Correspondence Address:
Mahmood R. K Motamedi
Arghavanieh Blvd., Isfahan Branch, Islamic Azad University, Isfahan 81551-39998
Iran

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Dear Editor,

The extraction of permanent teeth for orthodontic reasons has remained a debatable and challenging topic over decades. Although due to conservative concepts the rate of such extractions is decreasing,[1],[2],[3] in some cases there is no other option. In such cases, the most frequent candidate for extraction is the first premolar, and in particular situations, the clinician may decide to extract the second premolar instead.[3]

Suppose that a patient comes to you for receiving orthodontic treatment; after analyzing the clinical and paraclinical documents, you come to the conclusion that there is no way but extraction of four premolars. But you see the patient has recently received endodontic or vast restorative treatments on the teeth candidate for extraction; what a waste! Too much of expense and maybe time-consuming treatments are now sentenced to death! The ethical point here is that the previous dentist should have referred the patient for an orthodontic consultation prior to drilling the teeth. Within the past 38 years of my professional orthodontic practice, I have faced several such cases.

Recently, a young lady presented to our office with the chief complaint of gummy smile and bimaxillary dental protrusion. After analyzing her diagnostic records, the four first premolars were considered to be extracted based on the orthodontic treatment plan. However, the left upper and lower first premolars (teeth #24 and #34) had previous endodontic and restorative/prosthodontic treatments and now they are candidate for being extracted [Figure 1]. On the opposite arch side, the fixed partial prostheses were also modified [Figure 1]. All of the abovementioned previous treatments were unnecessary and could have been prevented (compare [Figure 1]a with [Figure 1]b).{Figure 1}

To prevent such unpleasant happenings and probable legal disputes, the authors suggest that prior to rendering any endodontic or restorative treatment on premolars, especially in young patients with crowded or protruded dentition, dentists refer the patient for an orthodontic consultation. If such patient needs a rapid root canal treatment due to the acute symptoms, the dentist can plan for a two-visit endodontic treatment and refer the patient for consultation between the visits.

As a dentist, we all have to evaluate every aspect of a quality dental treatment; this goal can be achieved through a teamwork between dentists of different specialties. Interprofessional education should be further put into practice during dental education programs.[4],[5]

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Conflicts of interest

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References