It's impossible to avoid tooth extraction

In most cases, extraction can now be avoided thanks to modern orthodontic techniques. In fact, these techniques allow space to be reclaimed more easily than in the past. These include transverse expansion of the arches, self-ligating bands to spread teeth slightly apart, and stripping.

Finally, if the space is too narrow or the teeth are too prominent, there are two possibilities:

• Extraction
• Do nothing

In the latter case, the smile is likely to be compromised, leading to teeth that are tilted too far forward ("horse smile" appearance, to put it mildly).

‍