Why extraction for braces

Tooth extraction is necessary to achieve the right results in cases where keeping all the teeth in will not allow for straight teeth and a healthy bite. Only severe dental crowding requires extraction. In certain cases, a tooth may need to be extracted prior to orthodontic treatment because it has decayed or become damaged from prior crowding, due to bacterial growth and plaque build-up. If the decay is too advanced, it may be more effective to simply remove the teeth and align the teeth properly without it, by filling the vacant space with healthy teeth, guided into position by braces or Invisalign.

Extractions are especially necessary for cases in which the results will be unstable without removing teeth, resulting in shifting and misalignment later on, requiring more orthodontic care to correct. In that case, it makes more sense to extract teeth in the first place to achieve healthy, safe results designed to last. A very severe bite issue, such us underbite , open bite , or deep overbite , may be fixed with help from a tooth extraction, especially if the patient elects not to have surgery to correct the condition.

Your orthodontist will thoroughly examine your teeth, including comprehensive x-rays , to determine the placements of each tooth and what will need to be done to achieve a healthy bite and smile — including the possibility of extractions. Some of the following signs may indicate a need for extraction, but it depends on the specifics of your case — even if some of these apply to your teeth, it does not necessarily mean they will need to be removed. This list is just to help you understand some of the signs of possible extraction cases: it does not mean your teeth will have to extracted!

If your orthodontic case requires dental extraction, your orthodontist will refer you to a general dentist or oral surgeon for the extraction. Orthodontists are dedicated entirely to shifting teeth, while general dentists and oral surgeons offer a wider variety of procedures, so they have all the medical equipment necessary to extract teeth. Teeth may be extracted before or during orthodontic treatment with braces or Invisalign.

Once the extractions have healed properly, the teeth can be guided into the site vacated by the extracted tooth. You will not feel pain during the extraction: your dentist or oral surgeon will use either local anesthesia or sedation to remove teeth without pain.

The dentist or surgeon will expertly and swiftly remove the teeth. After extractions, they may use a few small stiches to close the hole. These will either dissolve or be removed after a week or so when you come in for a check-up.

You can go home the same day. You may feel a bit of pain or discomfort when the anesthesia wears off: use any over-the-counter pain medication to treat. Avoid crunchy or sticky foods for a few days whole the holes heal, and rinse your mouth out with salt water or an antiseptic rinse provided by your dentist to keep them clean. Your dentist may also provide you with a specialized oral syringe to wash out any potential food or debris that could get caught in the holes left by extractions.

Your mouth is one of the fastest-healing parts of your body, so the holes will heal over very quickly. Once the holes from tooth removal have healed, you can begin or continue orthodontic treatment: before too long, the gap created by the extraction will be filled by the healthy teeth in proper alignment, under supervision by your doctor.

Not all cases require teeth extractions before beginning braces treatment. In fact, only a small percentage or orthodontic cases require extractions. Your orthodontist will decide if extractions are necessary to achieve a healthy bite and a beautiful smile. Tooth extraction is never the first option: they will determine what other procedures may be possible before recommending tooth extraction.

Only certain orthodontic cases will require extractions. If you are getting Invisalign, your orthodontist will determine what procedures will be necessary to help your teeth achieve their best results. Tooth extraction is a last-choice option, but if your orthodontist recommends an extraction, it will certainly help you achieve a healthy, happy smile built to last.

Your orthodontist will make a professional decision about whether teeth need to be extracted. Some signs you might need a tooth extracted include: teeth growing in the wrong direction; teeth too large to fit in the proper positions; jaw too small to fit all the teeth; teeth discolored or showing other signs of decay; or sensitive or painful teeth. Very pronounced issues with your bite may also require tooth extraction to properly correct, especially if surgery is not an option.

Orthodontists do not pull teeth. They decide if extraction is necessary to achieve a healthy bite and beautiful smile with straight teeth, and then refer you to a general dentist or oral surgeon to complete the extraction.

