American Journal of ORTHODONTICS

Volume 58, Number 1, July, 1970

ORIGINAL ARTICLES

Guidance of eruption versus serial

extraction
Rudolf P. Hotz*
Zkch, Switzerland

M ore than 30 years ago the spontaneous exfoliation of deciduous

canines in some of my younger patients aroused my interest. In one case, in
which all four deciduous canines were lost, I decided to follow through with
what Nature had initiated ; I extracted the four deciduous first molars and, later,
the first premolars. This simple procedure alone brought about a satisfactory
result. The boys family lived in Africa and every yca.r spent a few weeks in
Switzerland. The entire treatment was carried out with six appoirnments (Fig.
1: A and B).
In 1940 I began the treatment of my first, case with a fully developed concept
of serial extraction in mind, I, personally, have not examined this patient since
1945. While trying to contact him to see how he was faring, however, I learned
that he is now a physician at the Harvard Medical School in Boston, and
(loenraad F. A. Moorrces was kind enough to make the last casts and roentgeno-
grams for me. Therapy consisted only of extraction of the indicated teeth at the
proper time. Treatment was concluded 24 years ago, when the patient was 12
years old (Fig. 2).
In 1940 I published a small article1 on extraction therapy, mentioning the
possibility of early planned clxt ractions initiated by extraction of deciduous
teeth.
At t.he first postwar ChJ:l@t?SS oi the E nroltean C)rthodontic Society in
Brussels in 1947, Birger Bjellgren,? of Stockholm, spoke on serial extraction. My
own topic at that same congress was nctirle szcperG.sion of sruption by means of
tidructia in Class I.3 I later short.ened that lengthy term to guidoplce of erup-

Read before the Smerican Association of Orthodolltists? Miami Beach, Ha., April
30, 1969.
Chairman, Department of Orthodontics, University of Zurich, Zurich, Switzerland.

1
2 Hotx Amer. J. Orthodont.
JUlY1970

hon. Both Kjcllgren and I, quite independently of each other, had arrived at
almost identical conclusions. The fact that our audience was filled with vigorous
opponents of extract.ion of teeth for orthodontic purposes made the subsequent
discussion period a lively affair.
The principle of early treatment through well-planned extraction of decidu-
ous teeth followed by removal of permanent teeth has stood the test of time.
Along with it, Kjellgrens catchy term, seriaZ extraction, has also taken hold.
Dewel,4 Lloyd, Graber,G and others in the United States, and Heath,? in Aus-
tralia, have helped to make serial extraction an accepted method of treatment
throughout the world.
In all fairness, however, we must concede that the concept itself dates back
to at least 1851. We discovered a few years ago that Linderer,s a German dentist
in Berlin, in his book, Die Z~ahc?~.heilkunde nach ihrem neuesten Standpunkt,
wrote that quite often, in order to accommodate lateral incisors, one must strip
or extract the deciduous canines. Linderer further stated that often, because of
subsequent crowding in the buccal segments, removal of the first premolars
would be necessary. He arrived at these conclusions more than 100 years ago,
long before Roentgen discovered the x-ray.
I maintain that the expression serial extraction is incorrect, misleading, and
perhaps even dangerous. It tends to oversimplify. Xerial extraction implies a
cookbook method of treatment, which impresses the inadequately trained man,
who does not realize the complexities involved, and may end in poor results.
Thorough knowledge of morphology, growth, and development as well as correct
timing is essential when one is employing this mode of therapy. Although
perhaps I could not agree with 100 per cent of what Dewelgl lo wrote in the
AMERICAN JOURNAL OF ORTHODONTICS in December, 1967, and June, 1969, I
could endorse at least 80 or 90 per cent of what he said.
In German-speaking countries, the term guidance of eruption has prevailed.
It is comprehensive and encompasses all measures available for influencing tooth
eruption. Serial extraction is a recipe; guidance of eruption requires some brain
power and decision. Serial extra.ction is, to many, another way of creating space
and then moving teeth. For them, it simply means early extraction of the first
premolars, followed by a period of treatment with fixed appliances to close
spaces and secure intercuspation. Convincing patients and their parents of the
need for extraction is relatively easy when a frank malocclusion is already
present. Impressing upon them the need for early extraction as a preventive or
interceptive measure requires, as experienced orthodontists know, some power of
persuasion.
In my mind, the goal of guidance of eruption has always been to avoid the
need for active orthodontic treatment or to reduce it to a minimum. In this
sense, the term guidance of eruption is a synonym for interceptive orthodontics.
Guidance of eruption, in many cases, means extraction. In other cases, it may
mean only proximal stripping of deciduous teeth. Guidance of eruption can be
accomplished by using functional forces with simple appliances or through a
combination of various means which we refer to as minor orthodontic measures.
Since arch-length deficiencies and crowding are so common, it follows that ex-
 Guidance of eruption vs. serial extraction 3

