Dr. Greg Jorgensen
(505) 891-9440
1401 Barbara Loop SE
Rio Rancho, NM 87124

The Jorgensen Orthodontics Blog

Why do I need teeth removed for my braces?

Posted by Dr. Jorgensen on April 16th, 2012

Dentist Extraction“I want a perfect smile, but I don’t want any teeth removed!” This is one of the most common things that I hear from patients during their initial exam in my office. Why do orthodontists recommend that some patients have teeth removed but not others? Why are teeth sometimes extracted as part of having braces?

All of us have two sets of teeth, primary (baby) and permanent (adult). One of the first things your orthodontist will do at your initial consultation is take inventory of which teeth are in your mouth. Although everyone is different, baby teeth usually fall out by a certain age and in a certain order. They can create orthodontic problems if they fall out too early or too late. If they fall out too early, your orthodontist can help you devise a plan for maintaining the space until the permanent replacements come in. If they don’t fall out soon enough, they may create an orthodontic problem or signal that one already exists. Removing primary teeth is sometimes necessary for the normal eruption and development of the teeth that will come in later.

While most parents have no concerns regarding the removal of primary teeth, some do when the permanent ones are involved. There are a variety of reasons why permanent teeth may need to be removed for braces, but here there are three main ones:

The first is crowding. When the amount of space required to align the teeth is less than the space available, either the size of the arches must be increased or the number (or size) of teeth reduced. Mild to moderate crowding can be addressed with expanders and braces alone up until about age 15. (After that, surgery may be necessary to re-open the sutures.) The amount of expansion may be limited by the bone structure, the facial appearance, or the supporting tissues. If a patient has moderate to severe crowding and insufficient gums or bone, permanent teeth will need to be removed to provide the necessary room.

The second reason is protrusion. The position of the lips is determined by the underlying teeth. If the front teeth are already protrusive, removing some on the sides will allow the orthodontist to move the teeth backwards to improve the lip posture. If the lips are in good position already but the underlying teeth are crooked, removing teeth may be necessary to prevent making the teeth and lips stick out.

The third reason is to correct an overbite or underbite. If the upper an lower jaw sizes are mismatched, the ideal treatment is to surgically reposition them. In most patients however, the jaw size discrepancy is small enough that the teeth can be moved to “compensate” for the problem. This eliminates the need for jaw surgery in the majority of overbite patients and some underbite patients. A patient with a moderate overbite is usually receptive to the idea of having two upper bicuspids removed if it prevents the need for surgery.

There are a variety of other reasons your orthodontist may suggest the removal of teeth as part of your treatment. These include asymmetries and missing, impacted, or extra teeth. Treatment is usually faster for your orthodontist if teeth are NOT removed, so you can assume that if he does recommend extractions, they must really be necessary. As always, ask your doctor for a complete explanation of your specific treatment plan. Educated patients are the best patients!

NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist who is in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa in the United States. Dr. Jorgensen’s 25 years of specialty practice and 10,000 finished cases qualify him an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in the state of New Mexico. He cannot diagnose cases described in comments nor can he select treatment plans for readers. Because he has over 25,000 readers each month, it is impossible for him respond to all questions. Please read all of the comments associated with each article as most of the questions he receives each week have been asked and answered previously. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.

592 comments so far in response to “Why do I need teeth removed for my braces?”

  1. Finny says:

    Thankyou for the response doctor

  2. Amy says:

    I’ve been told that I have to have two teeth removed in order to have braces as I have a significant overbite. I’m really worried.

    • It is OK to be nervous, but having two teeth removed to reduce an overbite has been practiced for over 100 years and on millions of patients. It is a very common treatment approach that produces excellent results when needed.

  3. Neha says:

    Hi Doc
    I recently visited an orthodontist about my disaligned tooth. The edges on my tooth are blunt. Tooth on upper and lower jaw don’t fall on each other properly. I also have an right impacted cannine.
    My doc told me I might need to remove 2 upper and 2 lower teeth and that would be final after she takes impressions.Also, she said the impacted cannine will ne brought down. is all that possible?
    I am really worried to remove teeth as I am not sure if that would impair any of the functions of my mouth or speech or any other complication on vision or brain
    Please guide.

