schechtman orthodontics slogan
Westchester, NY's Only SureSmile® Orthodontist
divider line

Do They Still Extract Teeth for Orthodontic Treatment?

It’s an emotional thing: People are very attached to their teeth (humor intended) and hate to part with those.  And, dentists hate to remove healthy teeth.

Is tooth removal still necessary in order to have orthodontic treatment? In this blog article I will explain when and why teeth need to be removed for orthodontic treatment.

The internet is rife with youtube videos and orthodontic content warning against the extraction of permanent teeth, and how some hero dentists/orthodontists used some magic treatment to avoid the eviction of some bicuspids and how the patient was grateful and spared  from the  barbaric sentence of extractions.  Is this a suggestion that extractions are unnecessary and to be avoided?  Why the heck would anyone remove a tooth that wasn’t diseased or hopeless?  Here are the considerations to answer this question.

Anatomy    There are biologic limits on how much you can expand teeth orthodontically.   When you look at a face, the width of the jaws mirrors the shape of the face:  Long narrow faces have narrow jaws, and short broad faces have broad arches.  This is a function of genetics and the influence of the muscular environment around the teeth and bone:  Tight lips and cheeks that strain over the dentition usually are associated with crowded teeth in narrow arches.  Alternatively, loose buccal musculature and a large tongue are associated with a spaced dentition.

Equilibrium  There is a muscular balance between the buccal muscles (lips, buccinator), and the lingual muscle (the tongue).   The position the teeth occupy is the result of this equilibrium established.

What about Expansion?    The maxilla has a midline suture that can be separated with expansion treatments.  The mandible does not, and that means you cannot expand the lower jaw.  The maxilla is the more plastic of the two jaws.  It is possible to (non surgically) expand the maxillary arch to a significant degree (16mm) before the end of adolescence.  Thereafter, surgery is necessary to free up the maxillary articulations to allow it to expand. But, REMEMBER:  The limit of maxillary expansion is determined by the position of the mandibular dentition, so you can’t just expand the upper jaw to relieve crowding if it will no longer articulate well with the lower dentition .

While the lower jaw can’t be expanded skeletally, the dentition can be tipped buccally ( if  it is leaning lingually) to an upright position. Otherwise, the archform cannot be expanded more than 2mm per side without inviting future relapse or buccal gingival recession.  We all know that teeth are suspended in alveolar bone and if we are lucky, have the roots covered in cortical bone.  We are wise to try to keep them that way!    The patient’s biotype also determines how much expansion the gingiva can tolerate before receding.

So, should arches be expanded to gain arch length to relieve crowding?  Above are the considerations if expansion is biologically appropriate, but it is interesting to note that most crowding doesn’t benefit from transverse expansion.  Significant crowding only benefits from antero-posterior movements of teeth on the arch, and as indicated above, there are biologic limits which if exceeded, will result in gingival recession,crestal  bone loss, and instability:  You can’t tip incisors labially too much or the gum will recede, and the incisors will relapse back to their original position (without permanent retention).

How can crowding be conquered?  If the dentition is upright over the archform, that leaves only two other options:  Interproximal enamel reduction and extractions.

  • Interproximal reduction or IPR, is a very effective strategy for crowding in the range of 5 mm total deficiency.  If the crowding is distributed over several teeth, and the interproximal access to teeth is favorable (no unusual overlapping that could prevent access to instrumentation) then IPR can resolve the arch length shortage.  More aggressive IPR is seen in case reports in the literature with no regard to the amount of remaining enamel on the treated teeth.  It’s important to remember:  Lower incisors and canines have less than 0.75mm and 0.9mm enamel thickness, respectively.  Upper and lower premolars exceed 1mm thickness.  There is not alot of space to be gained from any one tooth if you want to leave some enamel behind, which is mandatory.
  • Extractions are the last resort in strategies to resolve crowding when arch length deficiency exceeds 5mm.  Extractions must be carefully chosen to also suit facial profile and occlusion.

Other reasons extractions are utilized in orthodontic treatment are:

  1. Elimination of a hopeless tooth and then closing its space
  2. Camouflage of a Class II malocclusion (overjet and deep overbite) or Class III malocclusion (underbite)

Myths about Extractions  Appropriately chosen extractions allow orthodontic treatment to fulfill cosmetic and functional goals.  (photo)  Here are a few myths spoken about extractions:

  • Extractions cause TMJ                             No, they don’t.  This has been disproven in multiple studies since the 1980’s
  • Extractions  “dish-in”  the profile       Yes, but that only occurs when poorly chosen
  • Extractions lead to sleep apnea           There are no studies to support this.  It is based on a supposition that extractions reduce arch size so they confine the tongue posteriorly.                                                                                                Sleep apnea is a multifactoral disease, and to date, extractions are not linked.

When are Extractions Indicated in Orthodontics?

  • Crowding relief
  • Profile reduction:  Reducing lip strain or protrusive lip posture
  • Dental protrusion:  Creating space to retract protrusive dentition
  • Open bite closure:  There are cases where extractions favor closing an open bite
  • Hopeless teeth related to perio or caries issues

I hope this post was informative and answers some questions that you may have about this sometimes controversial topic.    –  Richard

 

 

 

 

 

START YOUR JOURNEY TO YOUR BEST SMILE EVER:

At Schechtman Orthodontics, we want to ensure you are confident with your decision for not only your choice in orthodontic treatment, but also for the orthodontics office in New York you choose to start your braces and orthodontic treatment. To ensure you are completely confident in your decision, we offer a few no-obligation, no-pressure ways to get started!

  1. Find out what the most important aspects are in choosing the right orthodontist in Jefferson Valley or Purchase, NY for you or your child by reading our free report, "The Top 10 Things To Know Before Choosing Your Orthodontist."
  2. Take this assessment to see if Dr. Schechtman is the right orthodontist for you or your family!
  3. Click here to fill out the form to receive your complimentary Schechtman Smile Analysis, a $250 value!
  4. Call 914.962.9600 to speak with a Schechtman Orthodontics team member right away!
schechtman orthodontics google reviews
schechtman orthodontics facebook reviews
schechtman orthodontics healthgrades reviews
schechtman orthodontics demandforce reviews
dr schechtman huffington post
best orthodontist westchester ny   best white plains orthodontist