Fig. 1. Models showing sequence of serial extraction at the ages of 7 years, before
spontaneous loss of deciduous canines (A); 9 years, before extraction of first deciduous
molars (6); 10 years, before extraction of first premolars (C); and 12 years, before eruption
of second molars (D). E, Occlusion at the age of 21 years.

Fig. 2. Models at the ages of 7 years (A); 12 years (B), and 36 years (C).
4 Hotz Amer. J. Otihodont.
July 1970

traction assumes a major role in these measures. Much of the crowding seen in
the buccal segments is due to caries of the deciduous molars. We refer to this
as symptomatic crowding.
Removal of teeth must be carefully considered and well planned. One must
always keep in mind the fact that extraction of a tooth is an irreversible pro-
cedure. For emphasis, I repeat that the term serial extraction connotes a cookbook

Fig. 3. A 25year-old schematic drawing indicating the sequence of serial extraction.

Fig. 4. A difference in eruption sequence indicates different extraction time for maxillary
first premolars.
 Volume 58
Number1 Guidance of eruption vs. serial extraction 5

set of actions. Guidance of eruption demands an evaluation, individual reflec-

tion and planning, and a decision based on the information available.
I shall confine myself to an elaboration upon the philosophy of guidance of
eruption by means of extractions. In Class I cases we try to achieve a good
result without resorting to the use of appliances. Here professional pride rather
than fina.ncial success is involved. Another point that is also involved is the
socioeconomic problem with which we all are and will be increasingly confronted,
namely, the growing need and demand for orthodontic services. Interceptive
orthodontics is the most valuable contribution of the general practitioner to the
problem of orthodontic treatment for the masses (as Charles I!. L. Nordll called
it), a challenge, however, that we shall never be able to meet fully.
Let me illustrate the problem with the following analogy: Our traffic prob-
lems cannot bc solved by producing newer, bigger, and faster cars with more
chromalloy each year. It can be done only by reducing the size and number of
cars in use and by building larger, more efficient roads and highways. We will

age in years

age in years
Fig. 5. Sequence and times of eruption in boys and girls.
6 Hotz Amer. J. Orthodont.
JuZz/ 1970

never be able to cope with the increasing demand for orthodontic services by
producing newer and better brackets, arch wires, hea.dgears, preformed bands,
and elastics. This can be accomplished only through the reduction of mechanical
labor and by creating simple but efficient methods of treatment. Guidance of
eruption offers us one possibility for effecting this.
More than 50,000 children are examined and treated annually in the school
dental clinics of the town of Zurich by forty-four dentists employed on a full-
time basis. Of these, 20 per cent (approximately 10,000) actually require ortho-
dontic treatment. Of the remaining 80 per cent, about half are in need of some
guidance of eruption. In Zurich the school dentist is a pedodontist. Through his
undergraduate education, he receives a good but limited orthodontic background,
a good basic training which enables him to improve his skill through daily work
and continuing postgraduate education.
In our postgraduate program, the fundamentals of orthodontics, which the
student already learned in undergraduate lectures and courses, are studied in
much more depth. There, consideration is given to the significance of such things
as the relationship between teeth and jaw dimensions, arch-length determina-
tion, size ratio of deciduous to permanent teeth, probable sequence of eruption,
congenitally missing teeth, position of unerupted teeth, and types of occlusal and
skeletal abnormalities. The evaluation of such factors is necessary for a deter-
mination of the correct diagnosis and subsequent treatment plan.

