Zhylich D, Suri S. Mandibular incisor extraction: a systematic review of an uncommon extraction choice in orthodontic treatment. J Orthod. 2011; 38:185-195 https://doi.org/10.1179/14653121141452
Uribe F, Holliday B, Nanda R. Incidence of open gingival embrasures after mandibular incisor extractions: a clinical photographic evaluation. Am J Orthod Dentofacial Orthop. 2011; 139:49-54 https://doi.org/10.1016/j.ajodo.2009.03.049
Rufenacht CR. Principles of Esthetic Integration.Chicago: Quintessence Publishing; 2000
Thiruvenkatachari B, Javidi H, Griffiths SE, Shah AA, Sandler J. Extraction of maxillary canines: esthetic perceptions of patient smiles among dental professionals and laypeople. Am J Orthod Dentofacial Orthop. 2017; 152:509-515 https://doi.org/10.1016/j.ajodo.2017.02.015
Faerovig E, Zachrisson BU. Effects of mandibular incisor extraction on anterior occlusion in adults with Class III malocclusion and reduced overbite. Am J Orthod Dentofacial Orthop. 1999; 115:113-124 https://doi.org/10.1016/s0889-5406(99)70337-9
Khalaf K, Miskelly J, Voge E, Macfarlane TV. Prevalence of hypodontia and associated factors: a systematic review and meta-analysis. J Orthod. 2014; 41:299-316 https://doi.org/10.1179/1465313314Y.0000000116
Sheridan JJ, LeDoux W, McMinn R. Essix retainers: fabrication and supervision for permanent retention. J Clin Orthod. 1993; 27:37-45
Kokich VG, Shapiro PA. Lower incisor extraction in orthodontic treatment. Four clinical reports. Angle Orthod. 1984; 54:139-153
Management of Lower Incisor Extraction Cases. Part 1: Case Selection and Planning John Scholey Semina Visram Yatisha A Patel Dental Update 2024 14:4, 707-709.
Extraction of a lower incisor as part of an orthodontic treatment plan is still considered one of the more unusual choices in contemporary clinical practice. There are, however, situations where this treatment choice may be either enforced, or it provides an additional option that can both simplify treatment and increase efficiency. This article examines clinical situations where extraction of a lower incisor is necessary for reasons of poor pathology, position, or when actively choosing this incisor for extraction and maintaining the equivalent of three lower incisors is of benefit to the patient. In the first part of this series, we focus on appropriate case selection and aids to planning. The second part of this series concentrates on problems encountered when extracting a lower incisor, and how these are managed.
CPD/Clinical Relevance: This two-part series guides clinicians on case selection and management of patients where the final occlusion will result in three lower incisors. It will look at case selection, treatment planning, problems that may be encountered and potential solutions.
Article
Within orthodontic practice, extraction of permanent teeth to provide space for alignment is a common treatment planning decision. The most frequent choice for extraction is still the first or second premolar, which provides, on average, 7 mm of space within the buccal segments. This enables clinicians to balance anchorage, maintain centrelines and have teeth of an appropriate morphology for ideal interproximal contacts. Extractions are frequently carried out bilaterally to prevent significant centreline deviations.
Removal of a single lower incisor provides, on average, 6 mm of space within the anterior segment. This causes less disturbance to the posterior buccal fit of the teeth and, if planned correctly, does not need to compromise symmetry. There are a number of situations where choosing this single extraction can facilitate an acceptable outcome.1
There are many reasons why the prognosis of a lower incisor may be compromised. Although it may result in more challenging treatment, it may be prudent to consider removal of a tooth that has a poor long-term prognosis. In some cases, more than one lower incisor may be severely affected. If two incisors require removal, planning treatment to leave space that is the equivalent of three lower incisors means that, potentially, only one long-term restoration is needed, rather than two.
Register now to continue reading
Thank you for visiting Orthodontic Update and reading some of our resources. To read more, please register today. You’ll enjoy the following great benefits:
