~ev~~e~ce of orthodontic extra

The controversy regarding extractions for othodontic treatment continues and today is invoked by some as a feature of the “standard of care.” For this and other reasons, it is necessary to have contemporary data on the general prevalence of orthodontic extractions and the interpractice ran of extraction rates in current specialty practice and, if possible, also to establish possible reasons for, and consequences of, the extraction versus nonextraction decision. Although all treatment decisions are made on a case-by-case basis, practitioners appear to have personal preferences for or against extractions and hence adopt policies with different degrees of aversion to or bias toward extraction therapy. A number of factors enter into the extraction decision. These include features of the malocclusion, objectives of treatment, and the technique selected.to accomplish desired results. The present study does not address such issues but merely serves to provide epidemiologic data to estimate extraction frequency in contemporary orthodontic practice. Accordingly, a telephone survey of all licensed orthodontists in Michigan was conducted to determine their subjective estimates of extraction rates for patients in their practices. There were 238 respondents, for a response rate of 90.2%. Reported rates range from 5% to 87%. We then selected five practices from the extremes of the reported extraction rates. Three practices from the high end and two from the low end were included for an examination of patient records. Records of a total of 438 patient whose treatment had been completed were reviewed. The actual extraction rates for these practices ranged from 25% to 85%, which differed considerably from the clinicians’ subjective estimates. Differences ranged from an overestimate of about 20% to a 15% under&mate. Results from the survey indicate that a wide range of extraction frequency exists among orthodontists. The pilot study of the actual extraction rates suggests that discrepancies may exist between perceived and actual extraction rates. To obtain reliable estimates of extraction rates, it is therefore suggested that random sampling of a larger number of practices and objective evaluation of patient records are required rather than the use of questionnaires. (AM J ORTHOD DENTOFAC ORTHOP 1989;96:462-6.)