Is Tooth Extraction Really Necessary for Braces?

September 20, 2019

Tooth extraction or not tooth extraction, that is the question! Even in 2017, the question of whether or not to extract teeth for orthodontic purposes is widely debatable in our professional community. There are factions within orthodontics that are dogmatic about never extracting teeth, and there are some that always extract teeth. We believe that the truth lies somewhere in between. The need for extractions in conjunction with orthodontic treatment is a very individualized decision.

This decision should be made by a qualified orthodontic professional. Only after a thorough clinical examination and carefully analyzing a full set of diagnostic orthodontic records can this decision be made. In summary, extractions are absolutely the correct course of treatment for some people. But in other cases, they should be avoided at all costs. That’s where the orthodontist comes into play. It is our job to correctly make that decision based on individual treatment needs. Given that information, let’s examine which cases demand tooth extraction.

People Often Ask:

Is it OK to extract teeth for braces?
Which teeth are extracted for braces?
Is it possible to get braces without removing teeth?
Is tooth extraction for braces painful?

Why would tooth extraction be necessary?

Severe crowding is one problem when an orthodontist may recommend removal before placing braces or clear aligners. Ordinarily, non-extraction treatments are suitable when dealing with mild crowding. However, a patient may have too many teeth fighting for limited space, causing severe overcrowding. Some of the teeth may even be out of the dental arch due to lack of room. Extraction becomes necessary in such an instance because you cannot fit the aligners until all teeth are in the dental arch. Teeth alignment needs sufficient space to help them move in the intended direction.

One cause of misalignment of the teeth is a discrepancy between the positioning of the upper and lower jaw. Mismatching of the jaws is what causes overbite and underbite. The difference in jaw size in most patients is small enough that braces and aligners move them into position without a problem. In extreme circumstances, the doctor may have to remove a tooth or two to counter bite asymmetry. Some patients need corrective jaw surgery to fix an overbite/underbite to enhance the aesthetic results of orthodontics. Extraction in these circumstances negates the need for surgery.

Protrusion is another reason that will make orthodontists advise on pulling the teeth before straightening them. Teeth are critical in shaping the lip and its positioning. Extremely protruded front teeth can distort the appearance of the lip. Removing teeth from the sides allows the doctor to reposition protruded front teeth by moving them backward, which improves lip posture.

Your doctor may recommend pulling for patients with an excessively diseased tooth. An individual who has had periodontal disease that left a tooth seriously degraded may need to remove it to improve the success of teeth alignment. Trauma from an accident may also compromise a tooth, making it a liability when straightening teeth. Structurally compromised teeth will have trouble responding to the movement required during alignment.

Many other variables determine the appropriateness of pulling teeth when fitting braces. For example, a patient whose teeth are fused, or ankylosed, to the bone may have more satisfactory results with teeth straightening if the affected ones are removed first. Extra or missing teeth are other justifications for recommending extractions. Orthodontists conduct thorough examinations before treatment to determine if a patient requires any other procedures before the main one. It is during this consultation that a patient can learn if tooth extraction is necessary or not.

How many teeth should be extracted?

The number of teeth that you can remove without compromising the structure of the jaw or face will vary from one patient to the next. Orthodontists aim at pulling the least number of teeth, usually one to four, to meet orthodontic treatment goals. Extraction of an odd number of teeth is not uncommon. A doctor may find it necessary to pull only one or three teeth to fit the objectives of the treatment. Premolars are the most common teeth to be pulled, but doctors create solutions that respond to individual cases.

Reasons Against Pulling Teeth

Tooth extraction has its pros and cons, which a patient must consider before getting treatment. Some orthodontic doctors don’t advocate for teeth pulling before realignment for several reasons. The primary one is that removing teeth, when it is contraindicated, can compromise the facial profile and the smile. The profile of the face relies heavily on the structure of the teeth because it is responsible for supporting the muscles. Pulling excess teeth can alter the profile, causing the face to flatten or narrow too much. Extraction may also extend the time it takes for realignment to occur because the teeth have to move a greater distance to get into position.

Are there alternatives to teeth extraction?

Most orthodontists turn to teeth pulling only when it is absolutely necessary. Some common options can help fix dental problems before fitting braces. When dealing with overcrowding, the doctor can try out other methods to increase the space between teeth like using an expander. This tool works by expanding the palatal suture, which lies in the upper jaw ands runs from front to back. It is less challenging to increase the perimeter of the dental arch in young patients.

Headgear is another tool that orthodontic specialists may utilize as a substitute to increase the spacing between the teeth. However, due to social concerns, this appliance is rarely used in modern times. Some doctors also thin down or slenderize teeth by chipping away a small fraction of the enamel to deal with an overcrowding problem. A myriad of other spacing techniques, orthodontic stabilization devices, and bone screws are all options that orthodontists may consider as viable alternatives to tooth extraction.

The Damon System. This particular method has been proven to offer patients optimal teeth straightening results without the need to have any teeth removed prior to the installation of the braces. This system may be applied to the teeth using clear or metal hardware.

The Invisalign system for aligners offers patients a completely different alternative to traditional braces with no need to use any clear or metal hardware. This system uses hardware that is similar to retainers or mouth guards to gently move your teeth into place.

Tooth slimming is another orthodontic technique that can help to minimize or avoid the need for extracting teeth.

For younger patients (aged 16 or younger), a palate expander can often provide a smooth path to avoid tooth extraction.

Finally, the TAD is yet another option to potentially bypass tooth extraction. This technique secures one or more critical teeth in place using a small implant under the gemlike. With the help of these implants, it becomes easier to control jaw alignment and ease overcrowding issues into adulthood.

How Dr. Nease can Help

Everyone loses baby, or primary, teeth in a certain order. But in some instances, the phenomena may cause various dental problems. If a child loses teeth too early or too late, alignment challenges may result. In some cases, an orthodontist may need to remove the primary teeth to allow for proper growth. The removal of permanent teeth, however, is an individualized decision made between orthodontists and their patients.

When getting orthodontic treatment like braces or clear aligners, it may be necessary to pull some of these teeth. Orthodontists carry out extensive examinations before advising extraction and lay out the pros and cons of the procedure. Drs. Nease, Higginbotham & Thomas patients get customized treatment plans to guarantee the best results. Book an appointment today to learn how to get the smile you have always wanted.