Germectomy (Therapeutic Enucleation) of First Bicuspids and Eruption Guide to Treat Dental Crowding without Using Orthodontic Treatment. Case Report

Germectomy (enucleation) of the first bicuspids has shown to be an effective treatment in the management of dental crowding in mixed dentition because it produces intraosseous decongestion of the dental mass between permanent canines and second bicuspids. This provides early available space for the autonomic eruption without interference from the first bicuspid to the permanent canine which erupts into a highly stable position within the dental arch, facilitating and accelerating orthodontic treatment (if required) which would be terminating before the difficult adolescent age. This procedure differs from the orthodontic treatment of extracting the first bicuspids after they erupt when they are already facing a frank crowding, mature periodontal ligament, and deformity of the alveolar process. In our opinion, Germectomy of first bicuspids will replace serial extractions during which time the treating specialist will concentrate on preventive eruption guidance and the management of habits in general such as tongue, thumb, lips, and mouth breathing, in addition to performing Functional orthopedics of the jaws as in deep bites, deficiency or maxillary protrusion among others.