Extraction Orthodontics: Why Teeth Are Pulled During Orthodontics, Which Teeth Are Usually Extracted and How It Is Decided
Extraction orthodontics is a method in which some teeth are pulled to make room to line the teeth up evenly, and then orthodontics is done. The Korean Association of Orthodontists (KAO, 대한치과교정학회) explains that not every case needs extraction, and that it may be needed when the teeth are large for the jawbone and space is greatly lacking, or when protruding front teeth make the mouth look protruded. The teeth mainly extracted are the premolars, whose functional share is relatively small.
Key facts
| Cases where extraction may be needed | When space for arranging teeth is greatly lacking, or when the teeth make the mouth protrude (source: Korean Association of Orthodontists) |
|---|---|
| Teeth mainly extracted | Premolars (small molars) (source: Korean Association of Orthodontists) |
| Number extracted | Often paired teeth, upper-lower and left-right, are extracted together (varies with the malocclusion) (source: Korean Association of Orthodontists) |
| Function after extraction | No major impairment of chewing if orthodontics finishes smoothly (source: Korean Association of Orthodontists) |
| Health insurance | Dental orthodontics is not covered (check the cost of individual treatment such as extraction separately) (source: National Health Insurance Service (NHIS, 국민건강보험공단)) |
Why are teeth sometimes pulled during orthodontics?
The goal of orthodontics is to arrange the teeth neatly and make the upper and lower teeth meet correctly. But if the teeth are large for the jawbone and a lot of space is lacking, it is hard to line them all up evenly while leaving every tooth in place.
A protruding mouth, in which the front teeth are pushed forward and the mouth looks prominent, is also a typical case for considering extraction. The Korean Association of Orthodontists explains that if the front teeth are moved back using the space made by extraction, the lip protrusion decreases and the side profile of the face can improve.
The Association adds that if teeth that should be extracted are lined up without extraction, the mouth may protrude even more or the teeth may be arranged in a way that cannot function properly.
Which teeth are extracted in extraction orthodontics?
Mainly the premolars, called small molars, are extracted. The Korean Association of Orthodontists explains that premolars come as two identical teeth on each of the upper, lower, left and right sides, and that they are teeth of lower functional importance than the front teeth or large molars.
To make the bite meet correctly, the paired teeth on the upper, lower, left and right are often extracted together and the teeth arranged, so 3 or 4 may be extracted. However, the position and number of teeth extracted vary with the pattern of malocclusion.
Wisdom teeth that are impacted or that interfere with tooth movement during orthodontics may be extracted separately, but this may differ in purpose from premolar extraction to create orthodontic space, so have each reason explained.
How is the decision to extract made?
It is decided by analyzing tooth size, jawbone space, the inclination of the front teeth and lip position from radiographs, photos of the face and teeth, and dental models. Even for the same snaggle tooth, if space is only slightly short the teeth are lined up without extraction, and if much is short or the mouth protrudes, extraction may be recommended.
The Korean Association of Orthodontists says that what matters is normal tooth function and a harmonious facial appearance rather than whether teeth are extracted, and recommends deciding carefully through expert consultation and an accurate diagnosis. The explanation is that the goal is not pulling teeth but a correct bite and healthy teeth.
If the judgment is difficult, ask the dentist to explain together the expected tooth positions, the change in the side profile and the difference in duration with and without extraction.
Is there a problem with chewing if premolars are extracted?
The Korean Association of Orthodontists explains that there is no major impairment because mainly small molars, which have a relatively minor role, are extracted. The extracted space is closed during orthodontics and the remaining teeth are arranged correctly, so chewing force is divided evenly.
The Association adds that where extraction is truly necessary, the remaining teeth meet better in suitable positions after extraction orthodontics, which is rather advantageous in the long run. However, a temporary gap may be visible between the teeth while the space is being closed.
The Korean Association of Orthodontists explains that for some malocclusions the teeth that are extracted differ. The condition of the remaining teeth is also considered, for example when a tooth has already had major treatment, so confirming by tooth number which teeth are extracted and why will also help when you receive other treatment later.
How does extraction orthodontics affect duration and cost?
To close the extracted space the teeth must be moved farther, so it often takes longer than non-extraction orthodontics. If needed, orthodontic mini-screws are used as anchors to move only the desired teeth efficiently and to keep the back teeth from being pulled into the empty space.
Orthodontics is non-covered, so cost differences depending on extraction differ by clinic. Check whether the extraction cost is included in the quote, whether the extraction is done at the orthodontic clinic or referred to another clinic, and whether there is a separate mini-screw cost.
After extraction, do not chew hard on that side until the wound heals, and follow the instructions of the clinic that did the extraction for managing bleeding and swelling. If the gap between extraction and attaching the appliance gets long, neighboring teeth can tilt into the empty space, so decide the schedule in coordination with the orthodontic clinic.
Common myths and facts
Myth: You must extract teeth to have orthodontics.
The Korean Association of Orthodontists explains that not every case of orthodontics needs extraction. It is decided by looking at how much space is lacking and whether the mouth protrudes.
Myth: If small molars are extracted, chewing power weakens.
The Association explains that premolars, of lower functional importance, are mainly extracted, and that if orthodontics finishes smoothly, chewing force is distributed evenly with no major impairment of function.
Frequently asked questions
Does the face change a lot with extraction orthodontics?
If the front teeth are moved back into the extraction space, lip protrusion may decrease. The degree of change depends on the relationship among the teeth, lips and jaw, so at the diagnosis, ask to have the expected change explained with side-profile photos and analysis.
Isn't it too many to extract as many as 4 teeth?
The number rises because the paired teeth on the upper, lower, left and right must be extracted together to arrange the teeth so they meet correctly. The number and positions extracted vary with the malocclusion, so ask specifically why that many teeth need to be extracted.
When does the gap after extraction close?
It closes gradually as the teeth are moved with the appliance, so it shrinks little by little during treatment. The speed of closing differs from person to person, and progress is checked at adjustment visits; while a gap remains, clean well so that food does not get stuck in it.
Won't extracting only the wisdom teeth create space?
Wisdom teeth are at the very back, so they may be limited in solving the lack of space or protrusion in the front dental arch. Which teeth should be extracted is judged from the space analysis, and whether wisdom tooth extraction is separately needed is checked together.
Is relapse more likely after extraction orthodontics?
Regardless of whether teeth are extracted, after orthodontics teeth tend to return to their original positions. Wearing a retainer as the Korean Association of Orthodontists recommends is the way to reduce relapse, and at check-ups it is also checked that the closed extraction space does not open again.
Related topics
- Orthodontics
- Orthodontic duration
- Types of orthodontic appliances
- Orthodontic cost and insurance
- Wisdom Tooth Extraction Procedure