topic of update · current main criteria for tooth extrac-tions in the prophylaxis and treatment of...

ABSTRACTThe aim of this article is to review thecurrent main criteria for tooth extrac-tions in the prophylaxis and treatment ofmalocclusions and dentofacial deformi-ties. Dental extractions are an essentialtherapeutic weapon in the managementof certain malocclusions. They are indi-cated for obtaining arch space, improve-ment of facial aesthetics andachievement of balanced occlusion,among others.

"Conventional" standards of therapeuticextractions correspond to different com-binations of symmetrical extraction ofpremolars; however, atypical extractionswhich do not follow a definite pattern arebecoming increasingly frequent. They aremore common in adult patients and areperformed for reasons related to thepathology of the extracted tooth itself orto the demands of unconventional mal-occlusion treatment. Examples of atypi-cal extractions are that of a lower incisorwith indications, contraindications andundesirable effects which are well de-fined.

Temporary teeth extractions may be per-formed as part of an eruption guide pro-gramme, which must be adapted to the

situation of each patient and never con-sidered as a rigid scheme of general ap-plication.

KEYWORDSExtractions; Malocclusion; Orthodontics;Eruption guide; Facial aesthetics.

Extractions In Orthodontics:An update

Topic of update

Morón Duelo, RocíoGraduates in dentistry, 3rd yearresidents Orthodontics Postgra-duate Programme, Fundación Ji-ménez Díaz University Hospital.

Marcianes Moreno, MaríaGraduates in dentistry, 3rd yearresidents Orthodontics Postgra-duate Programme, Fundación Ji-ménez Díaz University Hospital.

De la Cruz Fernández, CarmenGraduates in dentistry, 3rd yearresidents Orthodontics Postgra-duate Programme, Fundación Ji-ménez Díaz University Hospital.

Domínguez-Mompell Micó,Ramón Graduates in dentistry, 3rd yearresidents Orthodontics Postgra-duate Programme, Fundación Ji-ménez Díaz University Hospital.

García-Camba Varela, PabloDentist, Doctor in the UAM De-partment of Medicine, Specialistin Orthodontics in OrthodonticsUnit and Lecturer in the Ortho-dontics Graduate Programme,Fundación Jiménez Díaz Univer-sity Hospital.

Varela Morales, MargaritaDoctor of Medicine and Surgery,Specialist in Orthodontics, Headof Orthodontics Unit and Directorof the Orthodontics GraduateProgramme, Fundación JiménezDíaz University Hospital.

científica dental. vol 12 (special supplement) 2015. 32

Correspondence address:Rocío Morón Duelo

C/El Majuelo nº1 portal 4, 4ºA28005 Madrid, [email protected]: 620477854

Received: 13 February 2014.Accepted (or accepted for publication): 4 April 2014.

Indexed in:- IME- IBECS- LATINDEX- GOOGLE SCHOLAR

Published in spanish Científica Dental Vol. 12. Nº 1. 2015www.cientificadental.es

33 científica dental. vol 12 (special supplement) 2015.

BACKGROUNDThe need to perform extractions as part of the treat-ment plan for some malocclusions remains one of thegreat controversies in orthodontics.

Since the dawn of the specialty, Angle passionatelydefended the conservation of all teeth for perfect oc-clusion. He eventually accepted the need to abandonthis ultraconservative position and to take into ac-count the impact on the profile, stability and otherconstraints, such as periodontal health and declaredto have acted to maintain the complete dental provi-sion of some of his patients at all costs. On the otherhand, Calvin Case, who could be considered a con-temporary scientific adversary, advocated the use ofpermanent teeth extractions, if necessary, to success-fully resolve malocclusion (Figure 1).

Since then, there have been swings in prevailing cur-rents of opinion regarding therapeutic extractions inorthodontics. On the one hand, these movementshave been based on the different fashions presidingover facial aesthetics at different historical times; butalso on the availability of therapeutic techniques andinstruments of varying scientific bases, replacingwhat were previously inevitable extractions for han-dling certain malocclusions. Fundamental amongthese was the introduction of the palatal arch bar byCetlin, distalisers, microscrews, and self-ligatingbracket systems.

This review discusses the most relevant aspects sur-rounding the application of this important therapeu-tic tool in orthodontics, in the light of informationfound in the literature. We will focus on the indica-

tions for extractions and the patterns of teeth to ex-tract.

