Lower incisor extraction a contemporary treatment option or an orthodontic no-go Jassin Arnold. Episode 78. March 10th 2021

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Farooq Ahmed



Join me as I describe Jassin Arnold’s lecture describing lower incisor extraction, its indications and management

Why should we use it?

o   Reduces anchorage demand, entact posterior segments

o   Improve dental occlusion in a shorter time frame

o   Profile improves in mandibular protrusion cases Levin 1964


When should we use it? Systematic review Zhylich 2011

o   Mild-moderate class 3

o   Edge to edge anterior occlusion

o   Crossbite with mild anterior mandibulae excess

o   4.5mm tooth size discrepancy of lower to upper Matsumoto 2010


When should we not use it?

o   Severe OB

o   Bimaxillary crowding

o   Triangular lower incisor and minimal crowding 3mm less

o   High insertion of labial frenum = gingival recession I removed


Risks of lower incisor extraction

o   Black triangle

o   Increased overjet and overbite

o   Tendency for spaces to reopen an aesthetic zone

o   Create tooth size discrepancy



Bolton’s anterior analysis

o   Anterior ratio 77% 3-3 lower Vs 3-3 upper



o   Class 1

o   4mm of crowding of the lower incisors

o   Bolton’s anterior analysis 87% – excess lower incisor tissue

§  = Extraction 1 lower incisor = 74.8% – TOO LOW (ideal 77%)

·      = Solution strip upper 2-2 by 2mm = 78% Bolton’ ratio

o   Case 2

o   Molars ½ II, increased overjet 6mm, lower incisors 4mm of crowding

o   Bolton’s anterior analysis 87% – excess lower incisor tissue

§  = Extraction 1 lower incisor and stripping  of upper incisors = 77%

§  = Extraction of 2 upper premolars as well

·      Stripping upper 2-2 to achieve ideal occlusion in the anterior 3-3 segment

·      Extraction of Upper 4s to correct the increased overjet







Zhylich, D. and Suri, S., 2011. Mandibular incisor extraction: a systematic review of an uncommon extraction choice in orthodontic treatment. Journal of Orthodontics38(3), pp.185-195.


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