The advisability of extraction as a therapeutic aid in orthodontics: Negative

Abstract

T HE subject of this presentation is a matter which involves the welfare of the patient and the reputation of the general practitioner and orthodontist. The extraction of sound, vital teeth as an aid in orthodontic treatment is not a new practice. The advisability of this procedure has been discussed for many years. The extraction of teeth and the discussion of when and where to extract is older than orthodontics. Ever since man has tried to change the positions of teeth, this subject has filled many pages in the literature. Modern orthodontics, fathered by Dr. Angle, was primarily opposed to this practice. Extraction of sound teeth for the purpose of aiding orthodontic corrections is advocated from time to time but as succeeding groups of orthodontists realize the errors of this procedure and evaluate the evidence of mutilated dentitions, it passes out of current thought and literateure only to be revived at a later period. During the last few years considerable effort has been made to promote extraction as an aid in the correction of malocclusion. Differences of opinion always create discussion and programs such as this are included in many orthodontic programs. This reflects an earnest desire to learn the truth. I do not extract teeth; I do not believe in the extraction of teeth as an aid in the correction of malocclusion. I believe that extraction makes treatment more difficult and the result less satisfactory from the viewpoint of both health and esthetics. The purpose of dentistry is the maintenance of the oral cavity in a state of health. Al! of us know the effect on the dental organism of the loss of a tooth. The alveolar process and dental periosteum suffer and the denture is unbalanced. There is a number of teeth and an arrangement of teeth common to man. The form of the dental arches is the result of a long evolutionary process. While the arrangement of teeth in man follows a general pattern, there is variation in the size and length of arches, in angle of inclination of the individual teeth in relation to the mandible and maxilla, in size and form of individual teeth, and in occlusion of the teeth on opposite sides of the mouth. Axial inclination not only varies in different individuals but in the ‘same individual at different ages. The arrangement of the teeth in the occlusal pattern common to man has a direct relationship to the lower half of the face. The contours of the face are often the result of the size and arrangement of the teeth. The result is usually pleasing and well proportioned.