This case report describes a complex full-step class II case in a young adult patient treated with lingual straight-wire appliance and upper first molar extraction. As the patient refused a surgical treatment, she was offered the best possible camouflage with the double aim of obtaining an ideal occlusal relationship and maintaining the profile; appropriate biomechanical strategies, including extraction choice and anchorage control during space closure, were needed to achieve the planned results. This case report demonstrates the possibility of successfully resolving severe sagittal discrepancies in an adult patient without surgical treatment by means of a completely invisible non-compliance technique, with the extraction of the most compromised teeth. This report also underlines the need for careful planning during both diagnostic and treatment phases, in order to obtain the best results.

During the treatment planning process, extraction decisions are crucial. As a therapy option, the extraction of teeth should be considered in instances where there is a lack of facial harmony and stability in the occlusion. Treatment aims, the kind of malocclusion, aesthetic considerations, and growth patterns are all factors that influence asymmetric extraction. For the most part, premolar extractions are required when there is a significant midline difference or an asymmetrical connection between the teeth. Premolars, which are the first teeth to erupt and occupy the posterior position in chewing, are more vulnerable to injury than other permanent teeth. The optimal time to remove a second molar is at the moment when the connection between the molars has normalized or when a major front cross-bite can be remedied.

OBJECTIVE: The objective of the following study is to investigate the mandibular vertical asymmetry in a group of patients with early unilateral mandibular first molar extractions.
METHODS: Mandibular asymmetry index measurements (condylar, ramal and condylar-plus-ramal) were performed on the panoramic radiographs of a study group including 51 patients (mean age: 18.60 ± 1.11 years) and a control group of 51 patients (mean age: 18.53 ± 1.29 years). Group I included patients with a unilateral mandibular first molar extracted before the age of 12 years. Group II included patients with no extractions and had excellent Class I relationships, no missing teeth and slight or moderate anterior crowding. A paired t-test was used to determine possible statistically significant differences between the sides for the measurements. Student\'s t-test was used for the comparison of asymmetry index values between the groups and genders.
RESULTS: No group showed statistically significant sex-or side-specific differences for posterior vertical height measurements. Condylar asymmetry index and ramal asymmetry index measurements were not statistically different between the groups, while condylar-plus-ramal asymmetry index (CRAI) measurements were statistically different between the groups (P = 0.019).
CONCLUSIONS: A slight difference for CRAI value was found in patients with early unilateral mandibular first molar extractions.