There is a current trend in our specialty to avoid extractions of teeth. Some selfappointed
“experts” send invitations to orthodontists promoting courses in
which it is claimed that using their technique and philosophy, almost 99% of
malocclusions can be corrected without sacrificing teeth to create beautiful,
“radiating” smiles. These treatment results are also claimed to enhance orthodontic
stability, although there is apparently little proof to back up the statement.
It is claimed that extracting teeth to resolve crowding will, in most cases,
produce a narrowing of the smile and/or irreversible areas of darkness at the
corners of the mouth. While preserving the dentition is a worthwhile goal whenever
possible, there are, in my opinion, obvious situations when tooth size–jaw
size discrepancies, as well as other reasons, call for premolar extractions. Does
this imply that the smiles in patients who have received orthodontic treatment
involving premolar extractions will become different from those in the nonextraction
patients? In other words, are premolar-extraction smiles generally more
constricted and less attractive than the nonextraction smiles?