Angle Class I malocclusion treated with lower incisor extraction

Abstract

In planning orthodontic cases that include extractions as an alternative to solve the problem of negative space discrepancy, the critical decision is to determine which teeth will be extracted. Several aspects must be considered, such as periodontal health, orthodontic mechanics, functional and esthetic alterations, and treatment stability. Despite controversies, extraction of teeth to solve dental crowding is a therapy that has been used for decades. Premolar extractions are the most common, but there are situations in which atypical extractions facilitate mechanics, preserve periodontal health and favor maintenance of the facial profile, which tends to unfavorably change due to facial changes with age. The extraction of a lower incisor, in selected cases, is an effective approach, and literature describes greater post-treatment stability when compared with premolar extractions. This article reports the clinical case of a patient with Angle Class I malocclusion and upper and lower anterior crowding, a balanced face and harmonious facial profile. The presence of gingival and bone recession limited large orthodontic movements. The molars and premolars were well occluded, and the discrepancy was mainly concentrated in the anterior region of the lower dental arch. The extraction of a lower incisor in the most ectopic position and with compromised periodontium, associated with interproximal stripping in the upper and lower arches, was the alternative of choice for this treatment, which restored function, providing improved periodontal health, maintained facial esthetics and allowed finishing with a stable and balanced occlusion. This case was presented to the Brazilian Board of Orthodontics and Dentofacial Orthopedics (BBO), as part of the requirements for obtaining the BBO Diplomate title.

Treating dental crowding with mandibular incisor extraction in an Angle Class I patient

“…The clinical case reported herein corroborates the findings in the literature which highlight that extraction of a mandibular incisor might be a good solution to correct mandibular dental crowding, 3 , 7 , 8 considering the through diagnosis of all issues involved. A set-up might be useful to aid this approach with a view to assessing the implications of extracting a mandibular incisor as well as avoiding an increased overjet.…”

Treatment of Adults with Anterior Mandibular Teeth Crowding: Reliability of Little’s Irregularity Index

“…Therefore, it may be concluded that extraction of the lower incisor is most effective in adults with crowding; furthermore, it is stable for at least a year after alleviation. Hegde et al [ 54 ], Barbosa [ 55 ], and Valli de Almeida et al [ 48 ] reported similar results as well as Zhylich and Suri [ 56 ] who established individual indications for extraction of one of the mandibular incisors. On the contrary, Kahl-Nieke et al [ 57 ] while evaluating postretention crowding and incisor irregularity found that stripping is more stable than extraction of one of the lower incisors in a long-term follow-up evaluation, although in insignificant manner.…”

Extrações atípicas em ortodontia

“…O tempo de tratamento foi em média de 4 anos. Acredita -se que esta ausência de uma linha média dentária mandibular não afeta a oclusão, estética, saúde periodontal, ou a estabilidade 20,21,22 .…”