George Anka (Japan)

The extraction for orthodontic treatment was carried out to create spaces to align the malocclusion of the cases. The reason will be individual to the clinician and the patients, ranging from concerning compliance, tooth-arch discrepancy, cephalometric discrepancy, facial profile, skeletal age (growth) and anteroposterior relationships, dental asymmetry, facial pattern, and pathologies. The constricted alveolar bone before being closed is one of the many problems that come with continuing the treatment. A narrowed alveolar bone in the extraction site can hinder the process of closing the space and prolong treatment time, and there is a high chance of relapse. Delayed timing of extraction will provide a better way of dealing with close space in clinical orthodontic extraction cases when the treatment decision is to extract first bicuspids in treating the case. To ensure interproximal reduction (IPR), root canal treatment (RCT) or pulpotomy should be performed first in this delayed extraction method. The alignment of the crowding can be facilitated by this as it can address some of the tooth-arch length discrepancy (ALD). When all the necessary preparations and mechanics to close the spaces are completed, the intended teeth can be removed. Immediate closure of the extraction site can be initiated, and the biological process known as regional acceleratory phenomenon (RAP) will help to close the spaces. It will be beneficial to extract the teeth after the alignment when we are ready to do the en-masse retraction and close the spaces using the TADs in the maxillary and the mandible.
The advocated method will be helpful in many ways. Eliminating the bowing effect when closing the extraction spaces, preventing alveolar resorption, and minimizing chewing disturbance can help close the space in less time. The details of each tooth can be followed, thus completing the primary objective of the treatment. The treatment method will be explained in detail with step-by-step instructions.