Planning is a methodical and conspicuously wise thing to do. Orthodontists, for instance, design a well-elaborated plan to define a path to follow to achieve a wonderful result, a beautiful smile for their patients.
However, patients should also carry out planning. This means that patients are also part of the process and must have information on all the upsides and downsides of orthodontic treatment; removing a piece of denture or two is indeed a major concern.
This article addresses a contested topic. Is removing teeth before starting orthodontic treatment good or bad? We found divergent positions about it that need to be exposed, and certainly, we include a final opinion we hope serves as a light at the end of the road.
Are Tooth Extractions Necessary for Orthodontics?
To start this discussion, removing teeth can and surely is avoidable when treating kids at an early age. This is a two-stage course that begins with interceptive orthodontics. The process involves detecting abnormalities that orthodontists can correct with special orthodontic appliances to expand the jaws.
Palatal expanders, for instance, make room for permanent teeth to sprout in a previously accommodated space. The American Association of Orthodontics recommends parents take their kids for a first orthodontic visit at seven.
After a first consultation visit, an orthodontist can decide whether or not a kid requires an expander that perfectly works with the malleable mouth structure. Then, a second stage starts in the early teen years when the young patients might need to use braces to complement the first stage’s achievements.
In this case, a patient might need the extraction of baby teeth after a study reveals a permanent tooth is developing, and there might be an orthodontic compromise if neglecting extraction.
But what about teens and adults? Do they need to get a piece of denture extracted before entering into orthodontic treatment? There are two sides of the same coin. Scholars of the subject evaluated extractions in patients with a variety of malocclusion cases.
The study findings revealed a statistical incidence of facial profile change in the lower lip and chin. However, these changes had no impact on the clinicians’ perspective, and they favored extractions as an effective approach to most malocclusions.
Notwithstanding, for some specific malocclusions, including lateral occlusion, mid-line symmetry, posterior occlusion, overbite, tooth alignment, and overjet, there was no consensus on whether or not removing the tooth was the most optimal option.
Also, extraction reduces protrusions related to the lower lip, supporting the inclination of the chin. These might be revealing in cases like underbites, where an extraction is an optimal option.
Another study demonstrated no significant differences in orthodontic treatment outcomes between subjects with no extraction, two maxillary premolar extraction, and four premolar extractions.
However, concerning differences were evident between patients with no extraction and four premolar extractions. Patients that kept their teeth showed better contact and relationships of the upper and lower teeth surfaces (occlusion) and better root angulations.
When Be Will Tooth Extractions Necessary?
An orthodontist will clear out any doubts concerning teeth extractions. Purposedly, the main reason that a specialist will point out is, without a doubt, to make room for overcrowded teeth to get aligned during orthodontic treatment.
Also, in some cases, persistent baby teeth are in the way and need to be removed to let permanent teeth sprout. Parallelly, orthodontists’ training helps them determine if removing a piece of denture is the path to follow.
However, we recommend patients ask as many questions as needed and work out options that can best ensure keeping dental pieces to the best possible. For example, there might be reasonable situations where removing a tooth does not affect the bite functionality. Still, there might also be cases where the orthodontist can set an alternative strategy.
Alternative strategies might include a more complex set of braces and a more extended treatment duration. However, after reaching a definition, if extraction is the path to follow, there is a list of reasons for extraction you need to know from where you can draw one that applies to your specific case.
This term refers to a jaw that is not sufficiently big to house permanent teeth. As teeth do not have sufficient space to erupt aligned, they erupt crooked or do so partially, twisted, or above other teeth.
An orthodontist knows what piece can strategically extract, and with the help of orthodontic treatment with braces or clear aligners, align teeth, moving them to the space previously created.
In some cases, front teeth protrude, which means they stick out to the front out of the arches line. This produces a considerably projected profile, lips to stick out, and might affect a person’s speech.
An orthodontist might remove a denture piece located in the back and place braces on a patient to transfer teeth a little backward and fix the projected profile.
This might sound a little strange, but some people develop extra teeth. Orthodontists can detect these abnormalities with an X-ray and plan an extraction of the extra denture piece that exerts unwanted pressure on other oddly angled teeth.
Jaw Development and Stability
Orthodontists’ training allows them to determine the best mechanism to align teeth and the jaw. However, to work on a growing jaw and to stabilize teeth, they need enough space. So, orthodontists’ work consists also in making dental pieces stable by eliminating the pressure that puts them at risk.
Sometimes teeth grow on top, behind, next (parallel) to other teeth in the palate, or stay in the gums producing pressure from above. In some cases, they might get infected due to the abnormal position of these teeth. Therefore, it might be inevitable not to remove one of the teeth that impacts its neighbor.
Do You Have To Get Wisdom Teeth Removed for Braces?
It depends on the case. We have made a tour that clearly depicts the types of abnormalities that can lead an orthodontist to recommend extraction before placing braces in a patient’s teeth, including impacted teeth.
Sometimes wisdom teeth remain below the gums but impact the lower portion of a second molar, producing an unnecessary strain that can reach the pulp. In this case, an orthodontist might recommend the extraction of a denture piece to avoid potential damage to a fully functional tooth (second molar).
Also, wisdom teeth might partially erupt angled, creating entrenched areas that favor food accumulation that is hard to remove. As food accumulates, bacteria feed from it, causing cavities, gum disease, and infections that affect the orthodontic treatment outcome. In this case, extraction of Wisdom Teeth is the optimal choice.
We have commented on two perspectives about the same case. Now it is necessary to reach a balance, so these pieces of information fully serve their purpose: to educate our patients and readers.
There is a long list of orthodontists favoring teeth extraction before entering into an orthodontic treatment with braces or other appliances. There is also an extensive list of specialists that refuse to recommend extractions. Then, good judgment enters into play.
Removing teeth might be harmful when it decreases the facial profile, making the lips and chin sink. However, in cases where teeth protrude to the front or there is an underbite, an extraction might serve to balance an already projected mandible.
Some orthodontists are against extracting denture pieces and recommend using a palatal expander to make the arches and jaws bigger. This creates space for teeth and helps avoid an extraction.
However, this method is undoubtedly more uncomfortable. In addition, it takes more time than a treatment that includes teeth extraction, as it first needs to produce mechanical jaw expansion before installing the braces.
On the other hand, losing a piece or more than one piece of denture affects the occlusion (upper and lower teeth touching each other), their matching relationship, and root angulations.
Our final verdict on this matter is to have an objective approach. Talk to your orthodontist and try to secure all of your dental pieces to the most possible, and also be open to getting an extraction.
Furthermore, if your orthodontists present you with the option of saving a denture piece at the expense of extending treatment time, and having a little more discomfort, try to opt for a not extraction of teeth.
Conversely, if there is no option due to an infection, the appearance of problematic impacted teeth, or a protrusion, be open to getting your teeth extracted as it will significantly impact your smile.