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1. METHODS OF GAINING SPACE.
EXTRACTIONS
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2. To Extract Or Not To Extract? Over 100yrs.
• Orthodontics:
• Other alternative-
• Opinions remarkably changed.
• Chart.
Align the teeth
Camouflage.
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3. The Pre 1900 era:
• Extraction: always been challenged.
• Late 1700s, early 1800s.
• By late 1800s-Kinsley- judicious to extract.
• Edward Hartley Angle:systematized and organized.
• Suggested extractions in earlier works.(1887).
• By 1907, strongly opposed extractions.
• His dogmatic views dominated for next 30yrs.
• Extraction – crime. Odontocides
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4. The great extraction controversy of
the 1920s:
Edward Angle - normal occlusion. (1899).Facial
esthetics and stability potential complications.
Rousseau-imperfections of modern man related to
negative influence of civilization and that man could reach
perfection with correct efforts..
•Inappropriate to extract, inherently capable of having
a perfect dentition.( Article of faith)
•Every person had potential for an ideal relationship
of all 32 teeth. extraction never needed.
•Skeletal elements-accommodate teeth.
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5. 1902 article,
“My belief is that if we would confer the greatest
benefits upon our patients from an esthetic
stand point, we must work hand in hand with
nature and assist her to establish the relations
of the teeth as the Creator intended they should
be,& not resort to mutilation”.
Prof. Edmund Wuerpel – led to his concepts
of facial beauty and harmony.
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6. • Influenced by Wolf.
• Led Angle to 2 key concepts:
• Skeletal growth influenced by external pressure.
• Rubber bands- overcome improper jaw relationship.
• Proper function of dentition key to maintaining teeth in their
correct position.
– “Bone growing appliance”
• Relapse: failure to achieve proper occlusion. (article
of faith)
• Concepts challenged by Calvin Case.
“although arches could be expanded,teeth aligned, neither
esthetics nor stability would be satisfactory in the long
term”
• Widely publicized debate – Dewey and Case.
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7. The extraction debate of 1911
• Question of extraction in orthodontia.- AJO 1964
• New School: Angle.
• Rationale School: Case.
• Angle- causes of malocclusion – ‘local’
• Case- based on laws of heredity- union of dissimilar
types/propagation of variations
• Buccal occlusion gives no indication of the real
position of dentition in relation to facial outlines.
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8. Bimax protrusion: nearly ideal occlusion
extraction mandatory to improve profile.
Retreated a case, after waiting to see if developing growth
would harmonize the relations.
Angle’s Class II :
Angle’s Class III : extraction is a must.
“New bone cannot be induced to grow beyond its
inherent size and that ,.’. there are indications for
extraction in certain forms of malocclusion”
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9. Dewey:
Ex of Negroes.
Extraction of 4 – molars moved mesial, incisors
proclined.
“Angle was not a man to compromise with his ideals.
He had to put a good fight to offset extremism in
extraction, and what he said needed to be said”
Leonard Bernstein- 6th
edition of Angle’s book.
Folk lore
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10. Response of Calvin Case:
“Extraction never resorted until certain that
developing growth of other parts will not correct the
dento-facial protrusion”
All experienced orthodontists…….
Sum up,
“it seems a most senseless thing for men to fight over,
when the truth is so evident;
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11. •Angle & his followers won the debate with
Case.
•With passing of time,& successful treatment of
many ext cases have shown that Case was more
accurate in assessing the issue.
•Extraction disappeared b/w world war I and II.
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12. Reintroduction of extraction in mid-
century:
By, 1930’s relapse frequently seen.
Charles Tweed: retreated 100 of his patients.
6 ½ yrs – philosophy of full complement of teeth.
11yrs otherwise.
70% recalled. Success rate less than 20%
Stability of end result.
Healthy investing tissues- longevity
Masticatory efficiency.
Good facial esthetics.
•Findings came as a shock.www.indiandentalacademy.com

13. Search for stability:
3yrs – devoted to study.
Mandibular incisors upright.
Margolis.
Retreated by Xn of 4s.
Results much more stable.
1st
paper published 1936.
By 1940- all 100 cases.
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14. Tweed: “ it is my opinion that it is necessary to remove
dental units in all those cases where there exists a
discrepancy b/w tooth structure and basal bone.”
Raymond Begg:
Attritional occlusion theory; lack of proximal wear.
“Tooth extraction as an aid to orthodontic treatment is
scientifically correct ‘.’ it simulates the natural loss of
tooth substance by attrition”.
By late 1940’s extraction treatment became more
widely accepted.
By early 1960’s more than half of American patients-
extraction.
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15. Recent trend towards non extraction:
Indiscriminate use of extractions.
Ortho Rx synonymous with extractions.
Later criticized
Arguments continued throughout 1960s
Prefer fuller and more prominent lips than std of
1950s and 1960s.
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16. Litigation: 1980s
TMD problems.
Witzig and Spahl- critical of bicuspid Xn.
•Distalization of mandible;
•Post displacement of condyles and TMDs
•Recommended 7 Xn.
•Studies concerning 4 Xn and TMDs.
•Jason and Hasund (Norway) 60 patients
•Dibbets Van der Weele (1991) 15 y study.
•No relation b/w choice of Xn , type of teeth , TMD .
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17. •Gianelly et all – position of the condyle in the fossa
(12 Cl II)
•Hesitant. Trend towards non extraction..
•Swing of the pendulum.
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18. A contemporary perspective:
recommendations for expansion Vs
extractions:
Either acceptable
estheticsFlat lips
Full lips
Either acceptable
stabilityMore stable? Less stable?
extraction Non extraction
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19. Contemporary extraction
guidelines:
For ortho Xn in Class I crowding &/protrusion:
•Less than 4mm- Xn rarely indicated.(severe incisor
protrusion or a severe vertical discrepancy)
•5-9mm: both;depends
•Hard and soft tissue characteristics.
•Final position of incisors.
•10mm/more: Xn almost always.
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