The descriptive nature of published articles precludes making strong evidence-based recommendations regarding this extraction choice, but it is clear that mandibular incisor extraction can be effectively used in the resolution of crowding, as well as intermaxillary malocclusion in carefully selected cases. Several factors that could lead to good outcomes of orthodontic treatment following mandibular incisor extraction were identified. Mild-to-moderate class III malocclusion, an edge-to-edge anterior occlusion or anterior crossbite, with mild anterior mandibular tooth size excess, and minimal open bite tendencies were the clinical situations most frequently treated with this unique extraction choice. On the other hand, clinicians should be careful to avoid poor outcomes such as gingival recession, open interproximal gingival embrasures, increased overjet and overbite.