 : 414 . Am. Rinchuse. Am. D. J. K. Magness. 105 : 19 . and Smith. : Vertical growth versus anteroposterior growth as related to function and treatment. J. M. Angel Orthod. Orthod.. Christensen. Dentofac . 1991. Am. Dentofac . F. Am. J. 1993. E. Lo. . T. Orthod. : Vertical changes following first premolar extractions. and Nada. Schudy. 1993 17 . J. F. : The effects of extraction versus nonextracton orthodontic treatment on the growth of the lower anterior face height. S.209 .463 . and Pawlowski B. Orthod. 1959.430 . Am. Dentofac . J. S. D. : Vertical control in treatment of patients having backward -rotational growth tendencies. 91: 385-394. J. and Mills. Lim. Pearson L. 82 : 384-391 . . Orthod. and Baker. J. R.24. 1962. J. 1987. 89 : 507 . F. J. Orthod. L. T. Bowman. S. E. K. : An evaluation of Cephalometric analysis and extraction formulas for orthodontic treatment planning. Orthop.428 . 100 : 443-452 . M. B. J. J. Orthop. Talass. 100 : 110 . . L. L. :Extraction of second molars. and. Orthop. Orthop. R. Orthod. A. 1992. Dentofac . Dentofac . Donegan. O’Reilly. Dentofac . : The effect of extraction and nonextraction treatment on the mandibular position. J. W. K.Klapper. A. D. and Ferguson. 104 : 361 . Young. 48 : 132-140 . J.1982. . J. 103 : 459 . Yamaguchi. Am. F. : The effect of two contrasting forms of orthodontic treatment on the facial profile. S. C. . August : 519-522. E. Am. 1991. D. Dentofac . Staggers. Quoted from Chua. 1964. R. 34: 75-93 . Orthop. W.115 . Am. J.