- Severe crowding (to gain space would be detrimental to attached gingival and teeth would not have proper basal bone)
- Profile considerations. In some patients to treat non-extraction would be detrimental to their profile. Those patients with a Bi- maxillary protrusion and lip incompetency would need retraction of anterior teeth for lip seal
- Camouflage treatment when adult patient refuses surgery
- To expedite treatment when space gaining via expansion, tads, etc would extend treatment in certain patients (cooperation problems, special needs,etc.)
I do not like to extract unless it’s absolutely necessary. However NOT extracting when it is needed in my opinion is just as detrimental as extracting when you shouldn’t. I like to use appropriate growth appliances for ideal correction. Appliances such as the Herbst appliance, expansion appliances, forsus appliance, face mask therpy and crossbows allow us to avoid extractions on many patients and improve facial esthetics.