Ideal torque, optimum interincisal angle and root parallelism were achieved at the end of the treatment. Preadjusted edge-wise appliance of MBT prescription (0.022" × 0.028" slot) was set up and extraction of lower right central incisor was carried out and inter-proximal reduction was done in the upper anterior region after making a diagnostic setup. The treatment was aimed to correct the lower incisor crowding and cross bite, level, align and establish optimum over jet and overbite while maintaining a Class I molar and canine relationship. Cephalometric analysis revealed skeletal Class I malocclusion, with normodivergent growth pattern, mild proclination of upper and lower incisors.įigure 1: Case 1 Pretreatment extra oral photographsįigure 2: Case 1 Pretreatment intra oral photographs Panoramic radiograph showed presence of all the permanent teeth. Two cases treated with single lower incisor extraction are documented in this presentation.Ī male patient aged 22 years reported for treatment with mesoprosopic facial pattern, mild convex profile, prominent nose, normal nasolabial angle, Angle's Class I molar and canine relationship, severe lower anterior crowding, 11 in cross bite with 41 and good posterior occlusion and. Whether to extract a central or lateral incisor depends on the type of malocclusion, amount of anterior tooth size discrepancy, arch length deficiency in the anterior region, health condition of the teeth and supporting tissues. Lower incisor extraction should be avoided in cases with an excessive overbite and over jet, bimaxillary crowding cases with no Bolton's discrepancy in the incisor area and cases having large maxillary incisors and small mandibular incisors. Lower incisors with loss of gingival tissue, normal maxillary dentition with good buccal interdigitation and severe lower anterior crowding, lower anterior Bolton's excess of >4 mm, adult cases with mild to moderate Class III malocclusion, ectopically erupted or supernumerary lower incisor, missing or peg shaped upper lateral incisors or macrodontia of lower incisors are good indicators for lower incisor extraction. However, a diagnostic set-up is required to predetermine the precise occlusal possibilities. As pointed out by Kokich and Shapiro extraction of a lower incisor in certain cases constitutes a therapeutic alternative and allows the orthodontist to improve occlusion and dental esthetics with a minimum of orthodontic treatment. Permanent first premolars are routinely extracted to alleviate anterior and/or posterior crowding due to their location in the center of each half of the arch. Lower incisor extraction: Can it be justified? A report of two cases. How to cite this URL: Mallavarapu K, Peddu R, Reddy SK, Adusumilli SP. How to cite this article: Mallavarapu K, Peddu R, Reddy SK, Adusumilli SP. Keywords: Bolton′s discrepancy, diagnostic setup, lower incisor extraction, posttreatment stability Two cases treated with single lower incisor extraction, indications, contraindications and measures to attain posttreatment stability are discussed in this presentation. Lower incisor extraction decision would be a better option in cases with anterior Bolton's discrepancy. Diagnostic setup reveals the posttreatment occlusal possibilities and hence the most important step in the diagnosis and treatment planning of these cases. Lower incisor extraction becomes a therapeutic alternative to premolar extractions in lower anterior crowding cases with good facial esthetics and well occluded posterior teeth. Some cases demand extraction of premolars, but the decision making is difficult in the border line cases with good facial esthetics. Extraction versus nonextraction debate is still continuing since 1900s.