Treatment with braces without extraction of teeth, jaw extension. Is it necessary to remove fours for braces without fail

Problem: to the orthodontic department "Dial-Dent" to the orthodontist O.A. A girl came to Baranova for a consultation. She didn't like that her front teeth were growing crooked. Since the girl already had an unsuccessful experience of orthodontic treatment, her main wishes are not only to straighten her teeth, but also to maintain the result for many years.

Solution: orthodontist O.A. Baranova performed the treatment with the Incognito lingual bracket system. During the treatment, the teeth were not removed. To create the space necessary to align the teeth, the doctor used the separation method.

Background: the girl had already undergone orthodontic treatment several years ago in a Moscow clinic. The treatment was successful, but for unknown reasons, the patient missed retention, a stage that is performed after the removal of the braces and lasts two to three times longer than the wearing of braces. The failure of this most important period in the treatment led to the fact that after a while the upper teeth protruded noticeably. In addition, both the lower and upper teeth "walked" in the rows (this can be clearly seen in the photo below).

Photos before treatment:

Before orthodontic treatment

The patient visited the orthodontist, received an initial consultation. At the consultation, the girl said that she had applied to other clinics, but everywhere she was offered to remove her teeth to solve the problem. The patient did not like this approach, and she turned to O.A. Baranova after she learned from a friend that this doctor can straighten crooked growing teeth without extraction. Since the patient agreed to undergo treatment, the orthodontist gave her a referral for in-depth diagnostics, which is necessary for accurate planning.

After analyzing the data of in-depth diagnostics (images of TRH in direct and lateral projection, OPTG, photographs, conclusions of a dentist, psychologist and osteopath), the doctor prepared a treatment plan and presented it to the patient.

Orthodontist's diagnosis: crowding of the frontal group of teeth from above and below, shortening of the upper and lower dentition, protrusion of the frontal upper teeth, displacement of the lower cosmetic center to the left, palatocclusion on the right, distal occlusion on the right.

According to the orthodontist, the size of the teeth is “to blame” for the crowding of the teeth (the jaws are of normal size). Thus, it is possible to perform the treatment without extracting the teeth to create additional space. The solution to the problem with the place in this case will be separation - grinding a thin layer of tooth enamel in the contact area.

The patient signed the treatment plan, choosing (with the help of the orthodontist) Incognito lingual braces during the discussion.

Individualized Incognito braces, which are installed on the inside of the teeth, are an excellent choice for those who want to perform treatment discreetly. And in combination with many years of experience O.A. Baranova's treatment results will exceed all expectations, as she knows everything about Incognito's braces!

Orthodontic treatment plan:

taking high-precision casts, ordering an individualized Incognito bracket system in Germany (approximate waiting time is 3 months);
hygienic preparation of teeth, fixation of braces;
a slight separation of the teeth in order to gain access to the lateral surfaces of the teeth and carry out the separation as carefully as possible - all separation calculations (how much enamel thickness in fractions of a millimeter should be removed) are performed by the Incognito laboratory using computer simulation;
separation of the upper and lower teeth - this stage is performed by the dentist;
alignment of teeth and closure of gaps;
creation of physiological contacts between teeth with the help of elastics;
removal of braces, retention to stabilize the results of treatment.

Treatment with lingual braces

Before the start of orthodontic treatment, the oral cavity is sanitized, as well as hygienic cleaning of the teeth. After taking impressions for Incognito braces, no manipulations with the teeth are carried out, since the installation cap with braces simply does not sit on the teeth.

Incognito braces fixed:

After 5 months, the dentist Yu.A. Borisova performed the separation of teeth. For separation, the doctor used soft discs that allow you to gently remove the enamel, as well as a special ruler with a "step" of 0.25 microns to control the amount of polished enamel. After separation, the enamel must be processed with polishing discs or special strips to achieve perfect smoothness. Working with a dental microscope helps the dentist achieve excellent polishing results.

The photo below shows the gaps between the teeth that have appeared - this is the place necessary for further alignment of the teeth.

