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Premolar Extraction Pattern — ORE Part 1 MCQ

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ModerateOrthodonticsPremolar Extraction PatternORE Part 1

A 13-year-old has a Class I molar relationship, 12 mm of lower-arch crowding and 3 mm of upper-arch crowding. Assuming extraction treatment is selected after full orthodontic assessment, which extraction pattern is most likely?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Extract both lower first premolars, with upper first premolars if coordination requires it

Answer: A. Severe lower crowding is the discriminating feature. If an extraction plan is chosen, lower first premolars are the conventional teeth for creating substantial space in a Class I crowded lower arch; the mild upper discrepancy may or may not justify corresponding upper-premolar extraction after full records are assessed. Canine extraction is not a routine crowding strategy because it compromises anterior guidance and appearance. Third-molar extraction does not create usable space for established anterior crowding. Incisor extraction is a selective compromise only in carefully chosen cases, usually involving favourable tooth-size relationships and anteriorly localised discrepancy, none of which is given here. Expansion alone is not the most likely solution for 12 mm of mandibular crowding. In practice, this decision requires specialist assessment of facial profile, incisor inclination, periodontal limits and radiographs.

Reference: Algharbi M, et al. Extraction decision and identification of treatment predictors in Class I malocclusions. 2013. https://pubmed.ncbi.nlm.nih.gov/35201405/