Germectomy (enucleation) of the first premolars has been shown to be an effective treatment in managing dental crowding in mixed dentition, since the intraosseous decongestion of dental mass between permanent canines in first and second premolars provides early available space for autonomic eruption without interference from the first premolar to the permanent canine, erupting into a highly stable position within the dental arch. This facilitates and accelerates orthodontic treatment (if required), which would culminate before adolescence, unlike what happens with orthodontic mechanics, when the first premolars are removed after eruption and a considerable crowding, mature periodontal ligament, and a deformity of the alveolar process already occur. In our opinion, germenectomy of the first premolars will replace serial extractions, so that the treating specialist will concentrate in handling general habits such as tongue, lips and mouth breathing within the guide of the eruption, in addition to performing functional jaw orthopedics like deep biting, maxillary deficiency and protrusion, among others. When the other permanent teeth erupt without crowding and if the use of appliances is still needed, in many cases the stage of leveling and alignment, and the distalization of the canines and closing arches to close the spaces is avoided, as it is a tedious procedure for both the orthodontist and the patient. With the therapeutic enucleation of the first premolars, and after the eruption of the succeeding teeth, bands and brackets or rectangular arches are immediately placed on the patient (if necessary), which are left at the discretion of the orthodontist to complete the treatment and allow more time for an “artistic finish”, as well as an excellent retention with little or no recurrence. With this procedure the orthodontic appliances would be taken from the patient at the age of 13. Otherwise, at that age, the patient would suffer teeth crowding, deformation of the alveolar apophysis, and would begin orthodontic treatment in the difficult stage of adolescence.
(Rev Esp Ortod. 2018;48(1):027-032)