If there are too many teeth to fit in the jaw properly, or certain teeth cannot be properly spaces into the row of teeth, it is sometimes more effective to remove the tooth than try to find space for it in the teeth. Your orthodontist may recommend between teeth, depending on the specifics of the case, to achieve the best results.

Dentists and oral surgeons are certified, trained, and experienced in dental extractions and will only do this procedure to help you achieve the best results for your smile. Tooth extraction is not very common for orthodontic care. It is more common for adults, whose teeth and bones have stopped growing and thus may be more difficult to move, creating severe crowding.

It is important to recognise whether a case is genuinely crowded or whether the teeth are displaced lingually as in a Class II Division 2 case. Lingually displaced lower labial segments are frequently not crowded, even though they may appear to be so. Proclination of the lower labial segment also reduces the overbite, as well as overjet, and may obviate the need for extractions. However, this treatment approach should be undertaken cautiously as uncontrolled and excessive proclination of the lower incisors can be unstable and should only be undertaken in selected cases by experienced clinicians.

Flattening of an accentuated curve of Spee in order to reduce an overbite, where proclination is contraindicated, does require space, for which the extraction of lower teeth can sometimes be considered. The space required to flatten a curve of Spee has historically been over rated, the amount of space required is 1—2 mm when the curve is severe and there is no crowding. It is difficult then to justify extracting teeth purely for the sake of creating space to flatten an occlusal curve.

The greatest challenge is the mechanical control of the teeth to prevent excessive proclination of the lower incisors. This usually occurs because the intrusion force is at some distance labial to the centre of resistance of the incisors and lingual crown torque is needed to prevent the labial movement of the incisors. Despite the factors discussed above, certain teeth are extracted preferentially for orthodontic reasons.

The high percentage of premolar extractions is related to their position in the arch and the timing of their eruption.

They are often ideal for the relief of anterior and posterior crowding. However, each patient should be seen as an individual and their treatment planned according to the merits of the malocclusion,.

In general, removal of a lower incisor should be avoided, as the inter-canine width tends to decrease which can result in crowding developing in the upper labial segment or the overjet increasing. However, a number of situations do exist in which a lower incisor may be considered as part of an orthodontic treatment plan and fixed appliances are generally required in these cases.

These include situations where a lower incisor is grossly displaced from the arch form or 'ectopic' and space is required to align the teeth. This is best considered in adults and especially those who have had previous loss of premolar units in each quadrant and present with late lower labial segment crowding Fig.

Class III cases at the limit of their growth can be camouflaged with loss of a lower incisor, to allow the lower labial segment to be tipped lingually, correcting the incisor relationship. This also tends to increase the overbite, which is helpful in these cases. An increase in overjet or a slightly Class III buccal segment relation may be an undesirable side effect. A Bolton analysis a measure of tooth size discrepancies may be used to analyse the extent of the disproportion.

A Kesling set up 17 where the anterior teeth are sectioned from a plaster model and re-positioned in wax as a trial set up, having left out a lower incisor may be helpful in predicting the final outcome Fig.

Crowding returned in the lower labial segment a , which was relieved by removal of a lower incisor and fixed appliance treatment. A bonded retainer was fitted at the completion of treatment b. Upper incisors are rarely the extraction of choice to treat a malocclusion.

However, the upper labial segment is particularly at risk from trauma, especially in Class II Division 1 cases with large overjets. In situations where the long-term prognosis of an incisor is poor, for example, the incisor is non vital, root filled, dilacerated or of abnormal form, the tooth should be considered for extraction as part of the orthodontic treatment plan.

Full consideration should be given to the resulting occlusion and aesthetics. Placing a lateral incisor in a central incisor position rarely gives a good result because the root of the tooth is narrow and the emergence angle of the built up crown is poor.

In some cases transplantation of a premolar with a developing root into the incisor socket can relieve crowding in the lower arch and provide a useful replacement in the upper labial segment Fig. A lower premolar has been transplanted to replace the upper left central incisor which had a poor prognosis. Where lateral incisors are diminutive or missing, space closure or space maintenance can be considered more equally. Attention must be paid to the shape, size, gingival height and colour of the canine if a good aesthetic result is to be achieved.

