Extraction. Sometimes it’s the best option.

May 10, 2018 | Pediatric Orthodontics, Treatment Advancements

Sometimes it’s easy to see that there are more teeth than the supporting bone can fit. Sometimes it’s not so clear. When it comes to deciding whether removal of permanent teeth is needed for your orthodontic treatment, we are here to help!

In certain cases, the upper and lower jaws are large enough to fit all of the roots of the front teeth, which are tapered. The crowns of the teeth are much wider, and need more room for alignment. If the underlying foundation isn’t large enough, the upper and lower teeth will be straight, but protrude, or “stick out”. We call this Bimaxillary Protrusion. Without removing teeth, uprighting them to make them look more “flat” can push the roots of the teeth through the bone, which is definitely something to be avoided. At the same time, teeth that protrude from their supporting bone are prone to gum recession. Some patients would rather have a protrusive smile than have permanent teeth extracted, but in many cases, it is the only option to achieve the most stable and esthetic outcome. If the upper and lower teeth are protruding before treatment, chances are they will protrude even more once the teeth are aligned. This can be predicted based on measurements we take during the consultation appointment, and even previewed with our 3D treatment simulation software. These tools let us design the most efficient treatment plans possible. The sooner extractions are done to prevent protrusion, the faster treatment will go.

Patient elected to complete treatment without extractions. Side View

Patient elected to complete treatment without extractions. Front View

When the need isn’t absolutely certain, some patients need to see for themselves. We also offer the option of Therapeutic Diagnosis, which is to see how the patient responds to treatment before diagnosing the need for extractions. That way, the decision to extract permanent teeth is more clear-cut, because the final result can be “previewed”. This treatment method does take longer, because the teeth need to take a “detour” out to a certain position on their way to their destination.

Patient elected to complete treatment with extractions. Side View

Patient elected to complete treatment with extractions. Front View

Once the teeth are aligned, the amount of protrusion and esthetic outcome can be assessed in real life. This way, some patients are more comfortable and confident in their decision to extract teeth. Once the teeth are removed, we immediately begin closing the spaces and retracting the upper and lower front teeth to a more upright and stable position.

At OrthoArts, we only offer treatment that will look good, feel good, and last a long time. And sometimes, removing permanent teeth is the best way to get the smile you’ve always wanted.

NOTE: The author, Dr. Jared Gianquinto, is an orthodontist in the private practice of orthodontics and dentofacial orthopedics in Bakersfield, CA. He was trained at Temple University and Naval Medical Center San Diego, completing orthodontic specialty training at Temple University and is past president of the Kern County Dental Society. Dr. Gianquinto’s unique combination of extensive past general/cosmetic and current specialty orthodontic practice qualify him an expert in two-phase treatment, extraction and non-extraction treatment, clear aligners, lingual braces, accelerated orthodontics and multiple bracket systems. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.

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