Many clinicians recommend the extraction of premolar teeth, in high angle patients, with the belief that forward movement of the molars (out of the palato-mandibular wedge) may allow anterior rotation of the mandible (1 – 3). Some authors have pointed out that this hypothesis is invalid for growing patients who tend to have more extrusion of the posterior teeth during orthodontic treatment. These clinicians recommend that the orthodontic treatment be postponed until the pubertal growth spurt is nearly complete (4 – 6).

In patients with a skeletal open bite and interocclusal contacts at the terminal molars only (first molars at an early age when the second molars have not yet erupted or second molars in the later ages) the terminal molars act as a wedge or fulcrum, so the extraction of the terminal molars instead of premolars has been prescribed (2,7,8).

Some authors advise extraction of first molars and forward movement of the second molars out of the wedge for the correction of skeletal open bites with interocclusal contact at both first and/or second molars (2 –9). Kim, however, refuted first molar extractions (8). He felt that these patients’ molars are mesially inclined, and to mobilise the mesially inclined second molars into an enormous extraction space (in an upright position) is a most inappropriate and difficult procedure. The same author advocated the extraction of second or third molars and uprighting of the buccal segments with a slight intrusion, or the non-extraction of molars via a technique called the multi-loop edgewise archwire technique (MEAW).

Subheading references:

1. Isaacson et al* Angle Orthodontist 1971; 41: 219 – 229
2. Ricketts R* Features of the Bioprogressive therapy 1979; RMO pages 281 –289
3. Ulgen M* Orthodontic thesis, Ankara University 1990 pages 72 – 73
4. Shudy F* Angle Orthodontist 1964; 34: 75 – 92
5. Bjork A* American Journal of Orthodontics 1969; 55: 585 – 599
6. Neilsen I* Angle Orthodontist 1991; 61: 247 – 260
7. Frankel R* “Functional Aspects of Molar Extraction in skeletal open bite” Graber Text Book St Louis 1986; 184 – 199
8. Kim YH* Angle Orthodontist 1987; 57: 290 – 321
9. Dale JD* “Guidance of Occlusion, serial extraction” in text book by Graber St Louis Mosby 1985; 341 - 343