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Getting Teeth Pulled Out For Braces Treatment

Extractions in conjugation with the braces treatment are not new. To establish straight teeth in functional occlusion, extraction of teeth is required. The crookedness of the teeth and the age of the patient may be the important factors in deciding whether extraction is required or not. Extractions in orthodontics include serial extraction carried out when both milk teeth and baby teeth are present and therapeutic extractions which are carried out as a treatment procedure for gaining the space.

To extract or not to extract has always been a controversy in orthodontics. Some orthodontics advocates non-extraction while some recommend extractions.

Need for pulling out teeth for braces treatment

A number of circumstances necessitate extraction of teeth as a part of braces treatment. These are:

1.    Arch length-tooth material discrepancy

The arch length and tooth material should be in harmony with each other. The presence of tooth material in excess of the arch length can result in crowding of the teeth or proclination of the front teeth.  In many cases, it can’t be treated by increasing the arch length so tooth material is reduced in such cases. Extraction of one or more teeth is done in case of severe tooth material-arch length discrepancy. Usually an orthodontist will first pull out the wisdom teeth. If there is still not enough space, then bicuspids are pulled out.


Crowding and Proclination of teeth due to Arch length-Tooth material discrepancy

2.    Correction of inter-arch relationship:

Abnormal malrelationships may require extraction of the teeth to achieve normal inter-arch relation. Pulling out teeth in such cases establish normal incisor and molar relationship

3.    Abnormal size and form of teeth:

If the teeth are abnormal in size or form, then extraction is required to achieve satisfactory occlusion. Abnormal teeth can be quite larger in size than the normal teeth, hypoplastic, teeth with curved roots or crown or teeth with abnormal appearance.

4.    Skeletal jaw malrelations:

Severe skeletal malrelationship of the jaws may not be treated with orthodontic appliances only. Surgical respective procedures along with extractions are required in these cases.  


Severe crowding and malalignment before the Braces Treatment

Teeth after 2 years following Braces Treatment with 4 Teeth Extraction

Choice of teeth for extraction

The choice of teeth for extraction is based on no of factors. These are:

  1. Arch length tooth material discrepancy
  2. Direction and amount of jaw growth
  3. State and position of teeth
  4. Entire dentition
  5. Age of the patient

Bicuspids are most commonly extracted teeth as a part of braces treatment.

To relieve moderate to severe crowding and proclination, first bicuspids are removed and to relieve mild crowding and proclination, second bicuspids are removed. In case of open bite, extraction of second bicuspid is preferred over the first bicuspid as deepening of bite is encouraged.

When the space required is less than 5mms but more than 2.5mm, then second bicuspids are removed and when the space required is more than 5mms, then first bicuspids are removed.

Extraction of second bicuspids for Braces Treatment

The teeth must be symmetrical. Same teeth are usually removed from  top and the bottom. If two teeth are removed from the same side, then midline shift can occur. So the teeth are usually removed in either 2’s or 4’s. More commonly 4 teeth are to be extracted.  

Extractions in Children

Extraction in children is not advocated. Extraction for braces treatment is usually done in adults. Growth in children is still taking place and additional options can be looked for in them apart from pulling out the tooth. The space can be gained in children by use of headgears, palate expansion or by guided growth method. In case of class III malocclusion, in the lower jaw is in the front of upper jaw, extraction may be required.

Who pulls out the tooth?

The tooth is pulled by an oral surgeon mostly. A simple dentist with tooth extraction training can also do the extraction.

How painful is the extraction?

In case of wisdom teeth extraction, sedation is mostly given. There may be pain and discomfort few days after extraction depending on the procedure used to pull out the tooth. Sutures may also be given after the tooth is pulled out.

In case of extraction of bicuspids, usually there is no pain or discomfort afterwards. The extraction is done under local anesthesia. It takes around few minutes to pull out the four bicuspids. Before the extractions, it is advised not to take any pain meds or anti-inflammatory tablets as they prevent clot formation so more of bleeding occurs.

After the teeth are pulled out, analgesics that are the pain pills are given by the dentist. It is advised to take soft and liquid diet and not to smoke minimum for 48hrs and to avoid sucking, spitting for a minimum of 24hrs. It is also advised to do warm saline rinses 24hrs after the tooth removal for proper healing to take place.

A dry socket can occur as a complication after the extraction if the clot gets dislodged or dissolves exposing the bone. The chances of dry socket increases in case if a person smokes within first 48hrs after the tooth removal or if the patient sucks or spits, quite a lot after extraction or if the patient doesn’t follow the postoperative instructions. In such cases, the socket area is first cleaned and then the dressing is given.

When Are the Braces given after extraction?

The orthodontist can give braces almost immediately after the tooth is pulled out. He may put on the braces a day after extraction only.

Gaps in mouth after teeth are pulled out

The patient may find gaps in the mouth very awkward. While eating, the patient has to change the way of chewing. He has to chew slowly and has to take small bites. There should be no food accumulation in the gaps. The chewing habits have to be changed until the gap closes.

With the lapse of time, the gap will start decreasing. As the gap decreases, the way the person bites and the way the teeth meet also changes.

