Extreme orthodontic case: non typical upper central incisors extraction pattern​

Crowded case that was treated with extracting upper incisors

Here is another complex case that was treated by Dr. Kanaan with a 7-year follow-up.

Sara –not her real name- came to Dr. Kanaan to get her teeth straight. She had a severe crowding that will require the removal of 4 teeth. She already had a consult with another orthodontist and was told that 4 teeth -the first bicuspids- are required to be removed to correct her crowding because of her small jaw. Sara wants a better smile and straight teeth.


start and finish
In this article, we will discuss in detail how this case was treated with excellent outcome.

Upon further examination and based on the X-rays, Dr. Kanaan noticed that her two front incisors have short roots and might not last for a long time after braces. Short roots for the front teeth are not uncommon among Hispanic patients and research has supported this prevalence. "click here"

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The existence of short roots is not a contra-indication of having orthodontic treatment and getting a beautiful smile with straight teeth "click here for more information". However, the experienced orthodontist needs to modify the approach on how to correct and straighten these teeth with short roots.

upper incisor extraction orthodontic case
8 years progress X-rays showing stable results 

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Dr. Kanaan did not choose to extract the upper first premolar as the other orthodontist had suggested but rather decided to extract the two short upper incisors.  This was done carefully and not at the same time.

The treatment plan was as followings:

Extraction case by removing 4 teeth; 2 upper incisors and 2 lower first bicuspids. Because the lateral incisors are usually smaller than the centrals, we will put two crowns on the upper laterals to match the extracted centrals and lateralize the canines. Note: upper central incisors extraction will be done 3-4 months after starting the treatment to monitor the response of the roots.

Treatment time: 24 – 30 months

Treatment Progress:

The treatment was completed in 26 months with the following progress:

1. Start orthodontic treatment with traditional metal braces.

2. Within a few weeks, extract only one upper incisor. Dr. Kanaan does not want Sara to walk with a big front gap. He decided to extract the most crooked tooth which was the upper right incisor. Dr. Kanaan asked her dentist to save the tooth so we can use it as a template later on the incisors. Dr. Kanaan extracted only one central at a time to make her front gap smaller.

upper incisor extraction orthodontic case
Note how only one upper incisor was removed first

3. Close the front space from the extraction and then in 4-6 months he will extract the upper left incisor.

4. In the lower arch, we ext

racted the first premolars at the same time the first upper incisors were extracted.

5. After 18 months, a template was created to make sure the space and size of the upper laterals are perfect to place the future two crowns.

6. The case was completed in 26 months and Dr. Samo – our cosmetic specialist- placed two crowns. These crowns should have light contact with the opposing teeth. It is important to include the lateralized canines in the anterior guidance movement.

upper incisor extraction orthodontic case
Final result with 2 crowns placed on upper laterals

7. A special retainer was given to the patient to keep the teeth in place. 

The patient visited our office with her mother after 7 years and she was extremely happy and satisfied. 


This is a case that demonstrates that non-typical extraction pattern could be utilized in certain cases. A thorough examination including different factors and long term stability for the patient should be considered before executing such an option.  

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