In many cases the canines can be disguised as lateral incisors by selective grinding, and where appropriate, aesthetic build-ups. These teeth are rarely considered for extraction unless very ectopic Fig. The loss of a canine makes canine guidance impossible and may compromise a good functional occlusal result.

Contact between a premolar and lateral incisor is often poor and canines can act as ideal abutment teeth because of their long root length and resistance to periodontal problems. Palatally ectopic canines can sometimes be in unfavourable positions for alignment, and lower ectopic canines often require extraction rather than alignment. In many of the former cases the first premolar can be aligned with a mesial inclination and rotated mesio-palatally to hide the palatal cusp and provide a better aesthetic result.

The resulting occlusion gave acceptable contacts between first premolar and lateral incisors and improved the arch form. Premolars are often ideal for the relief of both anterior and posterior crowding, the first and second premolars have similar crown forms, which means that an acceptable contact point can be achieved between the remaining premolar and the adjacent molar and canine. The choice between first or second premolar depends on a number of factors: for example, the degree of crowding, the anchorage requirements, the overjet and overbite.

In Class I cases where crowding exists and the canines are mesially angulated, loss of first premolars may produce spontaneous improvement in the alignment of the canines Fig. Any excess extraction spaces may close with time, although a study by Berg et al. However cases amenable to this type of treatment are rare and fixed appliances especially when second premolars have been extracted invariably produce better results. All four first premolars were extracted and the occlusion allowed to align spontaneously.

Second premolars are the third most commonly developmentally absent teeth after third molars and upper lateral incisors. In uncrowded arches deciduous molars with good roots are often retained, as space closure in these cases can be difficult Fig. Mesio-distal reduction or 'slenderising' can be used to maximise arch co-ordination, especially where deciduous molars are only retained in one arch.

Second premolars can become impacted either due to early loss of deciduous molars or severe crowding. Ectopic second premolars usually erupt lingually or palatally and should be considered for extraction if they are completely excluded from the arch Fig. Localised crowding often manifests in the lower buccal segments by lingual eruption of the second premolar. First permanent molars are often the first permanent teeth to erupt into the mouth.

Their deep fissure morphology predisposes them to caries and poor tooth brushing combined with a high sugar intake, may result in gross caries. Heavily restored or decayed first molars should be considered for removal over other non-carious teeth Fig. First molars extraction requires careful planning. Their position in the arch means that whilst relief of premolar crowding is achieved the space created is far from the site of any incisor crowding or overjet reduction. The timing of the loss of first molars is also an important consideration.

The orthopantomogram a shows gross caries in the left first molars and heavy restorations in the right first molars. Notice the discrepancy in space available in the two arches. In the upper arch the second molars have erupted in close proximity to the second premolars due to their mesial eruptive path b.

In the lower arch there is considerably more space remaining from the vertical eruptive path of the second molars c. Maxillary second molars have a curvilinear eruptive path with mesial and vertical components. The lower second molar has a more vertical path, but it has to move more horizontally in favourable spontaneous molar correction. This is one of the reasons why the spontaneous tooth movement is less favourable in the lower arch. Three periods of development can be considered when looking at the effects of loss of first molars.

Maximal space closure by mesial migration of the second molar occurs in the mixed dentition. At this stage the second molars are unerupted and their root furcation is just calcifying. The best results occur in the upper arch where the second molar will usually erupt mesially and make contact with the upper second premolar.

Spontaneous relief of mild crowding in the labial segments may be seen. In the lower arch, spontaneous closure is less likely, but mesial migration of the second molar is also optimal at this stage and may resulting in minimal space between the second molar and second premolar Fig. In the permanent dentition the effect of loss of a first molar can be difficult to predict after the second molar has erupted. Fixed appliances are invariably needed at this stage to align the teeth and achieve space closure with parallel roots.

