Background. Current trends in orthodontic care emphasize alternatives to the extraction of premolars, despite a lack of support from the refereed literature for many of the nonextraction treatments.
Description of the Situation. Anecdotal reports published in non–peer-reviewed journals have called into question the esthetic effects of extraction treatment. As calls for evidence-based treatments increase throughout dentistry, reports on the effects—both positive and negative—of different orthodontic options have appeared in growing numbers.
Clinical Implications. Given the results of a variety of reports in the peer-reviewed literature, it may be concluded that orthodontic treatment involving extractions can produce improved esthetics for many patients who have some combination of crowding and protrusion. However, careful diagnosis followed by evidence-based treatment decisions should be the accepted clinical norm as the specialty of orthodontics embarks on its second century.
