To Extract or Not to Extract: On What Basis Do We Make That Decision? (Part I)

The decision to remove permanent teeth is often challenging for the orthodontist, and multiple factors should be considered. The primary reason for extracting teeth is crowding, followed by aesthetic concerns, particularly the risk of creating a flat facial profile from over-retracting the front teeth. Often, the facial growth patterns are overlooked in this decision-making process. This review will explore how facial morphology, growth patterns, and maturation stages influence the extraction decision. We shall address common concerns related to extractions, such as the impact on esthetics, airways, the effect of extractions on buccal corridors, their relationship to TMJ issues, and the potential link to sleep apnea. The review will outline the indications and contraindications for extracting four first premolars and discuss factors affecting post-treatment stability, particularly the importance of establishing a solid anterior occlusion. A clinical example will illustrate an unusual extraction protocol for correcting a midline deviation and asymmetric occlusion. The correct timing of extractions is crucial, as improper timing can lead to relapse. Extraction of certain teeth for the best treatment outcomes and long-term occlusal stability will be discussed.