The CAD Non-extraction Philosophy: What Are the Differences Between Coordinated Arch Development® (CAD) Versus Expansion?

An excerpt from Dr. Greenfield’s new textbook, “NON EX FACTORS, 98.5% Non-extraction Therapy Using Coordinated Arch Development.” This article is the property of the AOS and Dr. Raphael Greenfield. No copies of this article may be reproduced or distributed without permission of the AOS.

For more than a century, the controversy of treating tooth-size and arch length discrepancies, either with or without extraction of permanent teeth has been at the forefront of diagnosis and treatment planning. Hunter’s proposal 200 years ago to extract maxillary first bicuspids to reduce maxillary procumbencies led to capricious extraction of teeth to resolve crowding and procumbencies for the next 100 years. Disregard of the functional and esthetic consequences of extraction treatment encouraged the Angle school to take the opposite position at the turn of the century.

Angle’s strong personality and unrelenting non-extraction stance overcame Case’s camp advocating maxillary first premolar extraction philosophy for the treatment of most malocclusions (actually only 4% of cases). For the next 25 years, treatment was heavily weighed towards the non-extraction approach with indiscriminate expansion of the arches. Inter-canine and intermolar widths were increased well beyond the “neutral zone” and the mandibular incisors were flared labially to resolve crowding.