Treatment decisions: Extraction versus nonextraction

Factor Extraction Borderline Nonextraction

Soft tissue profile

Mandibular incisor
position

Attached gingiva

Growth potential

Vertical skeletal
pattern

Mandibular arch
length discrepancy

Maxillary intermolar
width

Patient compliance

Total
Soft tissue profile

• Convex profile or bimaxillary protrusion: extraction

• Normal or Class II profile: nonextraction or borderline

• Concave profile: nonextraction

Mandibular incisor position

• Proclined incisors: extraction

• Normally inclined incisors: nonextraction or borderline

• Retroclined incisors: nonextraction

Attached gingiva

• Thin, narrow attached gingiva or gingival recession: extraction

• Compromised gingiva: borderline

• Healthy gingiva: nonextraction

Growthpotential

• Past growth potential : extraction

• End of peak growth period: borderline

• Within or before pubertal growth period : nonextraction

Vertical skeletal pattern

• High-angle (dolichocephalic): extraction

• Medium-angle (mesocephalic): nonextraction or borderline

• Low-angle (brachycephalic): nonextraction

Mandibular arch length discrepancy

• Severe (more than 6 mm): extraction

• Moderate (4 to 6 mm): borderline

• Slight (less than 4 mm): nonextraction

Maxillary intermolar width

• Narrow; less than 33 mm can be expanded: change borderline into nonextraction

• Normal; expansion not a factor

Patient compliance In a borderline case: • Poor cooperation: extraction

• Moderate cooperation : borderline • Excellent cooperation: nonextraction