The Key to Non Extraction Orthodontics

If you want to do more cases non extraction (at least in the lower arch), you need to see patients as the first bicuspids are erupting.  In my practice I call this point in time a “decision point.”  The patient may or may not be ready for braces but at this point it is possible to treatment plan the patient to know in which direction you should go for successful treatment.

According to the late Dr. Gianelly, 75-80% of patients can be treated non extraction in the lower arch if all you do is to maintain “e” space.  I’ve followed Dr. Gianelly’s teachings in this regard for over 25 years and it has greatly simplified things for me and allowed me to achieve more predictable, high quality results.

No need to expand the arches, no need to extract lower second molars, no need to do Damon.  Just straight forward, good quality orthodontics and you have 4 chances in 5 of a simple non extraction treatment plan.

Also consider that 40% of our patients have small maxillary laterals.  This usually means that the lower anterior teeth need a little IPR.  Let’s say 2 mm is about right.  If you add that into what you gain in preserving “e” space, I think that takes you into the realm of 90% non extraction as long as you see the patient as the lower first bicuspids are erupting.

The mistake that some make is to look at an eight year old and see that they’ve lost “5 to get 4” or 4 deciduous incisors and a deciduous cuspid.  This looks like 8 mm of crowding so they start thinking about extracting 4s.  If you take the “e’s” into account though, it becomes 3 mm of crowding which might be handled by IPR or at worst the extraction of lower 5s not 4s.  Extracting a lower incisor also might work well if the upper 2s are small.