Little spontaneous relief of anterior crowding is seen. The upper first molar if retained can over-erupt, further increasing the tipping and rolling of the lower second molar. In addition mesial movement of the lower molar may be prevented. The upper second molar shows less tipping and rolling than its lower counterpart, but does not align to the extent seen in the mixed dentition.

In adult patients the drifting of both upper and lower second molars is less marked, and the relief of crowding less reliable. In young patients, radiographs should be checked to ensure that the developing lower second premolar is contained by the roots of the primary molar. If not, then substantial drifting of the second premolar can take place including impaction into the mesial surface of the second molar. In general terms if a lower first molar is to be extracted, the upper molar on the same side should also be extracted compensating extraction.

This prevents unwanted over-eruption of the upper first molar and the upper second molar will usually erupt into a good position. However, if an upper first molar is to be extracted, the lower counterpart is usually left in situ. This is because the lower second molar behaves unpredictably and rarely achieves good spontaneous alignment. An additional factor is that lower molars over erupt less than upper molars and will not interfere with the generally good progress made by upper second molars.

If the case has no crowding, then balancing extractions should not be considered removal of a tooth on the opposite side of the same arch. Children presenting with carious first molars often show signs of disease in all of them. If the timing is correct and the malocclusion justifies treatment, all four first molars should be removed to allow second molars to erupt efficiently and reduce subsequent treatment times.

Thomas et al. They state that all other teeth should be present with the third molars of normal size, shape and in a good position to erupt. Mild lower labial segment crowding may be effectively treated by loss of second molars, however they should not be considered in the treatment of moderate or severe crowding.

Second molar loss may be undertaken under the following circumstances:. To facilitate the eruption of the third molars obviating the need for surgical removal at a later stage. May prevent crowding in a well-aligned lower arch Fig. Extraction of second molars allowed spontaneous relief of anterior crowding, with early eruption of the third molars. Eruption of third molars especially in the lower arch is unpredictable.

Where second molars are considered for extraction, the timing is important. Satisfactory third molar alignment is less likely if the second molars are extracted after the third molar roots are more than one third formed.

Whilst extraction of wisdom teeth for orthodontic purposes is rare, these teeth should be included in the treatment planning. The incidence of impaction of third molars varies widely in the literature. Extraction of teeth towards the front of the mouth has little effect on posterior crowding, whilst extractions towards the back improve the chances of acceptable third molars eruption. The greatest benefit occurs when second molars are removed, although eruption patterns are unpredictable.

Richardson et al. It also assumes a fairly broad minded view of what is a 'satisfactory' position. Third molars have in the past been implicated in the aetiology of late lower incisor crowding. Therefore, third molars should not be removed to relieve or prevent late lower incisor crowding. Virtual Consult In-Office Consult. People also ask Is it necessary to remove teeth for braces?

Does removing teeth for braces hurt? How long does it take for teeth to shift after extraction with braces? The Condition of the Teeth The first time you visit an orthodontist, he will look at all of your palate and teeth to see how many you have in your mouth. Reasons to Remove Teeth for Braces The doctor may suggest adult teeth removal for a number of reasons, but the main one is to make room so that the treatment device can bring your teeth back into alignment in the end.

The benefit of Removing Teeth for Braces Many benefits come from having troublesome and lingering teeth removed before you get your braces put on. The Teeth Removal Process The teeth removal process should only take one sitting.

Types of Braces Revolutionary orthodontic treatment systems are now available to help you with your teeth alignment problem. Traditional braces are, of course, your standard metal brackets. Lingual braces are an option that you may want to talk to your specialist about if you want to experience a discreet recovery. Lingual braces fit around the back of your teeth rather than the front. Therefore, you and the orthodontist will be the only ones who know that you are getting treatment.

Ceramic braces are another option as they can be the same color as your teeth are. Other options are available. Ask about such options like Invisalign during your consultation. Treatment Time Span The orthodontic treatment time for braces varies depending on the severity of your condition, the type of treatment you choose, and the amount of time it takes for you to heal from the tooth extraction.

Call Our Orthodontic Office Today If you want to repair your malocclusions and facial structure, then visit an orthodontic specialist in Ohio.