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The final article in our series on orthodontic conundrums considers the extraction of a single lower incisor as part of a wider orthodontic treatment plan. This is a relatively uncommon approach; however, when used in the appropriate clinical scenario, it can be highly effective. Extraction of a lower incisor may be required to provide space for alignment of the teeth and serve as a pragmatic way to facilitate treatment while preserving posterior units. This article explores some of the possible orthodontic indications and contraindications for extraction of a lower incisor.
CPD/Clinical Relevance: In certain clinical situations, extraction of a lower incisor has significant advantages. Dental professionals should be aware of this extraction pattern and its limitations.
Article
This final article in our series on orthodontic conundrums considers extraction of a single lower incisor. Like the topics covered in the previous articles, extraction of a lower incisor to facilitate orthodontic treatment is relatively uncommon.
When treatment planning, the orthodontist must take into account the salient features of a patient's malocclusion, as well as an assessment of their dental and facial aesthetics, and deliver care that addresses the patient's concerns and meets the treatment aims effectively.
One persistent debate centres on whether or not teeth should be extracted for the purposes of orthodontic treatment. Whilst there has been a reduction in the frequency of orthodontic extractions in recent years,1,2 there are of course times where dental extractions, including extraction of a single lower incisor, form an essential part of the orthodontic treatment plan. In the 1950s, extraction of a single lower incisor was undertaken in 6% of all treated cases,2 but the literature suggests far fewer extraction cases are now approached in a similar manner.2–4 In their systematic review of the literature, Zhylich and Suri found there to be a strong case for extraction of a lower incisor in specific clinical scenarios. Such indications include:
Mild to moderate Class III incisor relationships, where there is a suitable tooth size discrepancy, allowing Class I buccal segment relationships to be preserved at the end of treatment;
Moderate lower labial segment crowding;
Where a single lower incisor has a poor prognosis;
A relative lower tooth size excess indicated by a Bolton's discrepancy;
A lower tooth size-arch length discrepancy.
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