North Sydney Orthodontics

"No extractions and simple braces to correct crooked teeth in children and adults is the dream of both patients and orthodontists - and for most patients it is an achievable goal.  However some dentists and orthodontists exploit patient's natural reluctance to extraction treatment for cynical marketing reasons and claim that (without exception) extraction orthodontics damages the face / smile / joints.  However there is no evidence to suggest that properly planned and performed orthodontic treatment damages  the smile or face.   Extraction and non-extraction treatment modes are both accepted and acceptable in the right circumstances.  But the whole debate over extraction of teeth is really a debate about how to obtain space for tooth alignment and tooth movement in the crowded dentition,  and the options are as follows:

1. Expand the dental arches

2. Interdental stripping (Make the teeth smaller by stripping enamel from between the contacting surfaces)

3. Extract teeth

Dental arch expansion is a good treatment choice to align spaced or mild to moderately crowded teeth.  Often as a result the smile width is a little wider and the teeth positioned slightly further forward giving enhanced support to the position of the lips- an appearance that is regarded by many people as desirable.  Non-extraction treatment can take longer and require a bigger commitment to retainers compared to the alternative treatment involving tooth extraction but the aesthetic result is justified in many cases. To maximize the chance of a successful non-extraction treatment may require starting treatment early (9-10 years of age and sometimes even earlier).  It will certainly involve a longer treatment, more appliances and ultimately more expense. 'Self ligating' bracket systems e.g.The Damon System are a recent orthodontic innovation which use low force wires and low friction brackets which is well suited to aligning mild to moderately crowded teeth without extraction of teeth.  Dr Daniels has been using self ligating systems as well as other more conventional systems for several years and recommends them for this type of treatment.  About 85% of people can be treated without extraction but of those about 25% would make an easier cheaper quicker and more stable choice by having extraction therapy.  see examples of inappropriate non-extraction orthodontic treatment.

 Interdental Stripping: up to 1/2 mm of enamel can be filed from the adjacent surfaces of teeth to provide incremental space to improve the stability of the completed alignment.  up to 10mm of space per arch can be created in this way. This has the advantage of allowing smaller increments of space to be created compared to extracting whole teeth. This can make the teeth a little more susceptible to decay on the affected surfaces and is not very suitable for certain shaped teeth.

Orthodontic treatment involving extraction of teeth:  When there is significant overcrowding of the teeth (>7mm ), teeth may be extracted to give the most stable alignment of the teeth. Extractions are sometimes used  to provide space for the correction of excessively protrusive front teeth, correct centre-lines and provide space to permit the teeth to meet properly when there is a mild imbalance in the jaw sizes (see examples under prominent teeth or crossbite correction.  Sometimes  extraction and space closure is a better alternative than retaining poor quality or decayed teeth, and may be often cheaper than repairing these teeth for a lifetime. In addition 'Extraction orthodontics' can often provide the space for the emergence of the wisdom teeth. that may otherwise require extraction.   About 15% of patients require space from tooth extraction which cannot be obtained appropriately by any other method.    Normally the extraction spaces will completely close during the orthodontic treatment, but some space may remain if there is insufficient bone width at the extraction site or if the orthodontic treatment is not completed.  This can occur if there is a delay in starting space closure following the loss of the teeth.  Usually the teeth are chosen for the extraction space to get the best final tooth positions but sometimes, adjacent heavily repaired teeth are extracted instead, under such circumstance the use of mini-implants may be required to still obtain the most ideal outcome. 

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