Retractive philosophy

The retractive philosophy is still extremely prevalent in the orthodontic profession worldwide. It involves the treatment of patients mainly in permanent dentition with the use of fixed orthodontic braces, extractions, and the use of extra-oral cervical headgear sometimes.

Proponents of this technique rationalise the following:

1. Crooked teeth as a result of crowding are due mainly to the fact the patients’ teeth are too large for the size of the arch. Therefore, rather than develop the constricted arch to normal they prefer to extract teeth, usually the bicuspids.

2. When the patient presents with a moderate overjet, proponents of the retractive technique believe that the best solution would be to extract the upper bicuspids and retract the 6 anterior teeth into the extraction sites.

In the majority of cases with Caucasian patients that present with class II, div I malocclusions with moderate overjets the problem is not a prognathic maxilla but rather a normally positioned maxilla and a retrognathic mandible. Therefore, if the 6 anterior teeth are retracted this can result in the patient ending up with a much less favorable concave profile. The upper lip is more deficient, the nose appears longer and in some cases the patients ends up with a midface deficiency. These cases are easy to diagnose. In class II, div I malocclusions with a moderate overjet ask the patient to move the lower jaw forward end to end. If the profile drastically improves then this patient requires a functional appliance to move the deficient mandible forward to its proper position. Extractions in this case would be contra-indicated.