After separation, orthodontic treatment continued for about a year. The patient visited the doctor every two months. For the prevention of caries, the patient visited the hygienist several times, where she underwent professional cleaning of her teeth and braces. Air Flow brushing thoroughly removes plaque, keeping teeth, gums healthy and breath fresh.

Result of orthodontic treatment without extraction of teeth

The patient wore braces for 1 year and 8 months. The cost of treatment with the Incognito bracket system was 450 thousand rubles. The results of the treatment are straight teeth, the correct inclination of the teeth.

After removing the braces, the retention period begins, which is necessary to stabilize the results of treatment. It consists in wearing retention equipment (wire retainer on the lower teeth and a cap on the teeth of the upper jaw) and a scheduled visit to the orthodontist. The frequency of visits becomes less frequent - once every six months to monitor the situation. The duration of wearing the retention equipment is determined by the orthodontist.

Teeth are normal Orthodontics, braces Do I need to remove teeth before installing braces: misconceptions and real facts

Extraction of teeth before fixing the bracket system is part of pre-orthodontic preparation along with oral cavity sanitation. Although dentists usually try to preserve units by any means possible, extraction in this case is a necessary measure. However, sometimes you can do without it.

Why are teeth removed before orthotherapy?

Extraction before the installation of orthodontic structures is carried out in almost all patients. Curvature and crowding appear as a result of anomalies in the development of the dento-jaw system. The main ones are incorrectly formed rudiments of indigenous units and disproportionate development of the jaws.

Therefore, often sends the patient to the surgeon to remove one or more teeth. If this is not done, there will not be enough space for the correct location of the remaining units. There is simply nowhere to move them.

Testimony preorthodontic extirpation are:

underdeveloped upper or lower jaw;
dystopic and impacted units - if they are important for the full development of the dentition, they can be “pulled out” with braces;
correct formation of facial features - during the correction, the patient’s appearance changes, in some cases an “extra” crown can distort it;
severe crowding;
supernumerary teeth;
too large units;
asymmetrical arrangement of the lower jaw relative to the lower - it can protrude forward or be excessively deepened.

Additional Information! Strongly destroyed teeth are also removed, from which almost one root system remains. In a normal situation, they could be prosthetized, but with them it is impossible to displace and they will interfere.

After extraction, large gaps remain, for which the remaining units move (approximately 1 mm per month). Over time, they will completely close the gaps, and the bite will even out.

What units are removed before orthodontic treatment?

Due to structural features and a small functional role, third molars and first premolars are most often extracted. Less often - the second premolars - "fives". And only in exceptional cases, incisors, canines and large chewing teeth - “sixes” and “sevens”.

Important! When choosing which tooth to remove, doctors first of all pay attention to severely destroyed units: broken, with a deep carious cavity, with large fillings, depulped. It is highly likely that in a few years they will still have to be removed.

extra third molars

"Eights" - the first in line for removal. Most orthodontists are of the opinion that they should always be removed before aligning the bite with braces.

This position is due to several factors:

third molars do not perform significant functions - they are little involved in the process of primary food processing;
poorly developed root system - "eights" can hardly withstand even the slight load that falls on them, and will not withstand significant pressure from orthodontic structures;
the timing of cutting wisdom teeth is 18 - 21 years: as a rule, they try to correct occlusal defects in adolescence, and units that have grown in a couple of years will again distort the dentition;
frequent abnormal growth - to the side or outside the dentition;
frequent carious lesions of the "eights" and inflammatory processes in the tissues adjacent to them;
high risk of complicated eruption.

Additional Information! If the third molars have not yet erupted, and the dental arch is poorly developed, even impacted units are removed.

For these reasons, the G8 prefer to be removed as a reinsurance. Since there is a high risk of developing complications in the future, which will nullify all efforts.

When should premolars be removed?

If there is not enough space on the jaw to align the teeth, premolars are usually removed - "four" or "five". Moreover, they prefer to extract the first ones - they have small roots, crown sizes and a weak chewing load.

