You can ALWAYS treat people without extractions....it just might not be the best alternative! You can get additional room from expansion, slenderizing teeth, pushing teeth "backward" but there are limits to these methods and the final result might be better with exractions. Just make sure you have all of the pros and cons given to you and get a second or third opinion just to make sure!
Extraction is an option, but not always the best and not worst. It really depends on the case. Sometimes it is best to extract to lighten the bite forces, and at times extraction causes more bite forces on the remainig teeth.So I really do not think we should give any advice, unless some records or details are given. I am sorry if thais does not help. But I will bemore than happy to email and aswer you if you like to contat us and email photos or details.