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Orthodontic Extraction vs. Non-extraction

Updated: May 5, 2023

we removed four permanent teeth
Four permanent teeth extraction case--Actual Patient

Why orthodontic extraction (removing some permanent teeth) may be necessary

1. Creating space to resolve severe crowding

2. Creating an attractive smile without violating the facial aesthetic zone

3. Reducing relapse

How to make a decision: orthodontic extraction vs. non-extraction?

When deciding to remove permanent teeth, a complete diagnosis is a MUST.

1. Conservative approach - always ask if an extraction can be avoided or less extraction can be applied without compromising aesthetic and function too much. Extractions are permanent.

2. Facial Aesthetics - the goal is to accomplish an attractive face with a beautiful smile and straight teeth. Nobody wants perfectly straight teeth with a protruding smile. Combining scientific analysis with artistic sense regarding facial form frames the extraction decision.

Considerations when selecting teeth to extract

1. Symmetry - it is important for the midline of the teeth to center with the facial midline. Maintaining symmetry usually requires extraction of two teeth in the upper jaw. A single tooth extraction is indicated in some cases that upper midline is off the center to begin with.

2. Aesthetic zone - we have four pre-molars towards the back of the mouth outside the visible aesthetic zone. Removing a pre-molar on each side, for example, allows us to shift teeth resulting in imperceptible or no visual deficiency in the final smile.

3. Lower crowding - if upper teeth are crowded, the upper jaw allows us to expand to create space, but our lower jaw has no suture to expand. As a result, the severity of lower crowding dramatically influences extraction decisions. Without extraction, the likelihood of relapse often increases.

4. Bad teeth - teeth with severe cavities and/or gum disease are candidates for extraction. It is usually preferable to remove teeth that can cause additional problems in the future.

Are you going to have space left where the extractions occurred?

NO. We take advantage of the entire extraction space to align the teeth. Based on various techniques and calculations we move adjacent teeth to completely eliminate any gaps. In the end, only your dentist and orthodontist will notice that any teeth have been removed (because we can count your teeth when you are in chair 😊)

extraction of four permanent teeth
People barely can tell she had four permanent teeth removed---Actual Patient

Four permanent teeth were removed
Four permanent teeth were removed

expansion plus extraction
Four permanent teeth extraction case---Actual Patient

expansion and extraction
We did palatal expansion first. Then followed by the extraction of four permanent teeth ---Actual Patient

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