Introduction

Orthodontic treatment for crowded teeth usually involves wearing of braces and often include removal of teeth. Making decision to remove teeth for braces can be difficult and scary. Following are some facts to ease your mind!

Why are Teeth Removed for Braces?   

Teeth removal for braces is most commonly needed when there is inadequate space in the arch. Crowding or overlapping of the teeth occurs when the dental arch is too small for all the teeth to fit normally.  In order to straighten your teeth, orthodontist might need to make space by taking out some teeth to allow other teeth to be positioned correctly.

Generally, when the amount of space required to position the teeth is less than the space available, either the size of the arches must be increased or the number (or size) of teeth reduced. Mild to moderate teeth crowding sometimes can be addressed with expansion of the arches. However, the amount of expansion may be limited by the bone structure, the facial appearance, or the supporting tissues (gum). If a patient has moderate to severe crowding, permanent teeth might need to be removed to provide the space.

Another reason for teeth removal is protrusion (jutting teeth). If the front teeth are already protrusive, removing some teeth on the sides will allow the orthodontist to move the teeth backwards to improve the lip position.

When do I Need to Remove My Teeth?

You can start remove your teeth after discussion and confirmation of the treatment plan with your orthodontist. Usually a referral letter will be given to you stated which teeth and the number of teeth need to be removed.

To minimize the trauma, you can take out one tooth per week. It may take several weeks to complete the procedure, depending on how many teeth need to be taken out. After the extraction, braces can be arranged to put on.

Which Teeth Need to Be Removed?

The teeth most frequently removed for braces are the bicuspid (premolar) teeth. These are the teeth right in the middle, between the eyeteeth (canine) and the molar teeth (the biggest back teeth). In some cases, teeth with large filling, impacted or damaged previously will be an extraction choice.

But remember, each patient has different extraction plan!

Will The Extraction Gap Close?           

Yes. The extraction gaps are usually closed with special methods (power chain) linking the teeth together during braces treatment. Typically the teeth move about one millimetre per month. The length of time to close the gaps depends on individual case. It might take several months to a few years.

Can I do Braces Without Removing Teeth?     

In selected cases, it may be possible to fit all of the teeth into the arch without taking teeth out.  If the space required to straighten your teeth is small, orthodontist can gain space by reshaping teeth, flaring incisors (front teeth) and expanding arches. However there are limitations for these methods.

After extractions	After brace treatment

Conclusion     

There are a variety of reasons why your orthodontist may suggest removal of teeth as part of your brace treatment. As always, you (and parents) must be included in the planning stage as this is the best time to discuss treatment plan and treatment goals with your orthodontist. Educated patients are the best patients!

References      

1.  British Orthodontic Society Patient Information Leaflet.
2. Rinchuse DJ, Busch LS, DiBagno D, Cozzani M. Extraction treatment, Part 2: Guidelines for making the extraction decision. J Clin Orthod 2015; 49: 29-34.