Omar El Bayoumy
The major consideration in this important decision relates to management of crowding/ protrusion and the possibility of camouflage for skeletal problems. Crowding/Protrusion. If a patient presents with severe crowding, extremely procumbent maxillary and mandibular incisors, marked facial convexity and severe lip protrusion, it should be obvious that removing premolars to alleviate crowding and to allow for the retraction of anterior teeth is the best strategy for solving the problem. Unfortunately, most patients do not present such a clear-cut choice. It is for this reason the extraction versus expansion debate has raged in orthodontics for more than 100 years. To better understand the grounds for the debate, we must consider the pros and cons of dental arch expansion.