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

The Jorgensen Orthodontics Blog

Why does my orthodontist only want to remove two teeth in the upper arch?

Posted by Dr. Jorgensen on July 23rd, 2013

Overbite girlThe articles that attract the most comments on my blog are those addressing the removal of permanent teeth (also called pulling or extracting teeth). I sympathize with parents and patients who are worried about having perfectly healthy teeth extracted for orthodontic purposes. The explanations I’ve provided in other articles have helped many patients to understand why this can’t be avoided in many cases (see Are There Alternatives to Having Teeth Removed for Orthodontic Treatment?, Will Having Teeth Removed Ruin My Face?, and Why Do I Need Teeth Removed for My Braces?). Today’s blog post addresses a specific extraction pattern that I’ve been asked about numerous times: removing two teeth in the upper arch only.

There are three main reasons that I remove permanent teeth during orthodontic treatment: crowding, protrusion, and camouflage of a jaw-size discrepancy. As much as I would like to avoid removing teeth, there are some mouths that are just too small for all of the teeth. In these cases, NOT pulling teeth makes the smile less attractive, less healthy, and less stable. Protrusive teeth are just crowded teeth that have been flared out away from the bone. If they were to be moved back over the bone where they should be (without removing any), they would overlap (be crowded). To relieve crowding and protrusion I sometimes need for your dentist to remove some permanent teeth. The space created is then closed to eliminate the crowding or reduce the protrusion. Done correctly, no one but you and your dental team will ever know that you’ve had teeth removed.

When the upper and lower jaws are genetically different sizes, the only way to truly make them match is surgical repositioning (orthognathic surgery). Surgery is required when patients have a severe discrepancy or want a specific cosmetic improvement (i.e. a bigger chin). Most patients however are fine with just having their “overbite” corrected without the surgery if the final result is attractive, healthy, and stable. Removing teeth in only one arch is the most common way to camouflage a jaw-size discrepancy. About two-thirds of my patients have an overbite. Mild to moderate overbites can be corrected with rubber bands or springs. In those with more moderate to severe problems, extracting teeth or surgically moving the jaws is necessary.

If a patient has a small lower jaw, removing two teeth in the upper arch allows the orthodontist to move the upper front teeth back to match the position of the lower teeth without surgery. This allows us to hide or camouflage your small lower jaw. The same thing can be done in some underbites. If conditions are just right, two teeth may be removed from the lower arch to allow the lower front teeth to be moved backwards correcting the underbite. If teeth were removed in both the upper and lower arches in overbite and underbite patients, the upper and lower front teeth would move together and no improvement would be accomplished. Please understand there are many variables that your orthodontist must take into account when determining if camouflage treatment is appropriate for you. This explanation is an over simplification, but you get the idea.

So if your orthodontist suggests removing teeth from only your upper or lower arch, chances are that you have a jaw-size discrepancy that he is trying to improve for you. I’ve been using this extraction pattern for over 20 years and in the right patients the results are amazing. Remember to ask your orthodontist about any extraction pattern that doesn’t make sense to you. The best patients are the most informed 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.

64 comments so far in response to “Why does my orthodontist only want to remove two teeth in the upper arch?”

  1. joann says:

    Hi Dr Jorgensen,

    Thank you for your thorough explanation on the subject of extraction. I’m in fact en route to orthognathic surgery to correct a class 3 bite. I was told prior that I would be having lower jaw surgery only as my case was originally an edge to edge bite, extracted two upper bicuspid to decompensate the camouflage treatment i had 3 years earlier and to enhance the underbite. the thing is, as they retract my anterior upper arch, i started to notice a slight depression around my alar area and the depression on the right side is more prominent that the one one the left! was the extraction a bad decision? given the current situation, should i proceed with only lower jaw surgery? I would want to avoid upper jaw surgery as I’m a Chinese and the last thing i want is for my flat bordering-on-huge nose to widen. Bimax is out of question since the movement is minimal, around 7mm if operated on lower jaw only. Please advice, thank you!

    • I cannot diagnose your case for you Joann, but a lot of Class III Asian patients that I treat require the removal of upper bicuspids to remove the dental compensations and then only a maxillary advancement to correct the bite. There are soft tissue procedures to help keep the nose from widening (or to even make it more narrow) and the increased midface is a benefit to their profile.

