Extraction Vs Non-Extraction / the Debate Continues: A Review

The decision to extract teeth for orthodontic treatment is one of the most debated subjects in the history of the specialty. Angle advocated non-extraction while case a few years later proposed extraction in selected cases because of the concern for stability. In the 1930s, many practitioners began to observe generalized relapse with non-extraction treatment. Charles H. Tweed used cephalometric analysis to support the extraction of all four first premolars and initiated a swing among the orthodontic community toward extraction therapy.

The popularity of extraction therapy lasted well into the 1970s. During the 1980s, the pendulum swung back toward non-extraction, and that trend persisted until the end of the century. The resurgence of non-extraction therapy is probably the result of many factors, including the renewed popularity of early intervention, a greater acceptance of functional appliances in the United States, and the change from fully banded appliances to direct-bonded brackets. Finally, a consumer-driven market for treatment without extractions, combined until recently with a conspicuous lack of experimental evidence to support either position, has ultimately kept the extraction-non-extraction debate at the forefront of orthodontic concerns. The last two decades has seen noticeable decline of extraction in orthodontic treatment. This is augmented with increased pressure from the referring dentist to treat the patient without extraction treatment modality, being unaware of the literature supportive of extractions in specific cases. The controversy becomes even greater when dealing with borderline cases. In a respected specialty such as orthodontics, the decision to extract or not should, at least in part, be based on scientific assessments of treatment outcome. This review provides a summary of historical background of the controversy, the view points of various authors, the reasons for decline in extractions and the present understanding of the debate.