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In the daily practice, the orthodontist may be confronted with particular clinical situations with one or more missing teeth. This can complicate the therapeutic plan and influence the choice of possible extractions imposed by treatment requirements. In case of permanent molar absence, making decision becomes even more delicate. The practitioner must use his/her critical sense and clinical common sense to make the right choice between closing and redeveloping the residual spaces. Its choice must meet the patient's expectations and correct the clinical problem without risking overtreatment, or extending duration care. Several factors guide the therapeutic decision, ranging from the patient's age to economic factors, not to mention the technical complexity, therapeutic predictability, and patient comfort, which determine proper compliance and therefore success. In this chapter, we will focus on these decision-making factors by determining the scientific evidence level in terms of success, survival, and patient-centered outcomes (quality of life and functional efficiency).

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