There is little doubt that well-planned orthodontic treatment can both improve the bite and enhance a patient’s overall appearance. Every course of treatment needs to be tailored to the needs of the individual patient. For many patients, in order to get the best appearance and long-term result, extractions will still be part of the process. Extractions as part of orthodontic treatment are required somewhat less frequently than in the past on account of advances in orthodontic techniques. In reaching a decision on extractions, a full assessment of the patient’s face, teeth and state of development is essential.