The teeth most frequently extracted for orthodontic reasons are the first bicuspid teeth, the premolars. These are the teeth that are located right between the canines or fangs and the molars or molars. But they do not always have to be the premolars that have to be extracted necessarily, as we will see later.
When is extraction necessary?
Generally speaking, when there are too many teeth for the size of the dental arches, there may not be enough space to align them. A common solution is to create the necessary space by removing teeth to allow the others to align properly.
In orthodontic treatments, the first phase is to find out what should be done, so it is essential to carry out record-taking and a study to design a good treatment plan.
Not all cases will require extractions; in fact, it's usually not necessary. If it is possible to align all existing teeth into a healthy bite and correct position, it will be done without extractions, but for certain patients, a tooth extraction is an effective part of achieving straight teeth with lasting results.
Tooth extraction is only done if absolutely necessary: the orthodontist will consider all options for a good smile before recommending an extraction.
In addition, facial aesthetics is an important part of any orthodontic treatment. In many cases extraction of premolars is required, not only to relieve crowding, but also to change the facial profile. Supposedly, extraction of premolars provides some vertical reduction.
What teeth are extracted in each case?
The extracted teeth will vary according to the specific and individual needs of each case. A combination of teeth may be removed, such as:
Four premolar teeth.
Two upper or two lower premolars.
A single lower incisor tooth or upper and lower second molars.
Generally speaking, any tooth in the mouth can be removed to help the orthodontist achieve a proper bite and soft tissue profile and eliminate any crowding that exists.
Normally, to maintain symmetry it is necessary to extract pieces on both sides of the same arch, and even, depending on the case, there are times when it is necessary to extract the corresponding adjacent teeth to maintain the occlusal relationship between arches.
Extraction of an odd number of teeth is common when treating asymmetry in bite pattern or traumatic bite.
Wisdom teeth are not considered in orthodontic extraction cases, as their extraction does not create the space in the mouth necessary to eliminate crowding. The molars move from the back to the front of the mouth, not the other way around.
Eruption of the wisdom teeth often occurs simultaneously with the development or increase in lower anterior crowding. It is a common belief that this is due to the pressure created by the eruption of the wisdom teeth. However, current evidence suggests that the wisdom teeth play a minor, if any, role in late crowding of the lower incisors. Therefore, there is no evidence to support the recommendation to remove wisdom teeth to prevent late crowding of the incisors.
When deciding which teeth to remove, your orthodontist will consider how best to place the other teeth in their correct and healthy positions, with as little alteration as possible to the patient's mouth or facial shape and tongue positions.
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