Fig. 6. Stripping of maxillary deciduous canines if slight crowding of the incisors is

present and if the size relationship in the bvccal segment is favorable.
 GU~&LNCGof eruption vs. serial extraction 7

The schematic outline of guidance of eruption by means of extractions was

drawn by me some 25 years ago (Fig. 3). It shows the typical plan for serial
extraction. The probable sequence of eruption must be evaluated before the first
premolars are extracted. In its simplest form, we have the sequence of canines
before second premolars or second premolars before canines, as shown in Fig. 4.
Tf the second premolar erupts before the canine, the first premolar serves as
space maintainer a,nd should not be extracted before eruption of the second
premolar. In some cases the space has to be maintained after extraction by means
of a simple plate which can be used as a bite plate and for better alignment of
the incisors if necessary. If the canine erupts before the second premolar, the
first premolar must be extracted early, often before eruption,
Generally, serial extraction in the maxilla presents few problems. Spon-
taneous space closure and axial inclinations are usually favorable. In the
mandible, unfortunately, this is not the case Here, however, because of a more
favorable size ratio between deciduous and permanent teeth, the extraction of
premolars can often be avoided, and in some cases the extraction of an incisor
is indicated. Another important item must not be overlooked: The lower canines
erupt much earlier than the upper canines. In girls, in more than 50 per cent of

Fig. 7. Marked crowding of the incisors but favorable size relcttkmshi p in the buccal
segr nents. Under these conditions, early expansion of both arches is possi tble.
 8 Hotz Amer. J. Orthadont.
July 1970

the cases, the lower canines erupt before or perhaps simultaneously with the
first premolars. In boys, this tendency is a little less marked (Fig. 5).
Another important consideration is the mesiodistal relationship of the upper
and lower first permanent molars. Following eruption, we often find them in a
cusp-to-cusp position in a sagittal direction, sometimes tending toward either
a Class I or a Class II relation. Other considerations are the width of the upper
central and lateral incisors, as compared with the lower incisors, and the relation
of the unerupted second permanent molars to the first molars. We can summarize
our morphologic evaluation as follows :
1. State of tooth eruption and root formation
2. Size ratio of the deciduous and permanent teeth in the labial and
buccal segments

Fig. 8. Guidance of eruption in the buccal segment when size relationship of permanent
to deciduous teeth is questionable. Many of these borderline cases can be treated with-
out appliances and brought to an acceptable result. A, Size relationship in the buccal
segment (not too favorable). 6, In this diagram the first premolars have erupted before
the canines. However, in 50 per cent of the cases mandibular canines erupt before
mandibular first premolars. In these cases, stripping of the first deciduous molars
mesially is the first step. C, Stripping of the second deciduous molar begins mesially.
Distal stripping of them is indicated according to the expected time of eruption of the
second premolars [as a rule, an estimated 6 months prior to eruption of the second
premolar). D, Second deciduous mandibular molars serve as space maintainers.
 Volume 68 Guidance of eruption vs. serial extraction 9
Number 1

3. Size of the apical base

4. The relation of tooth size, arch width, and supporting bone
5. Probable sequence of eruption
6. Congenitally missing teeth
7. Positions of unerupted canines, premolars, and second molars
8. Intercuspation of the first molars
The many differences in the morphology of the dental arches affect the
management of guidance of eruption. We assume here that guidance of eruption

A B

Fig. 9. Guidance of erljptior. if there is s!ight crowding of the incisors and an vnfavorable
size relationship in the buccal segment is present. The latter is always more marked in
the upper arch, and a Class II position of the first molars is very frequent. The direction of
guidance leads to extraction of the upper premolars only, with a Class II position in the
molar region and a Class I position in the canine region, A, Crowding and unfavorable
size relationship. 8, Stripping of lower deciduous second molars in the mandible and
extraction of deciduous canines and first premolars in the maxilla. In many cases guidance
has already been started by early extraction of upper deciduous first molars. C, Strip-
ping of upper deciduous second molars distally allows mesial migration of upper first
molars and space closure. D, Final occlusion, with canines in Class I and molars in
Class 11 position. Occasionally, extraction of a lower incisor may be necessary.
m

u 4
Volume
Number
58
1 Guidanct! of eruptio?L us. serial extraction 11

has as its goal treatment without appliances or with a minimum of appliances.