I. INDICATIONS FOREXTRACTION IN DENTISTRY

Therapeutic extractions in orthodontics are primarilydone for the following reasons:

1. Achieving arch space: To correct negative osseo-dental discrepancy (DOD), which usually mani-fests as crowding.

2. Facial aesthetics: To reduce dentoalveolar pro-trusion.

3. Occlusion: To properly connect both arches innormo-occlusion.

4. Stability: To better maintain the results achieved.

5. Others: For example, periodontal health, dentaland medical pathology.

1. Extractions and arch space: DOD

One of the most important and common indicationsfor orthodontic extractions is the lack of space in thearch that usually manifests as more or less localisedcrowding.

Achieving proper dental alignment in their bony basesrequires consideration of the compromise betweenthe size of the teeth themselves and the size and shapeof their bases within the framework of the dentofacialskeletal relationship for each patient. The orthodontistcan act on the maxillomandibular skeleton well usingorthopaedic means in children, as well as in adoles-cents with residual growth or with surgical care wherethere is no such growth. In every case, the limits im-posed by the individual maxillomandibular anatomymust always be assessed when deciding whether amalocclusion with negative DOD can be resolved con-servatively or whether one must resort to extractions.

Some multibracket systems, particularly self-ligating,have entered the market declaring they are able to re-

Figure 1: A. Edward H Angle and B. Calvin S Case.


duce the need for extractions in a number of cases ofnegative osseodental discrepancy, where it wouldhave been essential to remove teeth if conventionaltechniques had been applied. However, disputes inthis regard are very important. Many authors considerthat these techniques only produce a dental overex-pansion of the arch which does not correspond to realproduction of alveolar bone to neutralise the DOD,and instead could lead to an unacceptable weakeningof the alveolar bone tables.

Distalisation devices to prevent extractions by mesial-isation of the maxillary molars where there is a lackof space deserve a special mention. Distalising thesemolars can lead to recovery of space in the arch thatcould otherwise only be obtained by extracting pre-molares7-10.

Mention must also be made of the unquestionablecontribution that micro-implant development hasmade in preventing many extractions; in fact, this isone of its numerous indications.

When there is a negative osseodental discrepancy dueto excess transverse dimensions in the teeth, it is fea-sible to reduce this by a stripping technique. How-ever, one or more teeth will have to be removed inmany cases, even after reasonable expansion of thearches. This method does not exclude extractions, butin many cases is complementary to them; i.e. achiev-ing a suitably wide arch is a goal in itself, which willnot always guarantee that DOD extractions will beavoided.

2. Extractions and facial aesthetics

One of the main indications for orthodontic extrac-tions is to achieve a more harmonious profile in pa-tients with excessive facial convexity secondary todental biprotrusion. It must be noted, in this regard,that the concept of the ideal profile has changed no-tably throughout the last century6. Several decadesago, the ideal Caucasian profile was flat or evenslightly biretrusive, with relatively thin lips; while inrecent times more convex profiles have become morepopular with a marked lip relief and a wide smile with

buccal corridors. This change in tastes for greater fa-cial convexity is mainly for women and in Caucasians;whereas in the male and in oriental races, the flat pro-file is still considered more harmonious. Obviously,this is not the case in negroid races, one of whosemost characteristic features is precisely biprotrusion.

The greater tolerance to convexity in our environmenthas naturally reduced the need for extractions due tobiprotrusion and DOD. For example, Proffit performeda study on the changes in the pattern of extractionsin the treatment of malocclusions during the last 60years. It showed that the frequency of extractions wasaround 30% for the years 1953 and 1993: 40 yearsapart. However, interestingly, the analysis in 1968gave a result of 76%. The explanation given for thishigh percentage was the trend at the time for remov-ing all teeth outside of the arch. At present, this pro-portion is limited to 5%; 20% down on most studies1.

However, there are some facial features linked to ex-cessive convexity which are objectionable in any aes-thetic framework and put a limit on the extractionoption. One of those features is the hyperactivity ofthe muscles of the chin associated with biprotrusionwhich, in an effort to close the lips, gives the chin akind of "golf ball" appearance.

