10/06/2026
Severe lower crowding. Treated without a single extraction. Full arch development.
This is one of my favorite categories of case to talk about, because so many patients come in already told they will need teeth pulled to make room. Sometimes that is the right call. Often it is not. This patient was in the not category, and the outcome reflects it.
Here is what he came in with. Severe crowding across the lower arch. Teeth overlapping, rotated, out of position, with nowhere to go. On paper it looked like a classic extraction case. But paper does not tell the whole story. A careful clinical exam did.
Instead of removing healthy teeth to create space, we developed the arch. We used orthodontic mechanics to give the teeth the room they needed while keeping every single one of them in the mouth. No extractions. No compromise. Just a thoughtful plan that respected the anatomy this patient was born with.
Here is why this matters. Every tooth you keep is a tooth that supports the bite, the smile, and the long-term health of the mouth. Extraction is a valid tool, but it should be reserved for cases that genuinely need it, not defaulted to because it makes the treatment plan easier to draw up. Conservative, growth-respecting orthodontics takes more planning and more time to diagnose correctly. But when it works, the result is better teeth, a broader smile, and a fuller arch that ages beautifully.
This case is a good reminder. If you have been told your child needs teeth pulled for orthodontics, get a second opinion first. Sometimes the answer is still yes. But sometimes there is a better path.
Dr. Baharvand, ABO Diplomate, AJO-DO cover clinician. Dr. Kang, Boston University, Harvard externship, JCO Resident of the Year finalist. 2026 D Magazine Best Dentist. 2026 Living Magazine Readers' Choice.
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