Dental Extractions for orthodontics

The invention of orthodontic extractions

Since the beginning of dentistry teeth have been removed for pain but routine extraction of healthy teeth for orthodontics started in the 20th century in an attempt make treatment successful for longer. Two influential professors adopted opposite views about the need for extractions and 2 opposite schools of thought became established -both were wrong.  Neither doctor considered the attributes of the individual patient.  Both approaches worked for some people but would fail for others.

Who might need teeth extractions for orthodontics?

Extraction of teeth is OK for people who have noticeably protruding teeth with full lip profile e.g. Chinese, Japanese and many Afro-Americans.  Most caucasians have much flatter lip profiles and suffer noticeable thinning of the lips in older age.  So to avoid making (whitish) people look old before their time we believe it is wise to avoid mid arch extractions for patients with flatter lip profiles.   Of course there are exceptions to all stereotypes so it is important to carefully assess each and every person.

Can extraction of teeth damage my face, smile,  jaw joints etc?

Cynical marketing by some orthodontic practices and dental practices have claimed orthodontists who order extractions damage the face and create a multitude of problems. However this has been extensively researched and it is now acknowledged that

Properly planned and performed orthodontic treatment does not damage the smile or face and all trained orthodontists know this.

“A few years ago I did a fun little test to see whether specialist pediatric dentists could tell whether a selection of different patients had had extractions during orthodontic treatment from photos of their smiling faces.  The average correct score was around 50% which is the same as marking the paper in an entirely random manner. Even highly trained dentists cannot tell the difference between extraction and non-extraction orthodontic results“

  7 reasons for dental extractions

1.  To relieve pain from tooth decay or gum disease or tooth impaction
2. To permit stable alignment of very crowded or protrusive teeth common in many Asian people
3. To correct centre-lines
4. To provide space to permit the teeth to meet properly when there is a mild imbalance in the jaw sizes (Camouflage)
5. To prepare for certain types of jaw surgery
6. To remove broken down teeth and close the space is often better than patching things up and may be cheaper than keeping bad teeth for a lifetime.
7. Extraction orthodontics’ can often provide the space for the emergence of the wisdom teeth. that may otherwise require extraction.

Which teeth are taken out?

Usually the teeth are chosen for the extraction space to get the best final tooth positions. Sometimes, adjacent heavily repaired teeth are extracted instead.  Under these circumstance the use of mini-implants may be required to obtain the most ideal outcome.  The further forward in the mouth teeth are extracted the larger effect this has on the position of the front teeth.  Normally the extraction spaces will completely close during the orthodontic treatment.  Occasionally some space may remain if there is insufficient bone width at the extraction site or if the orthodontic treatment is not completed.  This can occur if there is a delay in starting space closure following the loss of the teeth.

Are there other methods of space creation?

There are other methods to obtain space for tooth alignment and tooth movement in the crowded dentition,  and the options are as follows:

• Push the back teeth backwards (into the wisdom teeth space) using implant anchorage
• Dental arch expansion is a good treatment choice to align spaced or mild to moderately crowded teeth.  Often as a result the smile width is a little wider and the teeth positioned slightly further forward giving enhanced support to the position of the lips- an appearance that is regarded by many people as desirable.  Non-extraction treatment can take longer and requires a bigger commitment to retainers compared to the alternative treatment involving tooth extraction.  About 85% of caucasian patients can be treated without extractions but of the proportion in Asian patients is lower.
• Interdental Stripping: up to 1/2 mm of enamel can be filed from the adjacent surfaces of teeth to provide incremental space to improve the stability of the completed alignment.  This method is also valuable to assist alignment of triangular shaped teeth and to disguise triangular gum spaces in the older patient following alignment of crossed over teeth.