Is it necessary to extract my premolars for Braces?

Question

I had braces previously when I was 16, now I am twenty and my upper right cuspid is a little off. My doctor recommends 4 premolar extractions in order to align the cuspid and my bite, which is a little off as well. However, my bite is not an issue for me, but the cuspid is because it bothers me how it looks. Also, they are extracting my wisdom teeth via surgery next month. Is it necesary to remove the 4 premolars or is there another way to fix the upper right cuspid without teeth extractions?

Agustin Drubi, DMD · Answer

Hi Emily,

This is a hard question to answer without having all the information necessary.

There are usually 2 reasons why teeth would be recommended for extractions. The first one is because there is a severe amount of crowding, and space needs to be made to be able to fit all the teeth in the most stable position. The second reason is if the teeth are sticking out too much (buck teeth) and the spaces from the extracted teeth is used to move the front teeth back. Of course, to make this diagnosis, the relationship of the teeth to the rest of the face is taken into account, as well as the position of your lips and other factors such as your airway, your bite, etc.

Regarding the opinion that you already have, most orthodontists will give you a proposed treatment that takes care of all the issues they find. It is our duty to recommend the best treatment possible. Having said that, treatment plans can always be modified to fit each patient's desires. If you explain to your orthodontist that you are not interested in fixing your bite and only want to fix your canine tooth, this can usually be accommodated, and the recommended treatment may be different.

Feel free to upload some pictures if you'd like to me take a closer look.

Hope it helps!

Agustin Drubi, DMD

Brad Lockhart, DDS · Answer

PLEASE do NOT extract/amputate healthy premolars in order to straighten your remaining teeth. This is definitely NOT necessary and you will suffer tremendous adverse consequences. Premolar extraction orthodontics is antiquated treatment. This kind of treatment is prescribed by doctors who are only focused on straight teeth. Modern orthodontics focuses on the face, TMJ's, and airways NOT just straight teeth. If you extract four premolars you will end up with excess space that has to be filled in. This excess space is filled in by over-retracting anterior teeth. This over-retraction of anterior teeth leads to narrow dental arches and narrow smiles with black triangles in the corner of your mouth. Your upper lip will become smaller, your TMJ's potentially compromised, your airway potentially compromised, etc. These are a lot of adverse consequences for straight teeth. A MUCH better way to treat the problem is to develop your dental arches to make room for the teeth to be straightened. This is easily accomplished with arch development appliances. Good luck!

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