Guidebook

Pulling teeth – is that still common?

Our top priority is to preserve healthy teeth. At Dr. von Rom’s practice, we generally exhaust all possibilities for preserving teeth. From time to time, however, it is correct in orthodontics to extract teeth. In the following, we explain when an extraction is necessary and sensible for orthodontic reasons.

Author
Dr. Fabian von Rom

Date

14. Apr 2022

Estimated reading time
approx. min

Tooth extraction

Contents

Orthodontics: When does it make sense to pull teeth?

Extreme lack of space

If your jaw has far too little space for all your teeth, it makes sense to consider tooth extraction to resolve the crowding. Extracting small molars usually creates enough space so that the rest of the row of teeth can fit harmoniously into the jaw.

Create symmetry

If a tooth is missing on one side of the jaw and no prosthetic restoration of the gap is desired, a tooth extraction on the opposite side may be advisable. Why? To create symmetrical conditions on both sides. This is referred to as an equalizing extraction. Asymmetrical initial situations are often more difficult to treat than symmetrical ones. Asymmetry can lead to displacement of the remaining teeth, which can cause esthetic and functional problems.

Correction of malpositions

For example, if you suffer from a large overbite with a pronounced step between the upper and lower front teeth, we can compensate for this misalignment by extracting teeth and then closing the gap. By extracting teeth in the posterior region, we create space to move your upper front teeth backwards in a second step. This reduces the overbite level. Alternatively, it is possible to move the entire upper dental arch backwards (distalization).

Tooth extraction and fixed braces

Many people wonder whether tooth extraction must necessarily be followed by treatment with fixed braces. In many cases this is the case, because with fixed braces the teeth can be moved as a whole. For the gap closure that follows tooth removal, it is important that not only the neighboring tooth crowns are tilted into the gap, but that the entire tooth, including the root, is moved. Such movements are only possible with fixed braces.

Whether teeth need to be extracted depends on your individual situation. We will be happy to advise you in our specialist practice for orthodontics in Munich-Unterföhring.

Alternatives to tooth extraction – Non-Ex

Our greatest concern remains to preserve all your healthy teeth. In many potential extraction cases, there is a so-called non-ex alternative. This is an alternative orthodontic treatment approach that leads to the desired result without tooth extraction.

Below we show you 3 different alternatives to tooth extraction:

One way to gain space is to distalize (move backwards) your teeth. With the help of special appliances, we move molars backwards in a targeted manner. This creates space in the front dental arch without removing any teeth, which can then be used to correct the misaligned teeth.
Another way to gain space in the dental arch is to widen your jaw. This is how we resolve crowding. Depending on the initial situation, loose and fixed braces can be used for this type of expansion. The decisive factor here is your individual initial situation and whether the cause lies at tooth or jaw level.
If the teeth are initially tilted inwards, expansion of the dental arch by straightening the teeth is a good source of space. If the teeth are initially tilted far outwards, further expansion at tooth level is not possible. If the upper jaw is too narrow, it is possible to widen the entire jaw, at least in children, with the help of a so-called palatal suture expansion (GNE).
Another option for gaining space is the so-called approximal enamel reduction (ASR). Here we reduce the tooth width by removing some enamel at the point of contact with the neighboring tooth. The removal on a single tooth is minimal. However, as ASR is carried out on several teeth, we gain enough space in total to resolve the crowding. ASR is painless and has no long-term negative consequences for your treated teeth. We gain about 5 mm of space per dental arch.

In some cases, it makes sense to combine several of the above-mentioned sources of space in order to avoid tooth extraction in orthodontics. After an individual evaluation of your initial situation, we carry out either one or more of these methods to achieve the best result for you.

Our primary goal is a functional, long-term stable and esthetically pleasing result. We always present you with all sensible treatment options (ex and non-ex). In consultation with you, we then choose the most suitable treatment option for you.

Conclusion

Preserving your teeth is very important to us. However, if there are good reasons why treatment without extraction is not sensible or your result would not be stable, you should still consider a tooth extraction in orthodontics. We always pay attention to the individual initial situation of your jaw and teeth.

Dr. Fabian von Rom

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Do you still have questions?

We would be happy to advise you individually and personally in our specialist orthodontic practice in Munich - Unterföhring.

Make an appointment here. We look forward to hearing from you. By phone, e-mail or directly an online appointment

FAQ

Frequently asked questions about tooth extraction

Will a tooth extraction affect my lip contour?

Yes, which is why we decide on a case-by-case basis whether and to what extent teeth should be extracted. Lip fullness decreases when teeth are extracted and front teeth are moved. However, this may be desirable in some cases, for example if you have a very prominent lip profile or the position of your teeth impedes lip closure. Conversely, we tend not to extract teeth if you already have a flat lip profile.

Is a tooth gap visible after tooth extraction?

If the gap is visible, it can be optically concealed with a temporary denture. This consists of a thin plastic shell. This denture is gradually reduced as the gap closes.

For information on dental care with braces, please click here

Your expert for orthodontics
Dr. Fabian von Rom

In the specialist practice for orthodontics, Dr. med, dent. Fabian von Rom uses his extensive expertise and many years of experience to offer patients the best possible care. The practice offers the entire spectrum of modern orthodontics and specializes in innovative and advanced treatment methods. In addition to traditional procedures, the focus is on treatment with invisible braces for teenagers and adults - one of the most modern and discreet solutions in orthodontics. Dr. med. dent. Fabian von Rom attaches great importance to ensuring that medical precision goes hand in hand with a high level of patient satisfaction. By equipping the practice exclusively with individual treatment rooms, individual and professional care at the highest level is guaranteed.

Further topics

In our guide you will find lots more information on current, relevant and interesting topics relating to orthodontics. We hope you enjoy reading it!