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.