Managing localized mandibular anterior crowding while preserving posterior occlusion and facial soft tissue balance remains a delicate diagnostic dilemma in contemporary orthodontics.
While conventional therapeutic protocols routinely favor premolar extractions or interproximal enamel reduction (stripping), these standard modalities may prove excessive or biomechanically disadvantageous in specific clinical scenarios—particularly in adult patients presenting with well-interdigitated Class I buccal segments and significant anterior tooth-size discrepancies (Bolton index).
In carefully selected cases, the therapeutic extraction of a single mandibular incisor serves as a highly targeted, efficient, and conservative alternative.
By directly generating space within the primary zone of arch length deficiency, this strategy eliminates the need for extensive reciprocal anchorage mechanics, minimizes unnecessary profile flattening, and preserves the natural intercanine width.
Furthermore, clinical evidence suggests that resolving severe anterior crowding via single incisor removal provides superior post-treatment stability and reduces the risk of long-term relapse compared to traditional four-premolar extraction sequences.
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However, achieving ideal overjet, overbite, and harmonious anterior guidance demands rigorous diagnostic setup and precise biomechanical torque and tip control to prevent undesirable lingual collapse or gingival recession.
This clinical case report thoroughly documents the comprehensive management of a patient treated with targeted mandibular incisor extraction.
By evaluating the underlying diagnostic rationale, biomechanical sequencing, and functional occlusal finishing, the authors illustrate how this unconventional extraction protocol can successfully resolve severe crowding, restore functional harmony, and safeguard tissue structures with exceptional predictability.
📖 Read the Full Study: To examine the step-by-step diagnostic criteria, detailed photographic records, and comprehensive biomechanical treatment progression of this case, you can access and download the complete article in PDF format on PubMed Central / Cureus here.
