Part 2 | Considerations of Extracting Bicuspids: “Rules” to Ensure Extraction Space Is Utilized Optimally

In part 1 of this article series, we outlined the rationale for extraction of bicuspids in orthodontic treatment. There were four reasons to consider extraction of four bicuspids which included lower crowding, skeletal open bite, Class II, and facial protrusion. This article will expand the concepts to illustrate how they can enable us to make the best treatment decisions about which teeth to remove.

WHICH FOUR BICUSPIDS TO EXTRACT?

Using the model of assessment of the four reasons to extract bicuspids will not only let you know when to extract four bicuspids, but it will also let you know which four bicuspids to remove.

Let’s say you have already done the analysis to extract four bicuspids and you have made the treatment decision to extract four teeth. Many dentists make a serious mistake of assuming the upper and lower 4’s should always be extracted. The general principle is to extract teeth that are closest to the chief problem of the case. Take out the four bicuspids that offer the biggest orthodontic advantage.