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.
Other reasons extractions are utilized in orthodontic treatment are:
Myths about Extractions Appropriately chosen extractions allow orthodontic treatment to fulfill cosmetic and functional goals. (photo) Here are a few myths spoken about extractions:
When are Extractions Indicated in Orthodontics?
I hope this post was informative and answers some questions that you may have about this sometimes controversial topic. – Richard
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!