Extirpation of premolars is indicated for:

high degree of crowding;
distal and cross disocclusion;
open bite with severe crowding and pushing one of the jaws forward (protrusion) - get rid of the lower and upper premolars.

Should I agree to the extraction of the “bearing” and front teeth?

Large chewing teeth (“sixes”, “sevens”), as well as incisors and canines, are reluctantly removed. They play an important role in the formation of facial features, jaws, diction, food processing, and also have an aesthetic function.

To remove each of the "important" teeth, there must be serious testimony:

severe destruction and inflammatory and infectious processes at the top of the root;
mesial bite - in this case, the lower incisors are removed;
“sevens” are removed only if “eights” can be “pulled up” in their place;

Important! Canines and molars are trying to save by any means, because. these are "bearing" units that significantly affect the facial muscles and external features.

The extraction itself is carried out at least 1 week before the installation of bracket systems. It takes time for the hole to heal and soft tissues to recover.

Is it possible to do without extraction?

In some cases, extraction before alignment of the bite can be avoided. It is not carried out if:

the patient has minor areas of dystopia - small;
all third molars have erupted, do not affect the remaining units and are part of the dentoalveolar system;
"Eights" are also preserved in the absence of second molars - they are moved to the place of missing units.

If the lack of space is due not to the small size of the jaw, but to large teeth, you can resort to another method - separation. The procedure consists in grinding a thin layer of enamel from the contact surface. As a result, a few millimeters are released to align the bite.

Removing teeth before installing orthodontic structures in most cases is a mandatory procedure. Only sometimes it can be avoided. It should be borne in mind that the opinions and methods of bite alignment differ for different orthodontists. When there is doubt whether it is necessary to carry out extraction, it is better to consult 3-4 specialists.

What to do in difficult orthodontic cases?
If it so happened that you turned to an orthodontist late... The child is already an adult, and the teeth are very uneven... It may very well be that doctors suggest removing teeth. The explanations of the orthodontist are simple: there is a catastrophic lack of space ... And if you remove the teeth, then the place will appear.
Is the orthodontist right? Should healthy, permanent teeth be removed?
No, it's not worth it! If you are looking for a way to save your teeth and get a beautiful smile, then you are on the right track! Indeed, modern orthodontics is a high-tech industry with huge opportunities. On this page we will talk about a great way to avoid the removal of permanent teeth - this is the technique of syndication of transient orthodontic effects.
Very little is said about this technology... What a pity! Removing healthy teeth is barbaric! If it is possible to do without tooth extraction, then it is necessary to acquaint as many people as possible with this progressive method of treatment.

The method of syndication of transient orthodontic effects (expansion of the dentition with labile bracket systems)

The method of syndication of transient orthodontic influences is a young trend in orthodontics. It appeared about 10 years ago. The revolutionary philosophy of orthodontic treatment owes its appearance to the achievements of scientific and technological progress and the emergence of labile forms of bracket systems. Labile braces belong to the category of verification systems. The main feature of labile bracket systems is the configuration of brackets with a changing gap of its groove. The two surfaces of the bracket groove are in the form of convergent spherical surfaces. This shape of the groove brings the wire and bracket into contact very smoothly, which provides a unique biomechanics of tooth movement.
The initiation (beginning) of treatment is carried out with superelastic nickel-titanium wires with the addition of copper. Nowadays, many orthodontic philosophies work with elastic archwires, and this is nothing new. But in labile bracket systems, the first orthodontic archwire is a square wire. For example, in self-ligating braces, such an arc is used only in the final treatment. The elastic square-section archwire, combined with the spherical bracket groove configuration, allows the development of the effect of gentle forces acting throughout the entire treatment period. During treatment, there is no need to change the arches. Activations are not required, with the exception of checking or replacing clip-on ligatures (another know-how of labile braces).
Labile systems expand the horizons of the biomechanics of bracket treatment. This is the effect of widening the dentition, which has always been used in orthodontics to treat difficult cases of crowding without extraction of teeth. Labile bracket systems increase the effect of jaw expansion by 1.7 - 2.5 times. This technique works great on both the upper and lower jaw.

