Mandibular Incisor Extraction in Orthodontics: Case Reports

Case Report

J Dent App. 2014;1(2): 25-28.

Mandibular Incisor Extraction in Orthodontics: Case Reports

K.S.Negi* and Pranav Kapoor

Professor, Department of Orthodontics & Dentofacial Orthopedics, H. P. Govt Dental College, Shimla, Himachal Pradesh, India

Assistant Professor, Department of Orthodontics & Dentofacial Orthopedics, Faculty of Dentistry, Jamia Millia Islamia University, New Delhi, India

*Corresponding author: Dr. K.S. Negi, Professor, Department of Orthodontics & Dentofacial Orthopedics, H. P. Govt Dental College, Shimla, Himachal Pradesh - 171005, India

Received: July 05, 2014; Accepted: July 23, 2014; Published: July 25, 2014

Abstract

The extraction of teeth for orthodontic purpose always has been a topic of immense debate. With regards to orthodontic treatment planning, the pendulum has, over the past century, been swinging back and forth with non extraction therapy at one end of the spectrum and the extraction of all four premolars at the other. An alternative orthodontic treatment modality involving the extraction of only a single mandibular incisor has gained popularity in the past few years. Presented here are three cases with different types of malocclusions treated by mandibular incisor extraction. In carefully selected cases, mandibular incisor extraction allows the clinician to achieve optimum results with the use of simple treatment mechanics.

Keywords: Orthodontics; Tooth extraction; Incisor

Introduction

The decision of whether or not to extract teeth is one of the most crucial choices that the orthodontist has to make when planning a case. The extraction versus non extraction debate is perhaps the most lasting philosophic controversies in orthodontic practice with both biologic and mechanical ramifications. Traditionally, treatment planning in orthodontics has revolved around either a purely non extraction approach or an approach involving the extraction of all four first premolars. However, an alternative orthodontic treatment modality involving the extraction of only a single mandibular incisor has gained popularity in the recent past. Even though this approach was traditionally reserved for cases with an ectopically placed incisor or one with poor prognosis, it is now believed that mandibular incisor extraction in cautiously selected cases may allow the clinician to use simple treatment mechanics and achieve optimum results [1-4].

Cases that are ideal for treatment with single incisor extraction include those with minimal to moderate overbite and overjet, an acceptable soft tissue profile, a mandibular tooth material excess and minimal remaining growth potential [5,6]. Class III cases or those with an anterior cross bite or an edge-to-edge incisor relationship may be camouflaged by the removal of a lower incisor because some collapse of the lower arch may be acceptable in such instances [7,8]. Mandibular incisor extraction may not only reduce treatment time but may also provide a more stable result since no arch expansion is necessary and the intercanine width is minimally altered [9].

Mandibular incisor extraction is generally contraindicated in all cases requiring extractions in both arches with severe overbite and horizontal growth pattern, bimaxillary crowding, no tooth size discrepancy in the anterior teeth, anterior tooth size discrepancy due to narrow mandibular incisors and/or broad maxillary incisors, pronounced overjet and the cases where the diagnostic setup demonstrates that lower incisor extraction can result in excessive overbite.

We present here a report of three cases with different types of malocclusions treated with single mandibular incisor extraction.

Case 1

A 17 year old female reported to the orthodontic clinic with the chief complaint of irregular upper and lower front teeth. The patient's past medical and dental history were not contributory.

The patient presented with a convex facial profile, competent lips and relative facial asymmetry with deviation of chin to the left on closure and the tip of the nose deviated to the right (Figure 1). Intra-oral examination (Figure 2) revealed mild crowding in the maxillary arch and moderate crowding in mandibular arch. The maxillary left canine was in cross bite and the mandibular right canine was rotated disto-lingually. The patient had an Angle's Class I molar relationship, an overbite of approximately 5mm and an overjet of 1.5mm.