      • Prithvi says:

        Hello Dr. Jorgensen. I’m a 20year old male. Because my upper jaw teeth were proclained, my orthodontist extracted two premolars (4,4) from the upper jaw. Now he is unable to close the gap and has suggested extraction of lower premolars (5,5) so that the extraction gaps of the upper jaw can be closed. I’m worried if it will cause instability to the teeth as we are creating gaps and closing them and also about diminishing the tongue resting space as it may cause breathing issues. Should I go ahead with the lower premolar extractions or have implants on the existing extraction gaps on the upper jaw?
        My wisdom teeth are well grown and have nicely aligned with the remaining teeth. Only issue is the slight overjet of the upper jaw teeth and the gaps left my extraction. Do you recommend any surgery to close the gaps so that I can avoid the extraction of lower premolars?

        • These are very specific questions relative to your particular treatment. I’m sorry I can’t offer a professional opinion. I will say however that there is no evidence that removing bicuspids causes breathing issues.

  2. Sharra says:

    I’ve had braces for 2 years now and when I came into the treatment I started off originally with a deep bite and bottom crowding. I had all four of my wisdom teeth removed to make room. As things progressed and I was put on rubberbands for a few months, along with top row power chains, I ended up with a slight underbite. My ortho decides to give me two options, one is to get my bottom row filed but with that the result would be my top teeth will sit on top of my bottom teeth. The second option is to get a bottom teeth removed and that’ll cause me toward a slight overbite which is the goal. I honestly feel like somewhere in the process my ortho messed up because I feel I shouldn’t need to have anymore teeth removed, especially good teeth. I went from a deep bite to a slight underbite.

    • Nothing you have described to me makes me think your orthodontist did anything wrong. If the only teeth you had removed were your wisdom teeth and all he did was close your spaces with the help of rubber bands, it probably means that you have a skeletal discrepancy. I would guess that your upper jaw is smaller than your lower and that aligning the teeth revealed the underlying problem that was always present. Now you need to work with your orthodontist to determine the best alternative for you.

  3. Bhavi says:

    Hi, I’ve been told by 2 orthodontist that I have a class II overbite and I would require braces for 22 months and extraction of 2 teeth from the upper jaw. My concern is if my upper jaw is grown more outwards than my lower jaw. how will extracting teeth help? doesn’t the bone just remain in it’s position? The braces realign or move teeth, not jaw, correct? I really am not in the favor of removing healthy teeth but I do want to fix my overbite, and I’m definitely not interested in going under the knife. What should I do?

    • Removing two upper bicuspids allows your orthodontist to move the upper teeth backwards reducing your “overbite.” Although the whole jaw doesn’t move, the bone around the teeth does reform around the teeth in their new position. If you have a small lower jaw that results in excessive overjet (the official term), you have three options 1) move the bottom jaw forward, 2) move the top teeth back, or 3) leave the overjet. I have treated hundreds of patients by removing two upper bicuspids and the results are great in the right patients.

  4. alam says:

    Good day! I had my first premolar (upper) extracted to correct an overbite. How long does it usually take for the overbite to heal or for my teeth to move back?
    I had my lower premolar extracted 3 years ago. My lower teeth have shifted and it looks okay. I’m concerned about my upper teeth shifting and changing my facial structure. Is it true that it will make your nose look bigger when the overbite heals?

  5. michelle says:

    Hi. I have a class 2 div 1 overbite. My dentist gave me upper braces for a year, extracted two teeth from my upper jaw and then pulled it back with power bands. Then he took my upper braces off and gave me retainer for it and told me now its time for lower braces. I feel like i still needed braces because even tho my upper jaw moved backward my lips dont match up. Its idk.i feel like the lower jaw needs to move forward.my dentist initially said this too. But two months into lower braces hes telling me all thats wrong with my lower jaw is overcrowding and instead of extracting teeth hes using a drill to go between two teeth and make space. Im confused about this because wont it just pull my teeth back? Hows he gonna move my jaw forward with my upper braces gone and no way to attach bands or anything? Im really worried and my dentist doesnt want to explain anything to me.