Photo of the face before and after the expansion of the dentition

The photo of the patient's smile before and after jaw expansion perfectly demonstrates all the benefits of such treatment. After treatment, the smile is wide, open, beautiful. No sunken cheeks and sagging skin. All the positive characteristics of a smile, a beautiful oval of the face, the patient owes precisely to the effect of jaw expansion.

Apparatus for expanding the jaw bones

The use of a bracket system in combination with expanding devices operating in the area of the mid-palatal suture is a direction in orthodontics that allows it to be an excellent alternative to surgical methods of treatment.
The device looks bulky. But, this is an insignificant drawback, which is more than offset by the ability to avoid surgical treatment. This is a great alternative to complex and risky surgeries. Activation of the expansion screw once a day, for several weeks, will give a guaranteed result of the expansion of the dentition. The distance between the central incisors will indicate the expansion of the jaw in the region of the median suture.

Truths and myths about jaw expansion

Each patient begins preparation for braces treatment on Google or another search engine. Thousands of pages will answer your search query: "How to expand the jaw" or "Brace treatment without extraction of teeth." But how to make sense of this crazy flow of information. After all, a person cannot afford to read thousands of articles even on the most topical and important topic for health. And then there's the search engine ranks according to the relevance of the request and without any responsibility for the accuracy and security of information. You are offered truth and untruth, promotional articles and veiled publicity stunts. And patients fall into a trap... Copywriters lure with advertising, playing on the most delicate strings of the soul, confusing terms and concepts, speculating on human values.

This is how the first part of our article is written. Everything is mixed up: complex terms and mechanisms of orthodontic treatment, which put forward absurd ideas without evidence. Articles of this kind are permeated through and through with promises to cure everything and save everything, as if everything is allowed to the orthodontist. Most of these pages on the Internet provide incomplete, inconsistent, twisted information about the patient. The photo and verbal descriptions are torn out of the general scheme and therefore they can be interpreted in a variety of ways. Often you can see a collage - a photo of the face of one patient, and the teeth of another. It is even worse if the photos are processed in Photoshop, for example, by stretching the images, creating the effect of expanding the jaw.
Now I will begin to expose myself, refuting everything that was written in the first part of our article. Then, when reading other materials on the Internet, you will be careful and attentive, moderately suspicious and distrustful of information given in crumpled, inconsistent and torn pieces.
So all the same, how to be? To expand or not to expand the jaw?
For some reason, a stable fake has taken root in practical orthodontics - the expansion of the upper jaw solves the problem of lack of space. I can't explain why my colleagues propose to expand the jaw if the patient does not have signs of crossbite ... After all, the category of patients who really need to expand the jaw is very small. And every second patient is offered to expand the jaws. If we turn to the scientific literature, it is not possible to explain the relationship between the expansion of the dentition and the lack of space. So where did the fake jaw extension come from? I do not understand...
It is worth clearly distinguishing between two different concepts "jaw extension" and "lengthening of the dentition".

Another photo of a smile before and after braces

It cannot be denied that after treatment with braces, the patient's smile has changed dramatically, but! All patients who come to the first appointment with the doctor are shy. The doctor does not have established contacts and it is quite difficult to persuade a person to smile at the first appointment. Another thing is after 1 - 2 years of constant communication between the doctor and the patient. Therefore, after treatment, the patient is much more relaxed at a photo shoot with her doctor.
People with uneven teeth, for the most part, do not smile at all, showing their teeth. For them, such a smile is unnatural. They get used to smiling with closed lips. Another thing when your teeth are even! Therefore, after treatment with braces, the lips are not as clamped from the complexes as before.
If a person is asked to smile 10 times, then each time the smile will be different. Therefore, when taking a picture, each person makes duplicates and chooses the most successful photo. There are people with malocclusion, but with a very trained smile. They turn out better in the photo than people who have ideal natural data. That is, I want to say that smiling is also an art.