The positive effect on the profile of extracting the bi-cuspids in patients with a normal vertical dimensionor a little short and a marked biprotrusion, especiallyif associated with crowding, is generally clear; thus,there is usually agreement among authors for its in-dication1. This does not occur in the biprotrusive pa-tients with a pattern of mandibular posterorotationand dolicofacial growth. The aesthetic result in thesepatients of resolving biprotrusion with extractions isunpredictable, if not clearly wrong; so the clinician isoften faced with the choice of obtaining good occlu-sion at the risk of worsening facial aesthetics, or notaltering the profile and accepting the limitations in theresolution of the malocclusion. Obviously, in caseswhere the dentofacial deformity is more severe, or-thognathic surgery allows for both goals, facial and oc-clusial.


A trait that also determines the indication for thera-peutic extractions and the management of orthodon-tic appliances in these cases is the presence of overbiteor open bite. Extractions tend to increase overbite,which is positive when there is a tendency to open biteand undesirable in patients with a deep bite.

In short, the indication of therapeutic orthodontic ex-tractions is subject to multiple circumstances whichneed to be carefully assessed in the treatment plan. Infact, an identical malocclusion will require a conserva-tive or extractive approach depending precisely on arigorous evaluation of these circumstances. Figure 2outlines this unquestionable reality (Figure 2).

3. Extractions and normalising occlusion

Achieving a class I canine is not an objective to bewaived with a malocclusion; although in exceptionalcircumstances limitations have to be accepted in thisregard, especially in adult patients.

However, although desirable, an Angle class I molarseems inessential for either oral or joint health. Nev-ertheless, the orthodontist usually tries to achieve it.When the patient is in growth, the use of orthopaedic

and functional appliances may contribute to achievingthis desired molar class I, linked to the normalisationof the skeletal relationship. When no residual growthremains, apparatus specifically aimed at the normali-sation of occlusal relationships can be used. There arenumerous molar distalisation devices to treat Class IIteeth7-9 and designs with microscrews for classes II, IIIand open bites, for example10. However, it is often notpossible to achieve the objective of the molar normalocclusion, so extractions need to be resorted to for aclass I canine, and other aesthetic or periodontal goals,for example. As discussed below, these can be plannedaccording to a typical pattern (class II upper premolarsand class III lower ones), or atypical patterns can beused, depending on the circumstances of each case.

4. Extractions and stability of results

One of the key aspects in the success of orthodontictreatment is the stability of long-term results, whichdepends on certain parameters such as the interinci-sive angle, overbite, overjet, appropriate transversedimensions and good periodontal health. There is nogeneral agreement on the impact of therapeutic ex-tractions on the post-treatment stability of each ofthese parameters. One of the advantages that have

Figure 2: Patient A has a dentoalveolar biprotrusion with convex profile. Patient B has dentoalveolar biretrusion with concave profile.If both have the same malocclusion with crowding, patient A should be treated by removing the first bicuspid, while teeth extraction should be avoided inpatient B if possible, due to potential undesirable effects in facial aesthetics.

If both have the same malocclusion,which will be their treatment?

Treated by removing the first

bicuspid

Theeth extractionshould be avoided


been claimed for extractions is that they promotestability, both with overjet and crowding. However,not all authors agree, and some view the possibilitiesof extractions with scepticism and say that, overtime, the lower incisors tend to come together again,regardless of the treatment modality: conservativeor not conservative1. Others point out that the keyissue is the proper location of the teeth relative tothe alveolar bone to maintain stability and periodon-tal health; such that the only thing that would ensurestability would be obtaining a proper interincisiveangle (Figure 3).

One experience shared by orthodontists is that deepoverbite in extraction cases tends to recur more thanin cases where no extraction takes place12.

5. Extractions and intrinsic pathology

Sometimes, in planning the treatment of a malocclu-sion that could be treated without extractions, re-moval of one or more teeth is included simplybecause they have intrinsic pathology or are peri-odontally compromised. If ignored, this condition cancompromise medium- or long-term viability or hinderthe treatment of the malocclusion itself. At othertimes, it is the requirement of an interdisciplinarytreatment where other experts make the decision toextract. The most common pathology in this sense ispartly periodontal (including recessions and severedehiscence) and partly pulpar of an infectious or trau-matic nature. Although morphological abnormalitiesand ectopic eruption are other reasons.

II. PATTERNS OF TEETH TO BE REMOVED INORTHODONTICS

1. Conventional or typical patterns

Table I Shows the most common tooth extractionpatterns used and their main indications for treatingmalocclusions. It is open to multiple qualificationsand exceptions but is basically an indicative scheme.