The following cases, in which treatment was limited to guidance of eruption by
means of extraction, will not illustrate simply a selected sampling of results.
They will exemplify important treatment principles.
In general, guidance of eruption is based upon the principle of optimal
utilization of available space to accommodate the teeth in the labial and buccal
segments. Where space is not adequate, either expansion or extraction is neces-
sary. The following statement is valid as a lcitmotir : The removal of a permanent
tooth which was not planned one or two years before suggests that either the
planning was incorrect or the patient presented for treatment too late for such
a plan to hr formulated.
Guidance of eruption can be divided into different categories. The first is
one in which extraction of permanent teeth should be avoided. These are the
typical wait-and-see or borderline cases. Upon or immediately following
eruption of the lateral incisors, slight crowding is present. Through proximal
stripping of the deciduous canines, adequate space can be obtained. A pre-
requisite for this treatment is a favorable size ratio between deciduous and
permanent buccal teeth with no arch-length deficiency (Fig. 6). In cases in
which a clear crowding of the incisors but a favorable size ratio of the buccal
segment is present, early expansion may be indicated (Fig. 7). This can best
be accomplished with removable expansion plates or a plate on the upper teeth
and a lingual arch appliance on the lower teeth.
The next category of guidance of eruption includes those cases in which the
incisors are fairly well positioned but an unfavorable size ratio in the buccal
segments is present. These, t,oo, arc wait-and-see cases but, even here, eruption
wn be influenced (Fig. 8, d t,o D ) .
In these borderline cases extraction in the upper jaw alone is another possibility
of guidance of rruption. This procedure is used when a clear unfavorable size
ratio is present in the maxilla, with the permanent canine crowns in labioversion
ilnti an evident kntlency to a Class I1 relationship of the first molars (Eig. 9,
,1 to D).

Fig. 10. Class II maloclusion in a girl 10 years of age with crowding of upper incisors,
deep overbite, and unfavorable size relationship in the buccal segments. The position of
upper canines is especially unfavorable. A, Models of guidance of eruption started by ex-
rr!Xt:0Fl of upper deciduous first molars (lower deciduous canines already lost) and
corresponding roentgenograms taken before extraction. 8, Models 6 months later. Upper
first premolars were removed before eruption. Corresponding roentgenograms were taken
before extraction. C, Models 2 years after the first model (age 12). Upper deciduous second
molars were extracted, and lower deciduous molars were stripped distally and mesially.
The roentgenograms taken 6 months earlier, before stripping of lower second deciduous
molars, show mesial migration of upper second premolars. D, Models and corresponding
roentgenograms at age 15. E, Occlusion at 23 years; on the right side, the lower second
premolar has been extracted as a result of caries and negligence on the part of the
patient.
Fig. 11. Example of guidance of eruption by extraction of upper first premolars in a case of Class II, Division 2 malocclusion in an
1 l-year-old boy. A bite plate was inserted after eruption of upper canines and second premolars and a lingual arch after extrac-
tion of lower first deciduous molars and stripping of lower second deciduous molars mesially. Models and roentgenograms were
made on the day of extraction of upper first premolars. The extraction of upper second deciduous molars was carried out 6
months later. Intraoral photographs show occlusion at the age of 13. The lingual arch is removed after complete eruption of
lower second permanent molars.
Volume 68 Guidance of &>*uptio)s us. s&al extractio?a 13
Number 1

The next illustration (Fig. 10) shows the casts and radiographs of the first
case we treated by this method. Therapy was carried out without the aid of any
appliances.
Considering the case relative to the minimal therapeutic measures used, one
can be pleased with the outcome. In other cases the insertion of a bite plate is
necessary to reduce the excessive overbite. A plate hinders the desirable mesial
migration of the upper first molars. Therefore, we often wait until the canines
and second premolars have erupted. Further elongation of these teeth, together
with the molars, reduces the overbite in a few months. In some cases the plate
is inserted following removal of the upper first premolars. A lingual arch wire
may be necessary to maintain the arch length in the mandible. This is important
in cases in which the second deciduous molars are lost before eruption of the
canines and in which, therefore, even a slight mesial migration of the molars
would interefere with the accommodation of the canines (and sometimes even
of the second premolars) in the buccal segments (Fig. 11).
These are just a few examples of simple ways of managing borderline cases
and of dealing with hundreds of patients who cannot or will not spend time and
money on extensive orthodontic treatment.

Fig. 12. Guidance of eruption by extraction of deciduous canines and first premolars and
stripping of deciduous second molars distally (serial extraction).
14 Hota Amer. J. Orthodont.
July 1970
Volume 58 Guidance of eruption vs. serial extraction IS
Number 1