    • It does not sound like you are seeing a specialist. No specialty trained orthodontist would ever approach treatment in this way. It sounds to me like your dentist is making it up as he goes along. I would get a second opinion.

  6. Deana says:

    hi!

    I have had braces for six months and my orthodontists wants me to get to top teeth removed because of a deep overbite with jaw discrepancy. The main concern I have with removing my two top permanent teeth is if my face will change with having my top teeth moved back.

  7. Ari says:

    Hello,my son is 9 years old and he has only loss 3 to 4 baby teeth and he has on his panoromic x ray showing that he has teeth coming in on top of his teeth in almost all of his teeth. Now by now he will be 10 in a few months he should have already lost many teeth on his own and he hasn’t. His doctor recomended braces then a retainer but my question is, if he has not lost hardly any of his baby teeth and he has severe crowding plus teeth on top of teeth is braces the best option right now?

    • It really depends on the “totality” of the problem. Sometimes we need to start early if the unerupted teeth cannot come in correctly without our help. Have your orthodontist explain why he wants to begin your son’s treatment before all of the permanent teeth are in.

  8. Shirley says:

    Hello I’m 46 and planning on getting braces after all these years of not liking my teeth. I have a 12mm overjet and a narrow smile so the ortho is suggesting during the treatment to remove 2 teeth on the upper gum about half ways back, my concern is that because I already have a thin face (and my overjet smile makes it look thinner) I am afraid that by removing these that my face will appear thinner. But then again, shes saying that my teeth on each side will be widened out as they are tipped in so maybe that would compensate? I’m not a vain person and maybe I am doing this for cosmetic reasons, but I’m not happy with my teeth at all and find I’m always noticing other peoples teeth and how imperfect mine must seem.

    • I can’t diagnose your case for you, but here are some general concepts to consider. Removing two upper teeth will reduce your overbite, but it will also reduce your lip support. You can widen the upper arch with braces, but it is difficult to predict how that will look when the spaces are closed. If you really have an overjet (the official term for overbite) of 12mm, I would also look into NOT removing upper teeth and having the lower jaw surgically advanced. Not only would that eliminate the overjet, it may also tighten up the skin under your chin like a facelift and improve your profile all at the same time. It is worth asking about.

  9. lei says:

    hello doctor. i’m on braces for more than 2 years now. long before them, i already had 2 upper teeth extracted. my teeth were really not aligned and i have upper front teeth protrusion plus a gummy smile. as the braces go on, there had been a significant alignment of the upper teeth, the gummy smile was reduced, but then i’m still overbite. my upper teeth are covering up my lower teeth when i bite. my first orthodontist made me removed 2 teeth on the lower, since those 2 are obviously misaligned and were on the inside direction,(i wasn’t sure if that was a correct call to have them removed), then i had my two lower wisdom teeth extracted too since they were impacted ones. my teeth are small ( i’m 26 y.o). my case now gives me the impression that i have a small, narrow lower arch (if i’m correct), and i notice that my lower incisors and canines are slightly higher than the rest of the lower teeth (or is it my jaw?), what can be done to correct them? now i’m looking for other orthodontists since i relocated due to my job. one whom i have already consulted suggested to remove 2 upper front teeth to correct the overbite. (i’m trying to avoid extractions since i feel like my upper teeth are already aligned) and i don’t understand much why should another 2 upper teeth be removed (since i already had 2 upper teeth extracted long before the braces). the new ortho said if i’m just concerned with the alignment then no need for the extractions, but to correct the overbite, it’s needed. he said approximately i have 10mm overjet. i am more concerned on my lower teeth. thank you.

    • Your upper and lower sets of teeth are a set. They cannot be treated independently with good results. If you do have 10mm of overjet, you’ll probably either need to have upper teeth removed or your lower jaw surgically moved forward. These are decisions that you need to make in consultation with your local orthodontist. I cannot diagnose you remotely.

  10. Carolina says:

    Hi doc. I respect you from the bottom of my heart for being able to answer to so many people and provide us some insight on orthodontics.
    I have one question. Will having implants affect the adjacent tooth in anyway (decay, root shortening, impact)

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