2. Atypical extractions

In practice, they are very common and, althoughthey may be necessary in patients of all ages, theirfrequency has increased proportionally with the in-corporation of adult orthodontic consultations. Theyhave multiple indications, whether related to thepathology of the extracted tooth itself or unconven-tional malocclusion treatment demands. These ex-tractions are very commonly indicated in adultpatients because, after a certain age, dental mutila-tions, periodontal disease and other conditions thatwill affect the malocclusion treatment plan are aconstant feature in our environment.

Table II contains examples of reasons for unconven-tional or atypical extractions. Particular atypical ex-tractions worth a mention are extraction of a lowerincisor and the first molars, so these are particularlyreferred to from the orthodontic treatment point ofview34,35.

2.1 Extraction of a lower incisor

The frequency of extraction of a lower incisor in or-thodontic clinics is highly variable. Most authors putthe figure at 1.1-6% of all patients treated for mal-occlusion33,36. For example, Proffit in the 1950srecorded the extraction of a lower incisor in 20% ofall malocclusive patients treated with extractions6.

The main indications for extracting a lower incisor are:

- Malocclusion of Angle Class III, light – moderate,with little negative overjet or 0 overjet and de-creased overbite.

This is the fundamental indication, but has the limi-tation of not properly resolving the molar and canineclasses. Extracting a lower incisor involves a reduc-tion in arch length and extrusion and retrusion of theremaining lower incisors; thus increasing the over-bite and overjet. As a result, extraction of a lower in-cisor is only recommended in patients with an AngleClass III malocclusion to resolve mild to moderate an-terior crowding not accompanied by excessive over-bite or large negative overjet.


- Malocclusion of Angle Class I or II with Bolton dis-crepancy

The extraction of a lower incisor may be indicated foran increase in the transverse dimension of the lowerincisors (lower discrepancy excess), but also whenthe patient has microdontia, or even agenesis, of theupper ones (upper discrepancy defect). In thesecases, extraction of the lower incisor is consideredover other possible alternatives, as would be strip-ping in the anteroinferior sector for lower discrep-

ancy excess or remodelling of the upper incisors inupper discrepancy defect.

Specifically in class II with Bolton discrepancy, the ex-traction of a lower incisor may be combined with theuse of some distalisation mechanism, or with the ex-traction of two upper bicuspids. Skeletal class II casescan be treated with orthognathic surgery, with theextraction of a lower incisor possibly being part of apresurgical orthodontic treatment plan.

Figure 3: Patient with dentoalveolar biprotrusion treated by extracting first bicuspids. An improvement in the profile can be seen.a, b, c, d, e, f: Initially. g, h, i, j, k, l: After treatment. m, n, ñ, o, p: After one year of retention.

A B C

G H I

M N

O P

Ñ

D E F

J K L


C. Temporomandibular dysfunction with mandibu-lar retroposition

It has been suggested that the removal of a lower in-cisor facilitates the anterior reposition of themandible in patients with TMJ dysfunction and AngleClass I malocclusions without residual growth.

Table III lists the undesirable effects and contraindi-cations of therapeutic extraction of a lower incisor36.

2.2 Extraction of the first molars

The functional significance of the first molars meansthey are rarely suggested for extraction in the con-ventional treatment of malocclusion. However, it isnot uncommon to find first molars affected by severepathologies, such that their removal is consideredwithin an interdisciplinary therapeutic plan. Amongthese pathologies are those that involve significant

destruction of the crown which makes restorativetreatment difficult; particularly extensive decay andsevere enamel defects (isolated hypoplasia and inci-sor-molar syndrome).

Therapeutic removal of first molars may also be con-sidered for eruption disorders, whether due to anky-losis or ectopies of difficult renewal. Extracting thefirst molar with a pathology may be an alternative toa first premolar. When there is no indication to ex-tract premolars, the space left by the removal can beclosed by mesialisation of the second molars andeventually the wisdom teeth. In this case, the finalocclusal position should be considered beforehand,depending on the molars remaining after extraction.

In adult patients, the most common cause of perma-nent molar extraction is periodontal disease of thetooth.

2.3 Extraction of temporary teeth

Temporary teeth extraction is an important prophy-lactic weapon in the development of certain maloc-clusions. However, it is a subject of constant debateand clashes between orthodontists, who indicate theextractions, and paediatric and general dentists whohave to perform them and do not always understandthe need for them. Removing temporary teeth canbe prescribed in a timely and well located mannereither or within the framework of a programmederuption guide.