Another photo of the teeth before and after treatment with braces

The first look at the "before" and "after" photos of the teeth evokes a feeling of expansion of the dentition during the treatment with braces. But is it?
In order to assess the situation before and after treatment, to understand what kind of jaw expansion we are talking about, you need to see the full picture. Including it is necessary to see the bite.

Why did I choose to demonstrate the case of this particular girl? Because for the patient, this situation with the teeth looks frighteningly difficult. Looking at such uneven teeth, the patient wants to fix everything and does not believe whether this is possible ... If he is told to expand, he will expand. If they say that we need labile braces and we need to be treated by the syndication method, he will believe. And it doesn't matter that there is no such method... The patient is oppressed by the complexity of the situation, and the doctor speaks very authoritatively.
This case is bad because the patients did not want to treat the lower dentition. So we can't treat the patient perfectly. But there is no evil without good! For that, we can talk about how the upper jaw has expanded, measuring it with the lower jaw unchanged.

Orthodontic treatment planning

On the panoramic image, we evaluate the number of teeth, their position and the patient's dental age.
Based on the calculation of TRG, we draw up a treatment plan. We discuss with the patient how the face will change if treated with tooth extraction and what trends will appear in the case of treatment without tooth extraction.
If one of the patients was treated with the extraction of teeth and his facial proportions worsened, his cheekbones stood out, his skin sagged, etc., then either the doctor did not calculate the TRH, or mistakes were made during the treatment.

Treatment plan without extraction of teeth

As you can see, the most standard braces are installed on the teeth - these are classic, ligature braces.

After 3 months, the situation no longer seems so scary ...
After 6 months, everything looks innocent and most patients with this situation would not go to the doctor.

What happened to the dentition during the year of treatment? Did he expand? Or not?
How did we manage with classic braces? Would it be faster and better if we took a labile system with a spherical bracket slot configuration?

Now, knowing the whole history of treatment and remembering that the lower dentition has not changed, let's look at the before and after photos.

And in the photo "Before" and in the photo "After" I marked the width of the lower dentition in the region of the first premolars (4th teeth). Vertical marks begin in the region of the gum margin of the lower premolars. On the upper jaw, blue circles indicate the tops of the upper first premolars (4th teeth). When we took such a simple measurement on the before and after photos, the statement "We have expanded the jaw" does not sound convincing. Did we increase the distance between the upper fangs? Yes, such a statement is convincing! But we didn't widen the jaw and didn't even widen the dentition!

But what have we done? We have increased the length of the dentition! Such dynamics was observed, is observed and will be observed in cases of treatment of crowded position of the teeth, if treated without extraction. And this state of affairs does not depend on the shape of the braces, the qualifications of the doctor, the time of year and the phase of the moon.
In situations with an increase in the length of the dentition, a very important characteristic of the treatment will be the profile of the patient before and after the treatment. Incorrect planning leads to a pathological deviation of the teeth forward - this is what patients call the term "Fan". In such cases, the patient's profile looks disharmonious (ugly) after braces treatment.

There is an article on the length of the dentition on our blog. We will continue to develop the topic of jaw expansion.

If you think this topic is relevant and important, help your friends learn about it.

Separation is an enamel grinding procedure that serves to expansion of the space between the teeth. In the process, a thin layer is removed, not exceeding 0,25 mm.

This method is considered the most gentle and at the same time most effective to correct an overbite.

Increasing the space between teeth is the best option compared to removal.

Important! The procedure is not harmful to health. Clinical trials have confirmed that the removal of enamel does not affect its density, it remains just as strong and outwardly intact.

Thus separation is creating an aesthetic contour using dental equipment.

Separation happens two types:

mechanical- removal of enamel using special tools;
physiological- installation of wedges in interdental spaces for a certain period.