    • These questions are all good and are the exact things that your orthodontist is trained to understand and decide with you. Removing teeth is necessary in many patients and we rescue canines all of the time. Good luck with your treatment

  4. Allie says:

    Hi Doc,

    I had 4 teeth removed for my braces during high school about 10 years ago to make room for my wisdom teeth that were coming in. My braces were removed before my wisdom teeth came in and the plastic retainers I was given did not cover my wisdom teeth. After all 4 of my wisdom teeth had fully erupted, I noticed a open bite had developed. I still wear my retainers and my teeth are straight, it’s just my teeth don’t touch.

    I’ve gone on several consults with different orthodontists who all seem to agree that that my case is unusual. They believe that my wisdom teeth have over erupted causing a lateral open bite and that it will take 18-24 months to fix. But half suggest to remove my wisdom teeth and the other half say it’s not necessary because there’s plenty of space for them and they’re healthy. Any thoughts or suggestions?

    • Removing bicuspids makes room for wisdom teeth in about 50% of patients. The other 50% still need their wisdom teeth removed. If you’re one of them, do the right thing. Good luck!

      • Rachel says:

        Treatment plan for my 14 yo son’s braces includes removal of 4 wisdoms and two premolars (4th). I’m ok with the extraction of premolars. But Is 14 too young to have such a surgery to remove 4wisdoms at the same time?

        • It may or may not be Rachel. I haven’t seen an x-ray, but the wisdom teeth may be large enough to remove at that age. There are a lot of variables to consider that I can’t do for you here, but here are some questions to ask: 1) do the wisdom teeth really need to come out now for treatment or can their removal wait (it may be easier on your son to just have them all done at the same time), and 2) is there a chance that there would be room for the upper wisdom teeth if the two bicuspids are removed?

  5. Ishika says:

    My 4 teeth were removed just to make space for braces…But I have a concern that extraction of my 4 teeth whether affect my eye sight in future or not?
    Is there really any link between eyesight and tooth ?

  6. Noor says:

    Hello Doc!
    My teeth are crowded and I recently visited an orthodontist. He suggested that I have to remove 3 teeth in order to get braces. Should I?

    • Sorry, I can’t answer that. It is a very complex decision that requires an exam, pictures, x-rays, and sometimes models. For some, removing teeth is required. In others it would not be the right thing.

  7. Bogdana Popova says:

    Hello Doc!

    I need to remove 2 teeth to be able to fix my smile. We need to extract the two upper 4th teeth (sorry I do not know how it is in English but it is just after the canine tooth). Im 27 y/o. Can you please advise approximately how long it would take to ”fill in the gap”?

    Thanks.

  8. Laura says:

    Hello,
    I am 17y.o. I have crowded and crooked teeth. Some dentists said that I need 4 teeth removed, in order to make space for my other teeth and I can wear braces.(they said that there is no way to put braces in my current situation, cuz it is too crowded and my jaw is narrow). Others said that there is no need for teeth extraction, and can be fixed by no-brace (myobrace’s appliance) method. Should I remove my teeth? And is it possible that my jaw continue developing at my age?

    • It is almost impossible that a “no-brace” solution like the one you mentioned could ever solve the same problems that are solved by removing four teeth, don’t you think? If it was that easy, why wouldn’t all of us specialists use that product to prevent having to have teeth removed? If it sounds too good to be true…

  9. Hannah says:

    Hi,

    I have been recommended by my orthodontist to have 4 teeth out (5th pre molar 2 top, 2 bottom), initially he was unsure if extraction was necessary but I have 3-4mm crowding on a couple of teeth so came to the conclusion that extraction was necessary.

    My 2 options are clear ceramic fixed braces, or invisalign. He said the 2 options will both work.

    I am aware Invisalign is more of a modern practise and have been less studies of it being used after extraction. But technology has come a long way so do you think this will be successful after extraction? I only have a couple of teeth which are crowded, it isn’t overly severe, but I am worried if this is a good option or not.

    thanks
    Hannah

    • I haven’t reviewed your case personally, so I can only speak in generalities. I don’t treat four bicuspid extraction cases with Invisalign. I feel I have more control of the roots with standard ceramic brackets. Good luck!

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