Specific indications for removal of temporary teethwithout a predetermined pattern are very common;thus, only a few of the most frequent in orthodonticpractice will be outlined.

Firstly, the prevention of permanent teeth impactionmust be mentioned. Important in this area is the re-search by Ericson and Kurol on prophylaxis of the im-paction of palatal maxillary canines in cases oferuptive deviation during the period of mixed denti-tion40-41. These authors showed that the extractionof canines, and eventually the first upper molars, inchildren with deviation of the permanent ones pre-vented their evolution to inclusion in 60-90% of

EXTRACTION PATTERNS INDICATIONS- First 4 bicuspids - Angle class I with:

- Crowding and/or- Biprotrusion and/or- Open bite.

- First 2 upper bicuspids - Angle class II. - First upper bicuspids and second lower - Class II with:

- Overjet and/or- Crowding.

- First 2 lower bicuspid - Angle class III.

TABLE I: TYPICAL PATTERNS OFTOOTH EXTRACTIONS INORTHODONTICS: INDICATIONS

REASONS FOR EXTRACTION TOOTH TO BE EXTRACTED- Correction of the midline. - Bicuspid- Asymmetric malocclusions- Bolton Discrepancy - Lower Incisor- Lower crowding in Class III- Agenesis of a lateral incisor - Upper lateral incisor

(contralateral)- Ectopy, impaction - Upper canines- Ankylosis- Intrinsic pathology - Tooth affected

TABLE II. REASONS FOR ATYPICALORTHODONTIC EXTRACTIONS ANDTEETH EXTRACTED


cases. This prophylactic extraction procedure of tem-porary canines deserves special consideration in pa-tients with agenesis of the lateral incisors for itsproven association with canines.

Another indication that is frequently suggested is theextraction of temporary second molars in cases of im-paction of the permanent first with infraocclusion. Inthese cases, a distal reduction of the second tempo-rary molar (slicing) can be performed; but if this is notenough, they must be extracted. Usually, the perma-nent molar erupts spontaneously afterwards, but isessential to control the loss of the space required forthe premolar successor.

Finally, mention must be made of the extraction ofthe temporary incisors in the presence of eruptive al-terations of the permanent successors. The etiologyof their impaction is multiple: traumatic events withthe incisor itself or its temporary predecessor; thepresence of obstacles such as supernumerary teeth,odontomas or cysts; or jaw malformations, especiallya cleft palate. In all these cases, when the temporarypredecessor persists, usually removal is indicated, as-sociated or not with other orthodontic or surgicalprocedures28,42,43.

2.4 Guiding eruption

A programme of serial extraction of temporary teethor, even better, a guide to eruption may facilitate the

treatment of malocclusion in temporary or mixeddentition or prevent its full development44.

However, many authors have pointed out the impor-tance of extreme prudence and knowledge of thepathophysiology of the eruption when using thistherapeutic tool. In inexpert hands, significant unde-sirable effects can occur by improperly handling theanchor and maintaining spaces, for example. In short,programmes guiding the eruption are far from beinga rigid solution that apply in all cases; but must betailored to each patient's pathology, ending or not inthe removal of the first bicuspids45.

CONCLUSIONSDental extractions are a highly useful weapon in theprophylaxis and treatment of numerous malocclu-sions. However, their use requires great caution anda thorough understanding of the pathophysiology oferuption, occlusion and facial aesthetics. The ortho-dontist is faced with numerous facial and dental de-formities which cannot be managed by the rigidapplication of treatment plans; and this is particularlyapplicable to tooth extractions. Adult patients oftenhave very complex pathologies which pose manychallenges to the orthodontist, among which are theability to remove or keep teeth and to manage thiswithin an interdisciplinary approach.

UNDESIRABLE EFFECTS - Excessive overjet and overbite.- Reopening of extraction space.- Inadequate posterior occlusion.- Loss of interincisor papilla with appearance of "black triangles".- Mesial inclination of the lower canines.- Excessive lingual inclination of the remaining lower incisors.- Inconsistency of midlines (inevitable).

CONTRAINDICATIONS - Bolton Discrepancy, upper excess.- Increased overbite.- Triangular anatomy of lower incisors, especially with periodontal disease. - Increased overjet.

