Which factors influence orthodontists in their decision to extract? A questionnaire survey

BACKGROUND: To evaluate the relative influence of different criteria in the choice between extraction and nonextraction treatment in current orthodontics, and to assess how the percentage of extractions has evolved over time. MATERIAL AND METHODS: Pre-treatment records (panoramic radiograph, lateral cephalogram, study casts and photographs) of fourteen cases in permanent dentition (adult or adolescent) with class I molar relationship and moderate anterior crowding were evaluated by 28 orthodontists. For each case, each orthodontist filled out a questionnaire reporting his treatment plan proposal (extraction or nonextraction) and the importance of specific parameters in his decision-making process, using categorical scales. Orthodontists practicing for more than 15 years were also asked to compare this decision with the one they would have taken at the beginning of their professional career. RESULTS: The two most important factors in the decision-making were the soft tissue profile and the amount of crowding. The least important factor was the presence of third molars. In cases of nonextraction treatment, the lack of space was managed mostly by dental expansion and stripping. Twenty percent of the case evaluations revealed extraction(s) decisions. Among the orthodontists practicing for more than 15 years, the current extraction rate reached 24%, whereas the same orthodontists reported they would have extracted in 39% of the cases in the past. CONCLUSIONS: The present study suggests that soft tissue profile has a higher impact than traditional criteria such as cephalometric measurements in the extraction decision. This is associated with a decreased extractions rate compared to the past. Key words:Orthodontics, extractions, survey, treatment planning.