To extract or not to extract – that is the question

One of the greatest challenges for an orthodontist is treatment planning. Depending on when the orthodontist qualified and where they were taught will, to some extent, influence the treatment decisions. Ultimately the main goal for any treatment is to straighten teeth and to help maintain the result for the long term.

A generation ago, the most common treatment plan for everyone regardless of their problem was the extraction of 4 premolar teeth and treatment with fixed appliances. Headgear was used by many clinicians to avoid extractions but this often stayed on the bedside table because the patient hated wearing it. Following on from this, more forward thinking individuals started using functional jaw correcting braces.

Nowadays we have self-ligating brackets, “non extraction” brace systems and braces that fit on the inside of the teeth, but fundamentally the same issues with treatment planning are present to the modern orthodontist.

There are a growing number of dentists and orthodontists who would prefer to maintain a full set of adult teeth for both long term dental health and facial appearance. These professionals favour expanding the jaws in conjunction with tooth straightening, and using jaw correction braces to improve profile.

Extractions however are still unfortunately part of the treatment process for a few patients. This is largely due to their genetic makeup where they have smaller jaws, crowding of teeth, and often a mismatch between the top and bottom jaws. In certain patients, facial profile can only be improved by the removal of teeth – allowing the front teeth to become more upright and less prominent. In others, it would be absolutely detrimental to their facial appearance to take teeth out.

First class orthodontics is a blend of art and science, and the skill and training of the orthodontist is key to getting the best outcome. It is being able to balance the patients needs (what we both see needs correcting) with their wishes (what they want to be better) and the multiple teeth straightening options available to a fully trained orthodontist that makes happy patients at the end of their treatment.

Paula

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