TABLE III: UNDESIRABLE EFFECTS AND CONTRAINDICATIONS FORTHERAPEUTIC EXTRACTION OF A LOWER INCISOR


1 The hot seat of August. J Clin Or-thod 2013.

2 Angle EH. Treatment of malocclu-sion of the teeth. Philadelphia: SSWhite Manufacturing, 1907.

3 Bernstein L, Edward H. Angle ver-sus Calvin S. Case: extraction ver-sus nonextraction. Part I. Historicalrevisionism. Am J Orthod Dento-facial Orthop 1992; 102: 464-470.

4 Bernstein L, Edward H. Angle ver-sus Calvin S. Case: extraction ver-sus nonextraction. Part II. Histori-cal revisionism. Am J OrthodDentofacial Orthop 1992; 102:546-551.

5 The Extraction Debate of 1911. AmJ Orthod. 1964; 50: 656-691 TheExtraction Debate of 1911. Am JOrthod. 1964;50: 751-768 The Ex-traction Debate of 1911. Am J Or-thod. 1964; 50:843-851 The Ex-traction Debate of 1911. Am JOrthod 1964; 50: 900-912.

6 Proffit WR. Forty-year review of ex-traction frequencies at a universityorthodontic clinic. Angle Orthod1994; 64: 407-414.

7 Cetlin NM, Ten Hoeve A. Nonex-traction treatment. J Clin Orthod1983; 17: 396-413.

8 Carrière L. A new Class II distalizer.J Clin Orthod 2004; 38: 224-231.

9 Wilmes B, Ludwig B, Katyal V, Nien-kemper M, Rein A, Drescher D.

10 The Hybrid Hyrax Distalizer, a newall-in-one appliance for rapid pala-tal expansion, early class III treat-ment and upper molar distalization.J Orthod 2014; 41: 47-53.

11 Harradine N. Self-ligating bracketsincrease treatment efficiency. AmJ Orthod Dentofacial Orthop 2013;143: 10-18.

12 Canut Brusola JA. Ortodoncia clí-nica y terapeutica. Barcelona:Masson, 2000: 403-416.

13 Francisconi MF, Janson G, FreitasKM, Oliveira RC, Oliveira RC, Frei-tas MR, Henriques JF. Overjet,overbite, and anterior crowding re-lapses in extraction and nonextrac-tion patients, and their correlations.Am J Orthod Dentofacial Orthop2014; 146: 67-72.

14 Birnie D. The Damon Passive Self-Ligating Appliance System. SeminOrthod 2008; 14: 19-35.

15 Maltagliati LA, Myiahira YI, FattoriL, Filho LC, Cardoso M. Transver-sal changes in dental arches fromnon-extraction treatment with selfligating brackets. Dental Press JOrthod 2013; 18: 39-45.

16 Jaw-Hyun S, Hee-Moon K. Mi-croimplants in orthodontics. Korea:Dentos, 2006.

17 Livas C, Jongsma AC, Ren Y. En-amel reduction techniques in or-thodontics: a literature review.Open Dent J 2013; 7: 146-151.

18 Peck H, Peck S. A concept of facialesthetics. Angle Orthod 1970; 40:284-318.

19 Meyer AH, Woods MG, MantonDJ. Maxillary arch width and buc-cal corridor changes with ortho-dontic treatment. Part 1: differen-ces between premolar extractionand nonextraction treatment out-comes. Am J Orthod DentofacialOrthop 2014; 145: 207-216.

20 Solem RC, Marasco R, Guiterrez-Pulido L, Nielsen I, Kim SH, Nel-son G.

21 Three-dimensional soft-tissue andhard-tissue changes in the treat-ment of bimaxillary protrusion. AmJ Orthod Dentofacial Orthop 2013;144: 218-228.

22 Yin L, Jiang M, Chen W, SmalesRJ, Wang Q, Tang L. Differencesin facial profile and dental estheticperceptions between young adultsand orthodontists. Am J OrthodDentofacial Orthop 2014; 145:750-756.

23 Travess H, Roberts-Harry D,Sandy J. Orthodontics. Part 8: Ex-tractions in orthodontics. Br DentJ. 2004; 196: 195-203.

24 The editor corner of August, theextraction controversy. J Clin Or-thod 2013.

25 Kocadereli I. Changes in soft tis-sue profile after orthodontic treat-ment with and without extractions.

BIBLIOGRAPHY


Am J Orthod Dentofacial Orthop2002; 122: 67-72.