In Class II cases in which marked crowding is also present in the mandible,

the preceding measures are not indicated. Guidance of eruption presupposes that
the patient is at an age where growth can still be expected to take place. For
early Class II treatment in such cases, we use functional appliances, with or
without extraction, in both arches.
It is in cases of Class I malocclusion with true crowding in both maxilla and
tnandible that the classic concept of guidance of eruption is applied. Here, the
expression se&d extl-action, may be used. The diagrams in Fig. 12 show that,
even here, a cookbook method cannot be followed.
One example of a typical Class I serial extraction case is shown in Fig. 13.
This boy was treated by extraction only. A lower appliance to correct the posi-
tion of the rotated right central incisor was removed after 6 weeks, at the
rcqnest of the boys father.
In addition to this classic concept, there are special areas in which guidance
of eruption can be applied, namely, in cases of congenital absence of premolars
and lateral incisors.
When lateral incisors are absent, guidance of eruption is employed to guide
the posterior teeth mesially toward space closure. Here, whenever possible, we
do not use appliances. Naturally, we end up with Class II intercuspation, but a
well-functioning, esthetically pleasing result can be attained and can easily be
improved by mechanotherapy. In such cases, guidance of eruption is started
before eruption of the permanent teeth in the upper buccal segments by proxi-
mal stripping of the deciduous molars. These are then impregnated with silver
nitrate. Stripping is repeated two to three times, and at the opportune moment
the teeth are extracted. In effect, we are creating an artificial arch-length
deficiency. The time for removal of the deciduous lateral incisors and canines
has to be chosen carefully to guide the eruption of the permanent canines
mesially. It may be necessary to hold t,he central incisors to keep them from
clrifting distally (Fig. 14).
Treatment is similar when upper second premolars are missing. Our goal here
is to bring the first molars into a Class II relationship. If only the lower second
premolars are missing, guidance of eruption requires the extraction of upper
prcmolars, generally the second ones. The case shown in Fig. 15 is a good ex-
ample of guidance of eruption where all four second premolars are congenitally
missing. The prognosis did not seem especially favorable at the start of this CW,
because of spaces between the first and second molars. We like to see roent-
genograms such as these in nonextraction cases. Here treatment was carried out

Fig. 13. Typical serial extraction case involving an 8-year-old boy in whom eruption
was retarded. lop row: Models at the ages of 8, 10, 12, and 15 years. Middle row:
Roentgenograms at the ages of 12, 121/z, and 15 years. Bottom row: Occlusion at the
age of 28 years, 13 years after the last extractions. Deciduous upper central incisors were
extracted at age 8; deciduous upper and lower canines and left lateral incisors were
extracted at age 10; deciduous first molars were removed at age 12; and upper and
lower first premolars were extracted at age 121/z.
 16 Hotz Amer. J. Orthodont.
July 1970

Fig. 14. Absence of lateral incisors in a lo-year-old girl. A, Roentgenograms at age 10. 6,
Schematic outline of guidance of eruption by stripping the deciduous molars inducing
arch-length deficiency in the upper arch, leading to a Class II occlusion. C, Upper arch
and roentgenograms at age 12, showing distally stripped second deciduous molars. D,
Intraoral view at age l23/4. Eruption of the very close upper second permanent molars
will close spaces and possibly lead to a Class II occlusion. Orthodontic treatment to
close soaces and secure oood interrrrsoidntion will be reduced to n minimrrm
Volume 58 Guidance of eruption vs. serial extraction 17
Number 1

$ -,
, A

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Fig. 15. Early treatment in cases of misskg se&d premolars. A, Schematk outline of
guidance of eruption in cases of missing second premolars. B and C, Before and after
treatment; no appliance used. D, Roentgenograms of the q-year-old girl. Second premolars
are missing, position of first premolars is favorable, position of second permanent molars
is unfavorable for closure. E, Roentgenograms at the age of 10 years after stripping of
lower second deciduous molars mesiodistally and extraction of the stripped upper second
deciduous molars. F, Roentgenograms at the age of 16 years, showing complete space
closure with practically no tipping.
A B

Fig. 16. Guidance of eruption in a case of traumatically lost central incisors in an 81/z-
year-old boy with a Class II, Division 1, deep overbite, protruding and diverging upper
lateral incisors, arch-length deficiency, and impacted upper second premolars. Treat-
ment plan: Space closure in the front, space opening in the buccal segments, and bite
correction with a monobloc, possibly extraction of a lower incisor. A, Intraoral view
showing lower incisors tipped to the left. B, Intraoral view showing monobloc, 1 l/2 years
later, before extraction of a lower left lateral incisor. C, Oral view at the age of 17
years. D, Roentgenograms a few hours after accident. E, Roentgenograms at the age of
17 years.
 Guicla?lce of eruption vs. serial extraction 19

