The Endless Enigma of Extractions and Expansions
نویسنده
چکیده
The Endless Enigma of Extractions and Expansions The most divisive and persistent argument throughout the history of orthodontics has been whether to extract teeth. For patients that present with some degree of crowding or protrusion, the question is not whether to extract, but when and which teeth (even if only third molars). The instability of expansive treatments to avoid extraction has been repeatedly examined and reaffirmed, yet we continue to (re-)introduce “new” ways of squeezing all teeth into dental arches, encroaching upon the enveloping muscular and periodontal equilibrium and “filling” the face and smiles with teeth to o’erflowing. All this kvetching – in the hopes of avoiding the extraction of premolars – often ensures the removal of third molars and the utilization of “permanent” retention, permanently. So, what’s this Pecksniffian exchange actually worth? The contemporary meme of expanding younger patients (with jackscrew appliances) or older ones (with “slippery” braces and wider wires) is not an insurance policy for better stability, function or aesthetics (e.g., smiles, buccal corridors or profiles). We seem easily enticed to buy into concepts featuring braces that are said to have unique attributes, concepts of “truly lighter forces” and wide-body arch wires, or ancient appliances resurrected with arcane claims of bone development (e.g., bony “adaptation” or “tissue engineering” expanders); all with the promise of better treatment results through the avoidance of extraction. The hype is usually novel, but the patient’s intrinsic biology hasn’t changed.
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تاریخ انتشار 2011