Comments on the Case-Dewey-Cryer

extraction debate
‘i . THORXTOS T.IYLOIi. l).l).S(‘.
Sydney, Auddin

FOREWORD
The ?,ece:nt serial publication of the Case-Dewey-CT~CV crtraction dcbatc (rcpri?rtcd
frown the year 1911) has evokxd many telephone callsand lcttc?,s. In fact, no urticle
ccw printed in the AMERICAX JOFRNAL, OF ORTHODONTICS lm brought so much com-
mmt from 0u.r readcm.
Under the &cumsta,kces, we arc anxious lo secure the opi,Gons of orthodontists
outside the United States and, accordingly, have a&cd A. Thornton Taylor oj’
Sydney, Australia, for his obscrmtions and comments. Dr. Tnylor was a mcsmbcr of
1Sdzcard Il. Angle’s last class in California. Probably no foreign orthodontist has
traveled more widely in order to learn the methods of practice i7k rclri0u.s c0wntrif.s.
l)r, Taylor’s comments fo7lotc.

THE reprinting, more than a half-century later, of Calvin S. Case’s essay on the
question of extraction in ort,hodontics and its related discussion offers ortho-
dontists and others interested in this field an opportunity to ponder the progress
and development of our specialty.
Could not, and does not, the same debate occur today in virtually ever*)
congress, convention, sectional meeting, study group, and even private practice
where two or more orthodontist,s work in association? Has any pat,tern of p~‘ac~-
I ice emerged after a half-century of argument on this fundamental question !
One would need to survey this issue on more than a narrow r(lgional basis,
where credence and respect might be and is given to some central dorninant
tigurc-a teacher or outstanding clinician-but, internationally, gr+(‘at.txr*differ-
ences may be detected. Opinion on this subject would seem to be rcry sig-
nificantly related to capacity, but capacity in this sense does not mean rner~:
skill. It requires no less skill to reposition teeth and to close spaces created by
intentional extraction than is required in even the most complex malocclusion
treated without extraction.
Capacity, to my mind, means not only the ability t,o treat but implies tllc
strength of conviction that the determined procedure can and should be carried
out. This capacity undoubtedly influences diagnostic thinking, just, as it. in-
2.96
fluences etiologic thinking, for we know this can happen. One tends to read into
etiology and diagnosis what one consciously or subconsciously believes. One sets
what one wants to see, and Case and Dewey did just this. Overstatement is a
seemingly necessary and inescapable part of teaching, and the bias and emphasis
of the teacher is passed on to the student, to be mellowed with esperiencc illld
llioldcd in the unforgivin, 17realibies of day-to-da>- practice.
(‘xc saw bimasillary protrusions everywhere; yet, Dewey considered thrnl
a jokc~. (‘ax> saw unhappiness and misfortune in wrongly treated cases ((xx-
l)ilnsiOI1 11ith proclination of incisors), while “self poise and intellectuality”
stt~mmod from the extraction of four teeth. The “new school” (An&, r(lpr~-
scnted by I)ewcy in this debat,ej, on the other hand, firmly brliered that the>
I’~11tl(~rc,lol)rrlc~iltof facial beauty implied and necessitated retention of the full
c*omplcmcnt of teeth.
A1lthough Angle taught this concept of the ideal normal, he was human
t>nough to say (in private) that one had to use “horse sense” in dealing with
complex and doubtful cases, but he could not say this in print. Although of widr
philosophic and biologic interest, his reasoning narrowed on etiology. Not only
refuting the possibility of inheritance, he furthermore taught that most mal-
occlusions commenced, or were initiated, with the eruption of the first permanent
molars. I)ewvcy, in attacking Case and Cryer on inherit,ance, asked why “did not
presumabl>- inherited conditions appear in the deciduous teeth?” This qucst,iou
revealed the limitations of his t,hinking and his observations, highlighted by his
attitude on himaxillary protrusions, Angle’s (nonrcvealed) Class TV.
WC must relate Case’s treatment planning with regard to bimasillary pro-
trusions and prominent premaxillae to the techniques available at that time.
Anchorage, for the most part, was simple anchorage; body control, root torque,
and extraoral anchorage were just visions of things to come, and Case was no
tloubt right, in his crit,icism of the results of the tipping type of tooth movement
of that era. Angle, of course, believed that, once teeth were moved (tipped) into
posit,ions of correct intereuspal relations, the “forces of occlusion” would ul)-
right the teeth, induce bone growth, and stabilize the result. Cryer ~n~doubtedl~
sensed this, though as an anatomist he could not, knowledgeably support, Angle’s
thesis.
\\‘hile Cryer supported Case, particularly with regard to inhcritancc gun-
c~lly, he was cautious regarding the possibilities of induced growth, stating that
hc c*onsidered Case to b’e right in believing that “new bone cannot be intluccd to
grow beyond its inherited size,” but followed by saying that “what I may think
tomorrow is another question.” Crycr very definitely showed the mutability OI
alveolar bone, and, as newel admiringly points out, was scnt,ient to the mcch-
anisms of tissue reaction under orthodontic st,imulat.ion.
This mechanistic as distinct from biologic concept became the (y)rnerstonc
upon which the ‘(new school” was built. Let, us recognize that departures from
this concept admittedly have been based on failure, but let not failure blind us
t,o the possibilities of achieving the goal of the “ideal normal” and let L‘llors(~
sense”L and effort be the guide lines of future progress.
275 3~ucquarzeSt.