I am writing regarding a case report in the June 2017 issue in which a patient with a Class II malocclusion was treated with mandibular skeletal anchorage (Cakir E, Malkoç S, Kirtay M. Treatment of Class II malocclusion with mandibular skeletal anchorage. Am J Orthod Dentofacial Orthop 2017;151:1169-77).

The treatment results look great, but I question the teeth that were extracted and those that were retained. I am a general dentist with 35 years of restorative experience. When I do treatment planning, I look not just at tooth positions but at long-term goals for the patient.

On the original panorex, the maxillary right second premolar and both mandibular first molars were extensively compromised, and all 3 eventually had endonontic treatment and will need crowns.

In a 16-year-old boy, I can guarantee that these teeth will not last a lifetime. Large percentages of the crowns are gone. These teeth will need to be worked on throughout the patient’s life, and most likely they will be extracted some day. The maxillary right first premolar, a virgin tooth, was extracted, while the maxillary right second premolar was saved. The mandibular first premolars and third molars—all virgin teeth—were also extracted. A better idea might have been to extract the maxillary right second premolar, the maxillary left first premolar, and both mandibular first molars. It is more difficult to bring second and third molars forward, and the final result might not have been as pretty, but I would bet those teeth would be present 50 years from now.

I bring this up as a topic for discussion, not as a criticism. I am interested in hearing other thoughts on this topic.