There is no single answer to the question 'Do I need teeth out?'. There is no doubt that in certain cases extractions are required to align crowded teeth or correct the bite.
Much depends on the sort of problem which needs correcting and a decision can only be reached on the basis of a detailed case assessment. Every course of treatment needs to be tailored to the needs of the individual patient. For some patients, in order to get the best appearance and long-term result, extractions will still be part of a 'gold standard' plan.
Any claims that treatment can be completed without extractions, especially before an assessment has been completed, should be regarded with considerable caution. If you are unsure about the advice you are receiving, you should discuss your concerns with your own dentist or seek a second opinion from a specialist.
These following treatment options are all recognised techniques to create space to line up crowded teeth or correct the bite during orthodontic treatment
- Extracting teeth. In many cases there is no satisfactory alternative to extractions to permit the remaining teeth to be aligned or retracted. The extraction spaces are normally closed up during treatment so that there should be no gaps left at the end. Your orthodontist will warn you if this is unlikely. In making a decision about which teeth to extract, the orthodontist will give preference as far as possible to removing teeth which are unlikely to last indefinitely, perhaps because of previous decay or damage.
- Thinning down the teeth. This procedure goes by various names such as "slenderising", "stripping" or "thinning". The process involves removing a fraction of a millimetre of enamel from the surfaces of teeth where they contact the adjacent teeth. For example, by removing a quarter of a millimetre of enamel from both sides of all six lower front teeth , three millimetres of space can be created, enough to allow mild crowding to be corrected without extractions. Care is taken to ensure that a continuous layer of enamel is left on each tooth and given this precaution no harm results from the process. There are obvious limits to the amount of space which can be provided in this way.
- Moving the molars back to create more space for the teeth in front. This is a common procedure in adolescents. It can sometimes be achieved with a brace alone, but for larger movements often involves headgear. In adults there is no growth to assist and the process is more difficult. Nevertheless success can be achieved in some cases provided the objectives are set realistically.
- Expanding the dental arches. Expansion increases the perimeter of the dental arch and thereby creates more room for the teeth. Expansion may not be difficult to achieve technically but a degree of caution is required. Substantial expansion increases the risk of relapse afterwards and requires careful retention after treatment. Moving the roots outwards thins the layer of bone over the root surface and may increase the risk of the gum receding. Excessive expansion may lead to undue prominence of the teeth with adverse effects on the overall appearance.