Orthodontic treatment: To extract or not to extract

Gail-Ann Allen, Contributor

To extract or not to extract, that is the question. This is, quite possibly, the most frequently asked question at an orthodontic consultation visit.  The short answer: it depends!

Malocclusion refers to the misalignment of the teeth within and between the upper and lower dental arches. Every malocclusion is unique, therefore, treatment plans are also unique. As such, some malocclusions require the creation of space for correction, while others do not. It is this need for space that drives the decision to remove teeth for the purpose of orthodontic treatment.

For instance, if there is severe crowding (meaning, a severe shortage of space) extractions may be necessary to achieve an acceptable result. Likewise, if the front teeth are severely protrusive (meaning, they stick out too far beyond the lips) extraction of teeth may be required. If there is a combination of these two problems, and there often is, extraction of teeth is almost inevitable. Moreover, deciding which teeth will be extracted, and how many, is based on the specific malocclusion.

The extraction of teeth is a mode of creating the space needed to correct the malocclusion. Therefore, with few exceptions, complete space closure occurs during the course of treatment.

One exception is when the health of the tooth (or teeth) is severely compromised to begin with. In this case, the reason for the extraction is health-related, hence space closure may not occur during treatment and subsequent replacement (with an implant or a bridge) would also be recommended.

Another exception is the recommendation to extract third molars or wisdom teeth, as they are commonly called. Generally, these teeth are impacted and/or have insufficient space into which to erupt or grow. As a result, more often times than not wisdom teeth need to be removed.

So, when an orthodontist recommends extractions for treatment, the space that is thereby created is fully utilised to achieve a healthy, functional, and aesthetic result.

When teeth are extracted, treatment tends to take longer than if teeth were not extracted.

Extractions also tend to introduce additional steps for the finishing (or detailing) phase of treatment. Therefore, extractions for orthodontic treatment are recommended strictly on an 'as-needed' basis.

Dr Gail-Ann Allen is an orthodontist in private practice, a member of the American Association of Orthodontists, and an executive member of the Jamaica Dental Association