Extracting one mandibular incisor

We read with keen interest an article in the October 2019 issue reporting orthodontic treatment with an incisor extraction (Vilhjálmsson G, Zermeno JP, Proffit WR. Orthodontic treatment with removal of one mandibular incisor: Outcome data and the importance of extraction site preparation. Am J Orthod Dentofacial Orthop 2019;156:453-63). The article is indeed an informative one, and the authors have summarized the various aspects of mandibular incisor extraction in an excellent and elaborate manner.

Orthodontic treatment with mandibular incisor extraction is being routinely done in our department, and thus we would like to share some additional applications regarding the same. Apart from treating mild Class III malocclusions with mandibular anterior crowding or crossbites, extraction of 1 mandibular incisor has also proved beneficial in the following situations:

  • 1.

    Angle Class I occlusion on a Class I skeletal base with good cusp-to-groove relationship in the posterior segment and mandibular anterior crowding ≥5 mm.

  • 2.

    Angle Class II Division 1 malocclusion with 1 full cusp discrepancy on either side (full-step Class II molar relationship) and crowding of mandibular anterior teeth ≥5 mm. Here, the extraction of both maxillary first premolars along with 1 mandibular incisor can bring about a good occlusion. The Class II cusp-to-groove molar relationship is maintained, and canines are retracted to occlude within the embrasure between the mandibular canines and first premolars.

Unless the prognosis of the tooth is poor, we generally do not prefer the extraction of a mandibular lateral incisor for the following reasons:

  • 1.

    Symmetry of the anterior segments in occlusion is better achieved when the maxillary midline coincides with the midline of the remaining mandibular central incisor, with the 2 lateral incisors aligned on either side.

  • 2.

    An ideal contact point may not be achieved between the mandibular central incisor and the canine after the extraction of a single lateral incisor. This can lead to future periodontal problems.

The viewpoints expressed are solely those of the author(s) and do not reflect those of the editor(s), publisher(s), or Association.

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May 12, 2020 | Posted by in Orthodontics | Comments Off on Extracting one mandibular incisor
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