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To Extract or Not to Extract: That is the Question

Here at our Seattle, WA orthodontics practice, patients often ask us if it’s necessary that they have teeth extracted before getting braces. That’s why we’ve decided to dedicate this blog post to the topic.

Removing teeth is sometimes required in order to achieve the best orthodontic results. Straight teeth and a balanced facial profile are always the goal of orthodontics. Whether or not we extract teeth before orthodontic treatment is determined on a case-by-case basis and comes down to analyzing facial features, the profile, the amount of crowding present and incisor tooth position.

Extraction of Primary Teeth

Everyone has two sets of teeth during their lifetime – primary teeth and permanent teeth. One of the first things your orthodontist does at your initial consultation is to see how many teeth you have. While everyone is different, primary teeth usually come out by a certain age and in a certain order. These teeth can be problematic if they fall out too early or too late. If they come out too early, a plan can be put into place that will maintain the space until the permanent, replacement teeth grow in.

If the primary teeth do not fall out soon enough, they can create an orthodontic problem or indicate that a problem already exists. Therefore, it’s sometimes necessary to remove primary teeth to make sure there is normal eruption and development of the teeth that come in later.

Extraction of Permanent Teeth

While most parents don’t have concerns about their children having primary teeth removed, many people are hesitant to have permanent teeth extracted. There are several reasons why permanent teeth may need to be extracted before braces are placed and these are:

• Crowding – If the amount of space required to align the teeth is less than the space available, permanent teeth may need to be extracted. If the patient has moderate to severe crowding and insufficient gums or bone, it may be necessary to extract permanent teeth prior to orthodontic treatment.

• Protrusion – If a patient has protruding front teeth, extracting teeth on either side will allow the orthodontist to move the teeth into the proper positioning so that the patient obtains a good facial profile.

• Overbite or Underbite – If the upper and lower jaw sizes are different or mismatching, it may be necessary to extract teeth to compensate for the problem. This extraction of teeth can eliminate the need for jaw surgery in most overbite patients and in some underbite patients. Most patients with overbites or underbites are willing to have two upper bicuspids removed in order to prevent the need for jaw surgery.

At Orthodontics of Burien, we don’t always jump to extraction if we can avoid it. Dr. Peralta is able to plan treatment in a way that negates the need for extractions. Here is an example of a patient of our’s who did not have extractions, but might have been a candidate for them at another orthodontic office:

Before:

After: 

In other cases, extraction is necessary in order to move the teeth into ideal occlusion, as seen in the before and after images below of one of our patients.

Before: 

After: 

The teeth most often removed for orthodontic reasons are the first bicuspid or pre-molar teeth and the molars. Approximately 20 to 25 percent of patients require extraction of permanent teeth with their orthodontic treatment. When you are first seen by Dr. Jorge Peralta, our Seattle orthodontist, he will provide you with a comprehensive evaluation to determine whether or not some teeth should be removed prior to placing braces on your teeth.