# Extraction Timing in Growing Patient Pt is 10 yrs old and there is not enough space for laterals , at the same time no space for upper canines to erupt in future Would you extract all Cs right now to make space for laterals and then expansion and reevaluate after premolars erupt for bicuspid and extraction or would you do combination of course expansion and serial extraction ? ![](https://outline-production-attachments.s3-accelerate.amazonaws.com/uploads/db897cb1-45b7-428c-9f00-65156a5bd4eb/3cb954bc-0f37-4b9d-9cae-20d9ed7bf3ae/ApplicationFrameHost_gXh3mo1oUk.png?X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Content-Sha256=UNSIGNED-PAYLOAD&X-Amz-Credential=AKIA4EOUDTOVUICLPZ4P%2F20260920%2Fus-east-1%2Fs3%2Faws4_request&X-Amz-Date=20260920T213000Z&X-Amz-Expires=86400&X-Amz-Signature=cac2ae9e0600c7902a1b04bd272611214414301d2989c8df93d7f6a6f7e7d29e&X-Amz-SignedHeaders=host&x-amz-checksum-mode=ENABLED&x-id=GetObject "left-50 =760x378") ![](https://outline-production-attachments.s3-accelerate.amazonaws.com/uploads/db897cb1-45b7-428c-9f00-65156a5bd4eb/e6886307-6422-472a-9640-a96ce1426f69/ApplicationFrameHost_DsRLjY6QYM.jpg?X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Content-Sha256=UNSIGNED-PAYLOAD&X-Amz-Credential=AKIA4EOUDTOVUICLPZ4P%2F20260920%2Fus-east-1%2Fs3%2Faws4_request&X-Amz-Date=20260920T213000Z&X-Amz-Expires=86400&X-Amz-Signature=72158c1aab9fc66fe0096a35b3607864f4afe5b2588af6f89865769099227e0f&X-Amz-SignedHeaders=host&x-amz-checksum-mode=ENABLED&x-id=GetObject "left-50 =338x228") ![](https://outline-production-attachments.s3-accelerate.amazonaws.com/uploads/db897cb1-45b7-428c-9f00-65156a5bd4eb/8b6c8014-7c4f-4c0f-9930-48d88d237492/ApplicationFrameHost_AwIIl9XF1U.png?X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Content-Sha256=UNSIGNED-PAYLOAD&X-Amz-Credential=AKIA4EOUDTOVUICLPZ4P%2F20260920%2Fus-east-1%2Fs3%2Faws4_request&X-Amz-Date=20260920T213000Z&X-Amz-Expires=86400&X-Amz-Signature=2bb0ae39f6510c76759da976232a5eb92dbf8d283ee60efc1d8fc24e58300e31&X-Amz-SignedHeaders=host&x-amz-checksum-mode=ENABLED&x-id=GetObject "right-50 =338x248") ![](https://outline-production-attachments.s3-accelerate.amazonaws.com/uploads/db897cb1-45b7-428c-9f00-65156a5bd4eb/e03875e7-0376-4279-b329-b086cde9a687/ApplicationFrameHost_Ze5IMxHRuP.jpg?X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Content-Sha256=UNSIGNED-PAYLOAD&X-Amz-Credential=AKIA4EOUDTOVUICLPZ4P%2F20260920%2Fus-east-1%2Fs3%2Faws4_request&X-Amz-Date=20260920T213000Z&X-Amz-Expires=86400&X-Amz-Signature=3b2e8d06b21c7925f5b523c64e170e9ee93d67716914ea65a465a861728c507a&X-Amz-SignedHeaders=host&x-amz-checksum-mode=ENABLED&x-id=GetObject "left-50 =338x236") ![](https://outline-production-attachments.s3-accelerate.amazonaws.com/uploads/db897cb1-45b7-428c-9f00-65156a5bd4eb/81466664-c826-4c14-878e-f9768c32e8a7/ApplicationFrameHost_1Q7woB0vRb.png?X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Content-Sha256=UNSIGNED-PAYLOAD&X-Amz-Credential=AKIA4EOUDTOVUICLPZ4P%2F20260920%2Fus-east-1%2Fs3%2Faws4_request&X-Amz-Date=20260920T213000Z&X-Amz-Expires=86400&X-Amz-Signature=5c844e280d74a85b20ecdc2fb401b04e1d55fbaccf3b674cbe478a1b75acf3cf&X-Amz-SignedHeaders=host&x-amz-checksum-mode=ENABLED&x-id=GetObject "left-50 =211x259") # Answers: [https://www.loom.com/share/c0fd0fc383224bc4820bf92d692e3949?sid=83c5d193-74b1-4e85-9bb8-cb2b4a338eb7](https://www.loom.com/share/c0fd0fc383224bc4820bf92d692e3949?sid=83c5d193-74b1-4e85-9bb8-cb2b4a338eb7) The key consideration here is to create eruption pathways for the teeth coming in. The laterals are high and blocked out with limited space, similar to the situation on the lower arch. There’s almost no circumstance here where I believe permanent teeth need to be extracted. When we consider the leeway space, there’s generally more room when the adult premolars erupt because the primary molars are wider. For example, a lower primary molar (E) is typically about 10 mm wide, while the erupting premolar might be 7.5 mm, giving us about 5 mm of extra space. Given this, we could consider extractions to achieve proper alignment earlier. However, it’s critical that the molars do not shift forward, as losing that space would be problematic. Looking at the available space, it's not too bad. For example, a tooth might be about 7 mm wide, and with 5 mm of space available, we could potentially fit the canines without extractions by creating more expansion and developing the arch further. On the lower arch, there's a 2-3 mm discrepancy. Typically, a lower central incisor is about 5 mm, with laterals around 6 mm, so with 3-4 mm of available space, expansion could resolve the issue without needing extractions. That being said, if extractions were necessary, I wouldn’t hesitate to remove primary canines to create enough room for proper alignment. **Example 1 (No Extractions):** A patient with lower lateral incisors erupting lingually and not enough space for the teeth. The upper arch also had crowding and small primary laterals. We used aligners to expand the arch, creating enough space without any interproximal reduction (IPR) or extractions. With just expansion and proclination, we achieved enough room. As primary molars were lost, more space was created, and alignment was maintained. Expansion is easier at a younger age, and by the time the lateral incisors came in, we had sufficient space to align them. **Example 2 (Extractions):** Another patient, her sister, had significant crowding with little room for the lower incisors. We extracted the lower canines, creating room to move the lower incisors buccally and achieve good alignment. Despite the patient’s inconsistent compliance, we maintained arch development with expansion and eventually switched to nighttime trays. As the primary teeth were lost and the adult premolars erupted, we managed to align the teeth without significant issues. Although some Class II correction was necessary, we achieved the desired outcome with minimal disruption. In conclusion, for your patient, I would consider either extracting the primary canines or not—both approaches could be fine. Once the teeth are aligned, I would suggest moving to nighttime trays for retention. I recommend a five-year comprehensive Invisalign Teen product, with one year focused on moving the teeth and then holding them at night until everything comes in, followed by a final alignment.