Extraction in Orthodontics
Calvin Case (1847 – 1923) and his followers believed that malocclusions were inherited and arose from the mixing of face types and races. Calvin Case questioned Angle that retention and stability will not be satisfactory in the long term for patients whose arches are expanded. An intense rivalry ensued between Case and Angle, each questioning the basis of the other’s theory and practice. In response to Angle’s School, Case countered with what he called the rational school where he propagated the idea that new bone cannot be induced to grow beyond its inherent size and that, therefore, there are indications for extractions in certain forms of malocclusion.
Both sides drew on a handful of case studies leading to a widely publicized debate during the 1911 meeting of the National Dental Association (the former name of what is now known as the American Dental Association) between Case and Angle’s student Dewey, who was also a strict believer of non extraction.
By the 1930’s, an increasing trend of relapse after non extraction treatment was noted . Charles Tweed, a student of Angle decided to treat his relapse cases with tooth extraction. The four 1st premolars were extracted and the anterior teeth were aligned and retracted. After treatment, he noticed that the resultant occlusion was much more stable. Tweed gave a public presentation showing the stability of his cases treated with premolar extraction. This led to widespread acceptance of extractions for orthodontic treatment by late 1940s.
Ground breaking clinical research by Rudolf Hotz and Birger Kjellgren in Europe and B Dewed in the United States began to restore premolar extractions into the orthodontist’s armamentarium. In Australia, Raymond Begg, one of Angle’s student also agreed that non extraction treatment was unstable. Begg modified the Angle designed ribbon arch appliance he was using and adapted it for the extraction modality. At this time, the no extractions under any circumstances Angle forces had been defeated by extractions when necessary Case forces supported by scientific and clinical evidence.
Case CS (1964): The Question of Extraction in Orthodontia, AJODO, 5: 660-91.
Bernstein L, Angle EH, Case CS (1992): Extraction vs Nonextraction, Part I. Historical Revisionism, AJODO, 102 (5)
Profitt WR, Fields HW, Sarver DM (2007): Orthodontic Treatment Planning, Limitations, Controversies and Special Problems. In: Profitt WR, Fields HW, Sarver DM, editors. Contemporary Orthodontics 4th ed., St Louis pp 280-4
Josievitz U Tan Zafra DMD
Decision Making in Orthodontics
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