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.

48 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.

  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?

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