Frequency of tooth extraction orthodontic treatment Sheldon Peck, D.D.S., M.Sc.D.,* Boston, Mass. N


and Harvey


Peck, D.D.S., M.Sc.D.*


ound orthodontic diagnosis and treatment planning involve several intricate decisions. First, the need for treatment must be critically evaluated. If treatment is judged necessary, the orthodontist then must determine, among other matters, if successful therapy will require tooth extraction. For years the question of extracting permanent teeth as part of corrective orthodontics has provoked professional controversy and debate, often of religious intensity. Tooth extraction is commonly a treatment consideration in the orthodontic management of dental crowding. In addition, orthodontists may consider extraction in cases of jaw growth discrepancy, such as Angle Class Il relationships, and in various other conditions, such as tooth pathology or injury. Extraction frequency is used as a statistical measure describing the number of orthodontic patients having permanent tooth extractions, and it is expressed as a percentage of a total treatment sample. It is an unemotional statistic reflecting the sum of all the variables associated with the extraction question. Although seldom spoken of, and less often published, extraction frequency studies expose the clinical orthodontist to new objective information on a subject traditionally obscured by opinion and dogma. This article reports on the frequency of tooths extraction among a sample of North American orthodontic patients and examines some aspects of extraction frequency differences. Sample

and methods

The study sample consisted of 537 patients from an orthodontic practice in the northeastern United States. The sample was gathered from records on hand in the following manner: All Caucasian patients who had completed full corrective orthodontic treatment 1 year or more in duration and who were neither transferred patients nor surgical patients were included in the sample. There were 228 males (42.5 percent) and 309 females (57.5 percent). Age at the start of treatment ranged from 7 years to 41 years, and the median age was 11.4 years. Approximately two thirds of the sample were between 10 and 12 years old (Table I). The extraction-nonextraction treatment status was recorded for each subject. Extraction status was categorized separately for the maxillary and mandibular dental arches. Tooth extraction was defined in this study as the removal of one or more permanent teeth, excluding third molars, in the course of corrective orthodontics. Permanent tooth extrac*Adjunct



of Orthodontics, 0


1979 The C. V. Mosby

University Co.


of Graduate



.4m. J. Orthua. November 1979

[email protected] I. Age distribution at start of full orthodontic treatment


7 40 115 134 104 51 28 I! 2 3 3 - 39 537

1.3 7.4 21.4 25.0 19.4 9.5 5.2 2.1 0.4 0.6 0.6 7.1 100.0

tion for nonorthodontic reasons prior to treatment (“mutilated case”) was also included in this definition, and it involved 24 of the 537 subjects. Results The distribution of the sample of orthodontic patients according to extraction status and sex is shown in Table II. Nonextraction and extraction groups are tabulated, and the extraction category is further divided into the following three subgroups: (1) extraction in both arches, (2) extraction in the upper arch only, and (3) extraction in the lower arch only. Of the 537 patients, 226 experienced permanent tooth extractions as part of full orthodontic treatment, resulting in an over-all extraction frequency of 42.1 percent. Extractions in both arches were recorded for approximately 36 percent of the total sample, while upper extractions exclusively were recorded for nearly 5 percent and lower extractions exclusively were recorded for approximately 1 percent of the sample. The extraction frequency for males was 39.0 percent and that for females was 44.3 percent, indicating a sex difference of 5.3 percent in orthodontic extraction frequency within the sample. Discussion

Table III compares previously published orthodontic extraction frequencies:-I” with the results from the present study. The reported frequencies are arranged in ascending order from 6.5 percent to 83.5 percent. Nine European studies and three North American sources are represented. It is noteworthy that the European studies are generally quite detailed, while the three references from the American orthodontic literature give only clinical estimates without sample descriptions or supportive data. Informal interviews that we have conducted with many orthodontists here and abroad have recorded extraction frequency estimates from 15 to 95 percent, a remarkable 80 percent range of performance. The published extraction frequencies in Table III show a similar range. What is responsible for these enormous differences in diagnostic judgment?

Volume 76 Number




in orthodontic

Table II. Number and percentage distribution of patients completing treatment, according to extraction status and sex -Extraction


Nonextraction Extraction Upper and lower Upper only Lower only

Both sexes

194(36.1%) 26 (4.9%) 6 (1.1%)

Table Ill. Reported frequencies orthodontic treatment purposes &traction treatment (percent)

6.5 8.0 15.9 17.4 19.2 23.1 23.2 27.8

Frequency of tooth extraction in orthodontic treatment.

Frequency of tooth extraction orthodontic treatment Sheldon Peck, D.D.S., M.Sc.D.,* Boston, Mass. N b and Harvey in Peck, D.D.S., M.Sc.D.* 1 oun...
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