LOWER INCISOR EXTRACTION

Introduction
In 1757 Bourdet, a disciple of Pierre Fauchard, recommended the removal of the premolars to relieve crowding.

Hunter (1835) extracted the first premolars to allow incisor retrusion in cases of posterior protrusion.

 V.H Jackson (1904)

Milton Fisher (1940s)

 Schwarz (1961) reviewed 20-year postretention records of a patient who was congenitally missing two mandibular incisors. He was surprised to observe good long-term stability.

As pointed out by Kokich and Shapiro (1984), the deliberate extraction of a lower incisor in certain cases allows the orthodontist to improve occlusion and dental aesthetics with a minimum of orthodontic action.

Indications
Anomalies in the number of anterior teeth

 Tooth size anomalies - Discrepancies in the mesiodistal size of the six anterior teeth may be corrected by extracting a lower incisor. The disproportion, as reflected by Bolton's Index (1958), is established by the relative macrodontia of the lower incisors, or microdontia of the upper laterals. The fracture or morphological defect of a mandibular incisor indicates its extraction in cases of crowding.

 Ectopic eruption of incisors - The transposition of anterior teeth, particularly of the canines, or the severe malpositioning of a lower incisor, indicates extraction to protect the long-term survival of the dentition.

 Moderate Class III malocclusions - Anterior crossbite or an edge-to-edge relation of the incisors with a tendency towards anterior open bite is another indication for incisor extraction. The occlusion improves on shortening the length of the mandibular arch, which retrudes the position of the lower incisors

According to Owen, patients who are suitable for single lower incisor extractions usually fit the following diagnostic pattern: Class I molar relationship, Moderately crowded lower incisors, Mild or no crowding in the upper arch, Acceptable softtissue profile, Minimal to moderate overbite and overjet, No or minimal growth potential, and Missing lateral incisors or peg shaped laterals.

JCO 1993 Mar(153 - 160): Single Lower Incisor Extractions - ALBERT H. OWEN III

Contraindications
Deep-bite cases with horizontal growth pattern, All cases which require upper first premolar extraction while canines are in Class I relationship, Bimaxillary crowding cases which have no tooth-size discrepancy in the incisor area, and All cases having incisor discrepancy due to either small lower incisors and/or large maxillary incisors.

Selection of suitable cases

Treatment strategy should begin with accurate measurements of required arch length and available arch length in the entire mandibular arch, or tooth-size-arch-length-discrepancy. An additional consideration is the intercanine width, and the effect of an incisor extraction on it.

 With six maxillary anterior teeth now articulating with five mandibular anterior teeth, the overbite must be maintained or, if deep, reduced. Overjet is likewise maintained or reduced to produce centric occlusal contacts. Maxillary and mandibular canines will finish in ideal Class I relations.

 Boltons analysis or Neffs coeficient should be considered so as to calculate the discripancy and removal of lateral or central incisor accordingly. Kesslings setup of both arches is informative and often suggests minor interproximal reduction of maxillary anteriors to allow their retraction, alignment and maxillary to mandibular arch coordination

 The maxillary midline will overlie the remaining central incisor. Absence of a mandibular dental midline will not affect the occlusion, esthetics, periodontal health, or stability, the principal requirements of orthodontic therapy.

AJO-DO 1994 Feb (107 - 116): CLINICIANS' CORNER - Valinoti

Do mandibular incisor extraction cases exhibit less recrowding after long-term retention???

 Jose-antonio Canut - EJO (1996) Alignment stability seems to be better than that achieved in cases subjected to premolar extraction. Riedel has suggested that incisor extraction may give greater stability in this area in the absence of permanent retention

 This may be due to the maintenance of teeth nearer their original positions where muscle pressures are less likely to introduce instability Another possibility is the minimum stress on adjacent anchorage during space closure, leaving all or most of the acquired space for the anterior correction.

Conclusion
Four premolar extractions will continue to be the optimum treatment for many malocclusions having greater space requirements and the need for improved facial esthetics. However, with careful selection and management, there are cases that can be successfully treated with a mandibular incisor extraction. This approach will be a valuable addition to our armamentarium