Extraction Vs. Non-Extraction Orthodontics

Traditionally in the past, severely crowded teeth was solved by creating space through the extraction of teeth. Cases such as these would usually see the extraction of 4 premolars + 4 wisdom teeth and maybe even a lower incisor for a total of 8 or more missing teeth. The front teeth would then be pulled back and retracted to fill in the gaps created by the missing teeth.

The problem with this “extract & retract philosophy was that it assumed the size of the jaws was normal/fixed and the problem was always in the teeth being “oversized”. In reality, most of us with crowding have normal sized teeth but undersized jaws due to early childhood airway issues. Not to mention, with orthodontic extractions there are huge increases in the risk of obstructed sleep apnoea, bruxism & jaw joint disorders as well as an unsightly collapse of the lower face.

With the advancement of new technology, passive self ligating braces together with copper nickel titanium light wires such as that of the Damon system, allow for jaw expansion to create space and uncrowd the teeth. In addition, fixed expanders and orthognathic jaw surgery are also options to achieve jaw expansion in more severe cases.

So when do we decide to perform orthodontic extractions (and retract)? It actually has little to do with crowding. The answer lies in the second part of the philosophy – retraction. It has to do with facial profile. An over prominent facial profile (which is uncommon) would be suitable for extraction & retraction where as a collapsed or deficient facial profile (more common) would require growth. The above twin study shows cases of normal or under developed facial profiles where one twin went through extractions and one did not. It is obvious in both cases, extractions left the twin with extractions worse off than the twin who did not have extractions.

Key Points

  • Uncrowding teeth is best achieved with jaw expansion as opposed to extractions.
  • Jaw expansion can be achieved with Damon system &/or fixed expanders, otherwise jaw surgery for more severe cases.
  • Orthodontic extractions are only suitable for those with a protrusive lower facial profile.

If you are considering orthodontic treatment and are feeling apprehensive about orthodontic extractions, come and see us for a consult and we can give you our honest professional opinion for what is best for you or your child.

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