Extraction Decision

In Orthodontics

Dr. Waqar
Jeelani BDS,
FCPS
(Orthodontics)
Assistant
Professor of
 Why Space is Required?

The correction of different types of

malocclusions requires space in order
to move teeth into more ideal
locations.
Why We Require Space?

To treat
1. Crowding
2. Retraction of proclined teeth
3. Leveling of curve of Spee
4. Correction of molar and canine
relationship
5. To correct midlines
How Can We Gain Space in Arch?

[D2-E2-P2-U]
1. Proximal stripping
2. Expansion
3. Extraction
4. Distalization
5. Uprighting of molars
6. Derotation of posterior teeth
7. Proclination of anterior teeth
Problems Requiring Orthodontic
Extractions
• Crowding (TM-ALD)
• Proclination of teeth
• Procumbent lips
• Shifted midlines
• Abnormal molar and canine relationship
• Increased overjet
• Decompensations before orthognathic surgery
• Ectopic teeth
• Block out teeth
• Periodontally compromised teeth
• Carious teeth
 Extraction
s
• Premolars are the most common choice
• Extraction of one premolar from each quadrant does
not effect function & esthetics
• It is not uncommon to extract molars or lower
incisors during therapy
• Extractions of canines & upper incisors is
usually avoided
 Extraction
Indications s
1. Moderate to severe arch length tooth material
discrepancy
2. Proclined teeth
3. Procumbent incompetent lips
4. Teeth of poor prognosis (grossly carious / periodontally
compromised)
5. Correction of occlusal relationships
Balancing Extraction
• Removal of another tooth on the opposite side of same
arch
Compensating Extraction
Crowding
• 0-4 mm avoid extractions
• Use stripping where needed
• 4-8mm
• May or may not require extractions
• Consider other factors, lip procumbency, nasolabial angle,
lip competency, tooth inclination
• > 9 mm
• Almost always treated with extractions
Treatment without Extractions
Extraction of lower single incisor
• Indications
• Cases with crowding in lower anterior region only with
good buccal occlusion
• Anterior mandibular tooth material excess on Bolton’s
analysis
• Edge to Edge bite (Class III incisor relationship)
• Minimum Overjet and Overbite
• Blocked out incisor
• Contraindications
• Deepbite with increased overjet
• Maxillary tooth material excess
• Generalized spacing
Extraction of First Molars
• Indications:
• Grossly Carious
• As compensating extraction
• As balancing extraction
• Already extracted 3 first molars, extraction of remaining 1
• Crowding in posterior region
Post Treatment Molar Relationship
in Different Extraction Patterns
• Single Unit = Any tooth from central incisor to 2nd Premolar
in both arches, except lower incisor, is considered as single
unit
Single Unit Extraction from all quadrants
Molar relationship at the end of treatment – Class
I e.g.
4 4 5 5 4 4 5 5 4 5
1 5
4 4 5 5 5 5 4 4 4 5
3 5

4 5 2 2 2 4 1 5 1 5
1 3
5 4 4 4 4 5 4 4 4 4
4 3
 Post Treatment Molar Relationship
in Different Extraction Patterns
• Single Unit = Any tooth from central incisor to 2nd Premolar
in both arches, except lower incisor, is considered as single
unit
Single Unit Extraction from only upper quadrants
Molar relationship at the end of treatment – Class
II e.g.
4 4 5 5 4 5
1 5

2 2 2 4 1 5 3 5
1 3
Post Treatment Molar Relationship
in Different Extraction Patterns
• Single Unit = Any tooth from central incisor to 2nd Premolar
in both arches, except lower incisor, is considered as single
unit
Single Unit Extraction from only lower quadrants
Molar relationship at the end of treatment – Class
III e.g.

4 4 5 5 4 5

3 5 4 5 3 4 3 3
Post Treatment Molar Relationship
in Different Extraction Patterns
• Single Unit = Any tooth from central incisor to 2nd Premolar
in both arches, except lower incisor, is considered as single
unit
Extraction of One or more molars from any quadrant does not
affect the post treatment molar relationship

Extraction of lower single incisor keep molar relationship Class I

or super class I.
Questions?