26 Faerovig E, Zachrisson BU. Effectsof mandibular incisor extraction onanterior occlusion in adults withClass III malocclusion and reducedoverbite. Am J Orthod DentofacialOrthop 1999; 115: 113-124.

27 Rinchuse DJ, Kandasamy S.Myths of orthodontic gnathology.Am J Orthod

28 Dentofacial Orthop. 2009; 136:322-30.

29 Erdinc AE, Nanda RS, Işiksal E.Relapse of anterior crowding in pa-tients treated with extraction andnonextraction of premolars. Am JOrthod Dentofacial Orthop. 2006;129: 775-84.

30 Kokich VO Jr. Treatment of a ClassI malocclusion with a carious man-dibular

31 incisor and no Bolton discrepancy.Am J Orthod Dentofacial Orthop2000; 118: 107-113.

32 anson G, Valarelli DP, Valarelli FP,de Freitas MR, Pinzan A. Atypicalextraction of maxillary central inci-sors. Am J Orthod Dentofacial Or-thop 2010; 138: 510-517.

33 Bravo González, LA. Manual deOrtodoncia. Madrid: Sintesis,2003:15-16.

34 Proffit WR, Henry W. OrtodonciaContemporánea. Barcelona: Else-vier Mosby, 2008: 7-8.

35 Chung KR, Choo H, Lee JH, KimSH. Atypical orthodontic extraction

pattern managed by differential en-masse retraction against a tempo-rary skeletal anchorage device inthe treatment of bimaxillary protru-sion. Am J Orthod Dentofacial Or-thop 2011; 140: 423-432.

36 Tai K, Park JH, Takayama A. Con-genitally missing maxillary lateralincisor treated with atypical extrac-tion pattern. J Clin Pediatr Dent2011; 36: 11-18.

37 Canut JA. Mandibular incisor ex-traction: indications and long-termevaluation. Eur J Orthod 1996; 18:485-489.

38 Brandt S, Safirstein R. Differentextractions for different malocclu-sions. Am J Orthod 1975; 68: 15-41.

39 Tayer BH. The asymmetric extrac-tion decision. Angle Orthod. 1992;62: 291-297.

40 Zhylich D, Suri S. Mandibular inci-sor extraction: a systematic reviewof an uncommon extraction choicein orthodontic treatment. J Orthod2011; 38: 185-195.

41 Bahreman A. Lower incisor extrac-tion in orthodontic treatment. Am JOrthod 1977; 72: 560-567.

42 Uribe F, Nanda R. Considerationsin mandibular incisor extraction ca-ses. J Clin Orthod 2009; 43: 145-151.

43 Alessandri Bonetti G1, Zanarini M,Incerti Parenti S, Marini I, GattoMR. Preventive treatment of ecto-pically erupting maxillary perma-nent canines by extraction of deci-

duous canines and first molars: Arandomized clinical trial. Am J Or-thod Dentofacial Orthop 2011; 139:316-323.

44 Ericson S, Kurol J. Early treatmentof palatally erupting maxillary ca-nines by extraction of the primarycanines. Eur J Orthod 1988; 10:283-295.

45 Naoumova J, Kurol J, Kjellberg H.Extraction of the deciduous canineas an interceptive treatment in chil-dren with palatal displaced cani-nes-part I: shall we extract the de-ciduous canine or not? Eur JOrthod 2014; 22: 15-16.

46 Andreasen JO, Lauridsen E,Gerds TA, Ahrensburg SS. DentalTrauma Guide: a source of evi-dence-based treatment guidelinesfor dental trauma. Dent Traumatol2012; 28: 345-350.

47 Altun C, Cehreli ZC, Güven G, Aci-kel C. Traumatic intrusion of pri-mary teeth and its effects on thepermanent successors: a clinicalfollow-up study. Oral Surg OralMed Oral Pathol Oral Radiol En-dod 2009; 107: 493-498.

48 O'Shaughnessy KW, Koroluk LD,Phillips C, Kennedy DB. Efficiencyof serial extraction and late pre-molar extraction cases treated withfixed appliances. Am J OrthodDentofacial Orthop 2011; 139: 510-516.

49 Migliaccio S, Aprile V, Zicari S,Grenci A. Eruption guidance ap-pliance: a review. Eur J PaediatrDent 2014; 15: 163-166.

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