In some rare cases, front teeth may also require to be pulled out for braces treatment. Missing front teeth is quite noticeable. So a person might be quite embarrassed because of it. But this is for a short span only. The gap will close within some time and the teeth will become straightened.

After how long does the gap closes?

The time taken for the gap to close varies from person to person and case to case. On an average it takes 4months to 1year for gap to close. The gaps which are present on the upper teeth closes faster than the gap present in the lower teeth. The movement of the teeth per month is about 1millimeter.

To close the gaps, power chains or some other methods can also be used. On some of the brackets, hooks are present to which power chains are attached. The power chains can also be put in place of ligatures directly on brackets. Lighter shades power chains get stained easily so it’s very to go for colors which don’t stain as grey color. Loops in the arch wire can also be made to close the gaps. It is usually done near the completion of the treatment and is so called as closing or finishing loops at times.  

Tooth with the chain around it, which is covering up the wire that's on it as well

The orthodontist can check that whether the gap between the teeth is reducing or not by a special ruler. Initially a person might feel that the teeth are not at all moving but in actual they are.

Poking wire

An extra wire may poke at the soft tissue when the gaps are closing. This occurs quite often. In such cases, an orthodontist needs to be consulted asap. The extra wire is trimmed by orthodontist. To prevent poking for a time being, wax can be used.
 

 

 User Comments on -  Getting Teeth Pulled Out For Braces Treatment


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Posted By : Dr. Ritz on 08-Sep-2013 08:28 AM
Cindy, Normally when extraction is done for ortho treatment, first premolars are extracted but in your case, it seems that on one side second premolar has to be pulled out. It may be due to some space calculation. It cannot be commented upon with seeing case, xrays etc. You can talk to your orthodontist about this or take second opinion.
 


Posted By : Cindy on 03-Sep-2013 11:10 PM
Hello, I have already done Xray, the mould and also received a letter from my orthodontist and inside writing to extract 4 | 4, 5 | 4. What does that mean? Is it to extract upper right and left 1st bicuspid, lower left 2nd bicuspid and lower right 1st bicuspid. If that's the case, the teeth extracted is not symmetrical. Why is that so? I am afraid it will look odd after removing the braces. Should I go to another orthodontist for 2nd opinion? Thanks.
 


Posted By : don on 02-Sep-2013 01:59 AM
7 year old would braces help or some pulling of teeth help the new teeth comeing
 


Posted By : Dr. Rtiz on 15-May-2013 09:13 PM
Hi Leanne, for Braces treatment, getting 4 bicupinds extracted is a normal procedure if space is less for the alignment of teeth. This space is filled by the movement of adjacent teeth and it does not cause any sagging of the face. So if the treatment requires the extraction of bicupids then you have to get them pulled out. If you are very apprehensive then you may take second opinion.
 


Posted By : Leanne on 15-May-2013 01:33 AM
Hi! My orthodontist recommended for me to have 4 of the 1st bicuspid teeth extracted. I'm scared that it will make an extreme facial change for me, causing my face to sag? (or something like that) Should I have my teeth extracted? By the way, I'm 14 years old.
 


Posted By : Dr.Ritz on 15-Nov-2012 04:52 AM

Hi DAISY,With braces, the slower the better. The bone that makes up your tooth sockets has to change shape as your teeth move,and eventually form complete sockets in the new places.This obviously takes time,and if rushed may not be as effective.The best way to get your braces off early is to follow instructions,and there is no average time for braces.It depends on the individual's teeth placement.Just be patient and follow all instructions.Hope this helps.Good luck!!

 


Posted By : daisy on 12-Nov-2012 01:55 PM
hello i have had braces for almost 5 yrs now, I had four teeth extracted two in the upper area and 2 in the lower. I have been using power chains for as long as I can remember for my treatment. I am beginning to feel restless with my process and my orthodontist continues to tell me "you have to be patient", I understand that patience is key here but I was wondering do I have any other options to speed up the process of closing the gaps. thank you
 


Posted By : daisy on 12-Nov-2012 01:51 PM
hello i have had braces for over 4yrs now, I had for
 


Posted By : Ayesha khan on 12-Nov-2012 07:45 AM
i'll make sure thanks alot for helping me
 


Posted By : Dr.Ritz on 05-Nov-2012 12:46 AM

Hi AISHA,You can get braces treatment done to correct your crooked tooth and close the gap.Look for orthodontists in your locality or get a referral.The best way to find the right orthodontist is usually by getting a referral from your general dentist.Schedule an appointment with the orthodontist and discuss the possible treatment options.Braces will cost anywhere up to around $5000 for both the upper and lower teeth and entails two years of treatment.This will vary slightly depending on the specific service that you might require. There are private orthodontists who charge on a higher scale when compared to the dental schools.In dental schools,treatment is done by budding dentists under the watchful eye of their professor. Before getting dental braces,you can consult two or more orthodontists.It will let you know whether you are getting the best and most affordable of dental braces.Hope that solves your query.Keep us updated.

 


Posted By : aisha on 03-Nov-2012 02:11 PM
hi i need to put braces coz my front tooth r bit out side and gap between thm and i dont know wht to do, where to go and how much it cost plz let me know about
 

 
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