ORTHOBITES EXTRACTION ORTHODONTICS By David Jackson, DDS, FAGD, IBO I am a non-extractionist by philosophy, and I am listed in all organization directories as such. If you have attended any of my basic level one courses, you know that I teach the student doctor to treat by non-extraction therapy. Why? Since most cases can be treated successfully by not removing any teeth, non-extraction therapy is a must. Further, if you are new to the orthodontic world, when you remove premolars, you have created a permanent change to the patient. I remain firm in my belief that if you are a newcomer to orthodontics, treat only non-extraction and refer cases that are beyond the guide-lines that I teach in my beginning courses. However, sometimes removing teeth proves to be the correct modality of treatment for the orthodontic patient. For years, I thought removing a premolar was a mortal sin. How could the orthodontic community do this to a fellow human being! So I plodded along, distalizing the lower arch, distalizing the upper arch, finally finishing the case most often with an increased GoGn, especially with lower distalizing appliances, and an increased treatment time. And sometimes, even 12 September/October 2010 JAOS OMG! though I distalized both arches (and by the way, I still do most of the time), I ended up with full profiles. Also (I bet this has never happened to you), I had poor patient compliance, blew out the upper teeth or lost anchorage in the distalization process and finished the patient in slight Class I. We are going to be honest here, right?? By the way, non-extraction and removing wisdom teeth is an oxymoron. It is especially an oxymoron if you must remove the wisdom teeth to distalize the upper and lower arches. Wow!! I feel so relieved to come out of the orthodontic closet!! Years ago, I realized that facial beauty and symmetry, along with straight teeth, should be our true common goals as orthodontic practitioners. Equally important is what the best treatment for the patient is. If we can provide a shorter treatment time by the removal of teeth, remove most of the compliance issues and produce an excellent esthetic result, extraction mechan-ics should be considered. I would like to share the following case with you: This 14-year-old male presented to my office for an orthodontic evaluation (Fig.1). He presented a negative
Journal of the American Orthodontic Society September-October 2010: Page 12
