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.

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

  1. Packirisamy Neelagandam says:

    Dear Doctor

    My daughter is 8 years old. our orthodentist told us, she has narrow arches. Her six lower milk (baby) teeth need to be removed. Then she needs to use an expander kind of thing. Her upper acrh also will be adjusted. I am not sure whether to agree this procedure or not.Is it a normal procedure? Could you please shed some light on the need of such a procedure. Because google gives like TMJ, TMD kind of threats. Your help on this is much appreciated.

    Thanks.

    Regards
    Packirisamy N

    Sorry, Earlier instead of milk teeth I wrote molar teeth

  2. Sam says:

    I recently got my 3 more premolars removed, one to go. i have a slight overbite and crowding. my chin is already receeded (i look like i have a turkey neck). the thing is my ortho is going to be pushing my teeth back and i’m really worried if it’s going to push my jawline even more inward and my face will be more ruined. i don’t want jaw surgery or any kinds of surgery. i’m only 17… I really hope you answer because i’ve read people’s expriences online and they are all bad. is pushing the teeth back will cause my chin to receed even more?

    • Moving your teeth back may bring your lips back slightly, but it will not change the position of your jaws at all. The only thing that can move your jaws is surgery. If you don’t want that, and you still want your overbite fixed, removing teeth to allow the teeth to be shifted may be your only option. Please don’t believe everything you read online. Find a doctor you trust and discuss your concerns with him.

  3. Dee says:

    Dr. Jorgensen,

    My son is 12 years old. He has a class 2 overbite, in addition to malocclusion. He has already undergone phase 1 treatment to relieve overcrowding. He has now started phase 2 to correct the malocclusion. But for the overbite correction, we are getting differing opinions.

    We went with a different orthodontist for phase 2 because he is closer to home. He is telling us that my son would need pre-molar extraction to correct the overbite if we don’t get the results we are looking for with rubber bands. I had also sought the opinion of the orthodontist who did phase 1 about this. Her plan was to use the MARA appliance to correct his overbite and let that work in conjunction with his growth spurt. All things being equal I would much prefer not to have his teeth extracted. But I am confused what is the better option.

    If you can provide any guidance I would appreciate it. Thanks in advance!

    • The approaches that you are describing will give different results. The rubber bands and MARA appliance will move the top teeth back and the bottom teeth forward. If your son has enough supporting bone and gum tissue in the lower arch, either may be acceptable. If your son’s jaw size is smaller and he can’t afford to have the lower teeth pushed forward, then removing two teeth in the upper or moving the lower jaw forward with surgery are the best options. The orthodontists you saw have the responsibility to determine which is best for your son.

  4. ryan says:

    Does the size of the jaw bone itself change at all with extractions

    • Removing teeth because of crowding will not change the size or shape of the bone because the resulting position of the other teeth is almost the same as it was before. If you remove teeth to reduce an overbite, the lips and bone may move back slightly with the teeth.

  5. Kam says:

    I am 13 and have an overbite and severe crowding. We’ve visited three orthodontics and did not like them. My new dentist recommends pulling my two premolars out to fix the severe crowding and overbite. Do you recommend that I take out the teeth? Will my jaw look narrow? Is there a way to fix the overbite and severe crowding without pulling them out ?

    • First, I would trust an orthodontist much more than a dentist when it comes to fixing an overbite. They are specialists and have two years more intense training than general practitioners. Second, it is hard to believe that there was not one of the three orthodontists that you liked. Could it be that they were telling you something you didn’t want to hear? Please find a specialist who is a good fit for you and put your trust in him or her

  6. Akanksha Shetty says:

    Hi I am a 27 year old and I have an overbite. And as correctly pointed by you I have a smaller lower jaw. So for the same reason my ortho gave me two option.
    1. Self Ligating braces with two extraction on mu upper jaw.
    2. Invisalign with one extraction and filing of the enamel for the upper jaw.

    What I am worried most is the extraction. Will it not be possible to get the self ligating braces without extraction but with removing some enamel from my teeth.

    • I can’t diagnose your case, but I will offer this. Self-ligating brackets do not change the need to have teeth removed. You either need it or you don’t. I usually don’t feel comfortable using clear aligners in extraction cases, but there have been exceptions.

  7. Dina says:

    Dr. Jorgensen, Thank you for all the information you provide! My almost 9 year old daughter recently was given this diagnosis: Class II, division 1 deep bite, severe upper crowding with ectopic upper cuspids over the roots of the upper lateral incisors, moderate lower crowding with available E Space. Treatment: Initial extraction of the upper 1st bicuspids, lower lingual holding arch, recall visits until all permanent teeth have erupted, then comprehensive treatment.

    I do like this orthodontist. Prior to the treatment study he said we could start braces right away and she’d only have a phase one — three years of braces, no teeth pulled(they had a fairly recent pano X-ray).

    After the treatment study everything changed and I’m concerned about pulling permanent teeth. I’m concerned about altering her face and having gaps until the upper cuspids come down. What if they don’t turn on their own, how long will she have gaps? I’m also concerned about root damage to permanent teeth as the doctor is. Why wouldn’t they put braces on to move the teeth back to make room for the ectopic cuspids to come down? Why didn’t they ever suggest an expander? We’ve had several “checks” with this orthodontist over the past few years to see if she needed any interventions.

    Thanks for your help!

    • You either trust your orthodontist or you don’t. I can’t diagnose your daughter for you, but I have no problem with this treatment plan in the right patient. If you trust your orthodontist, “give him the reins” and don’t question your decision. If you don’t really trust him, find another.

  8. stephenie says:

    hi im a 15 year old who just got my 2nd molar teeth in my uppwe jaw removed required by my orthodontist.He told me that my overbite is caused by me having a big upper jaw.Right now I have two concern,first is that he said that after my orthodontic treatment,I will still have a gummy smile and it l won’t help much with my appearance,just with a more beautiful set of teeth.However,after I got my teeth extraction,I came across some blogs that features cases where orthodontic treatment can make a significant difference in cases similar to mine.The doctor in that blog said that somehow with the correct method.The bone near the root will move with teeth inwards bodily.Is it a common method?And should I discuss it with my orthodontist?
    Second,the doctor said that my wisdom teeth should grow out and replace the molar teeth that get extracted.Is there a guarantee?I have already taken a x-ray and the doctor said it should grow out.But is there also a possibility that my wisdom teeth would just stay there and never grow out?

    • There are ways to intrude the upper incisors to reduce the gummy appearance. Ask your orthodontist about TADS or maxillary impaction surgery. As for the eruption of the wisdom teeth, there are no guarantees. Removing the upper second molars would greatly increase your chances, but nothing is for sure with the human body.

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