without appliances. We used few minor orthodontic measures and much wait
and see.
Cases of symptomatic crowding (that is, arch-length deficiency as the result
of premature deciduous tooth loss) also fall within the realm of guidance of
eruption. Such patients, wherr neglect is evident, will seldom have the necessary
understanding or financial means for an intensive course of orthodontic trcat-
merit. Yet theso childrelt must, also be helped. ln these cases, guidance of erup-
tion is no longer indicated in the sense of an early planned orthodontic treat-
ment but in a modified, limited sense. Here the general practitioner, under the
guidance of an orthodontist, is the one to carry out the treatment.
It was emphasized at the beginning of this article that, I would elaborate
on the principles or philosophy of guidance of eruption and not simply dem-
onstrate extraction cases brought to successful conclusions with removable or
fixed appliances. I, like every orthodontist, could show extraction cases treated
with appliances to close spaces and upright teeth. This, however, is not guidance
of eruption in its true sense. At times simple guidance of eruption is not com-
pletely effective, and barely acceptable results (if not outright failures) do oc-
cur. Follow-up treatment with active appliances may then be required. Inasmuch
as orthodontics is considered a dentomcdical necessity, it is our responsibility to
ensure that treatment is accessible to all who need it. Through guidance of
eruption, it is possible to help many children who would otherwise have been
left without adequate care. Guidance of eruption is one possibility of intercep-
tive orthodontics and is in complete accord with the ideals of orthodontics. In
many cases, guidance of eruption will bc the only treatment required to bring
about successful results. In others, active treatment time will have been greatly
diminished, thus alleviating the hnrclen for both patient, and orthodontist.
The case shown in Fig. 16 may demonstrate the combination of guidance of
cruptioll with simple functional trr~atmellt and will at the same time be the link
t0 a, liIt?r l)npC?l 011 Applieat,ion and Appliance bianipulat,ion of Functional
Forces.
Ccrt;linl~, as iu all fnccts of treatment, guidance of erliption has its limita-
tions. It is ap to all members of the orthodontic community to be aware of its
indications ant1 c~ontraindications.
Our specialty must, assume its responsibility for clclucating the undergraduate
stllclmt in the science of guidance of eruption. \Vith such knowledge, the general
;)l~actitionel~. with the orthodontist :IS c*orlsl~ltalIt. will be able to bring the benefits
lri o~t~tloclcmtivsto mom chil~lren. Hrrc;in lies I hc tl;le mcsning of pm-mtivc and
iu tctrccptivi: iix%hodorltic philosopliy.
REFERENCES

4. Pewel, R. F.: Serial extraction in ol,l.llr),lontics: ln(licationa: objectives, and treatment

procedures, AM. J. ()KTEIODONTJCS 40: 9OG-926, lQ54.
20 Hotx Amer. J. Orthodmt.
July1970

5. Lloyd, Z. Bernard: Serial extraction as a treatment procedure, AM. J. ORTHODONTICS

42: 728-739, 1956.
6. Graber, T. M.: Orthodontics: Principles and Practice, ed. 2, Philadelphia, 1966, W. B.
Saunders Company.
7. Heath, John: The interception of malocclusion by planned serial extraction, New
Zealand Dent. J. 49: 77-88, 1953.
8. Linderer, J.: Die Zahnheilkunde nach ihrem neuesten Standpunkte, Erlangen, 1851,
J. J. Palm und E. Enke, pp. 202-210.
9. Dewel, B. F.: Serial extraction in orthodontics: Its limitations and contraindications
in orthodontic treatment, AM. J. ORTHODONTICS 53: 904-921, 1967.
10. Dewel, B. F.: Prerequisites in serial extraction, AM. J. ORTHODONTICS 55: 633-639, 1969.
11. Nord, C. F. L.: Orthodontic treatment for the masses, Tr. European Orthodont. Sot.,
pp. 48-55, 1947-1948.

Plattenstrasse 11.

It is almost unthinkable that anyone should consider normal occlusion of the teeth as
just their definite, mechanical relationship, yet literature and past practice seem to point
to this understanding. It is not just a question of moving teeth to a prescribed position.
If we wish them to stay, this movement must be brought about in such a way, and at
such a period, that a harmony of all related parts is obtained, and this harmony of
parts should be maintained all through the period of treatment if we expect to retain
our results. In my opinion, the principal cause for failure is that men are only thinking
of tooth occlusion and moving teeth to achieve this, and disregarding any abuse that
may occur to the related parts and supporting structures. (Mershon, John V.: The re-
movable lingual arch appliance, Transactions of the First [ 19261 International Ortho-
dontic Congress, St. Louis, 1927, The C. V. Mosby Company, pp. 279-303.)