Today, most orthodontic problems such as dental crowding and jaw size discrepancy can be treated without the extraction of teeth in order to produce a beautiful long lasting smile. This is facilitated in the case of children by starting treatment before the last remaining baby molar teeth are lost. Using arch developing techniques, space can be created for otherwise crowded erupting permanent teeth. Functional or growth modifying appliances can be used in growing patients to correct prominent teeth or underdeveloped lower or upper jaws.
In the case of adolescent and adult patients, primary consideration must be given to the shape of the face in terms of smile, tooth display, profile and the extent of the crowding of the teeth, before extractions are contemplated.
In many situations space can be made by expanding and uprighting tipped or trapped teeth, enamel reduction and the use of miniscrews or TADS (temporary anchorage devices).