Separation when installing braces

Separation is necessary for following cases:

need to free up space orthodontic treatment without removal;
necessary get rid of crowded teeth;
present developmental anomalies and cuttings.

Separation process before system installation

Mechanical separation:

orthodontist removes a layer of enamel a special nail file or a single-sided or double-sided disc, which is installed on the drill;
in order not to damage soft tissues during turning, a specialist during the procedure gently pushes them away with a mouth mirror;
after enamel removal grinding processed teeth so that sharp edges do not injure the mucous membrane of the mouth and lips;
at the end of the procedure, the doctor applies special compound to prevent hyperesthesia.

Physiological separation:

instead of turning the enamel, the doctor decides to put in the interdental areas special wedges for a day. This time is usually enough to expand the space between them.

Important! In the presence of caries, inflammation of the gums, pulpitis and other diseases of the teeth, separation is contraindicated. Before the procedure being treated teeth.

The separation procedure itself is simple, most often painless, and does not take much time. The patient may feel only slight discomfort. If there is still pain, the specialist resorts to the use of local anesthesia.

Do I need to remove teeth when getting braces? A photo

Indications for preorthodontic extraction:

misalignment of the upper and lower jaws relative to each other;
crowding dentition and severe curvature of the teeth;
carious lesions, not amenable to treatment;
the presence of extra teeth;
too much big size some teeth.

When installing braces, they most often remove:

teeth wisdom;
premolars ( fourth pair);
molars ( sixth pair).

Wisdom teeth, removal of eights

Extirpation eighth couples spend in the following cases:

It is important to properly assess the situation eights in teenagers. AT 14—16 years, these teeth are at the rudimentary stage, and begin to erupt by twenty years old. If orthodontic treatment was carried out without taking into account these features and places of eights were occupied by others teeth, then subsequently they can erupt with pathology and cause a shift in the row.

Do I need to remove wisdom teeth before getting braces?

In the case of normal development and eruption of wisdom teeth, there is no need to get rid of them. Although quite often 8s removed for insurance purposes guarantee maximum effect after wearing braces.

Photo 2. Dentists almost always come to the decision to remove a healthy wisdom tooth with the help of special tools.

In the presence of pathologies eights not removing them before installing braces can minimize the overall outcome of treatment and lead to the following:

pressure eights on neighboring teeth and their gradual destruction;
due to lack of space on the jaw crowding out eights neighboring teeth, which leads to crowding and malocclusion;
inflammation of the gums pericoronitis) during teething, leading to the occurrence of an abscess, phlegmon, sepsis.

Important! Among dentists no consensus on the removal eights. It is advisable to get advice on this matter before removal. one, but several orthodontists.

Removal of wisdom teeth while wearing braces

Before installing braces a specialist performs a complete examination of the oral cavity and identifies problems that need to be addressed before starting orthodontic treatment. This also includes the issue of removing eights.

Usually, eighths Teeth are removed prior to braces, when necessary. But if there are situations in which you need to urgently remove eights(inflammation, limited access to a carious lesion, cutting pressure eights on the adjacent tooth), and the braces are already in place, then the extraction is carried out while wearing the braces.

Why get rid of fours

Extraction of premolars is necessary in following cases:

crowding of teeth;
distal occlusion;
cross occlusion;
open bite with protrusion.

Photo 3. The removal of the sixth pair is often necessary due to the fact that they experience strong chewing loads and are prone to destruction.

Before installing braces fours are removed quite often, since these teeth are small in size, have a weak root system and carry an insignificant chewing load. Them easy to replace with others dental units.

After extraction fours remain the smallest in comparison with other intervals. These holes shrink while wearing braces. Pulling speed - approx. 1 mm per month.

Delete fours usually a week before the installation of the bracket system.

Sixth pair

sixth a pair (molars) is rarely removed, as this is a complex process, and the holes after them are tightened for a long time. Moreover, these teeth participate in the primary processing of food and form facial features and diction.

Photo 4. The wisdom tooth has four to five roots, often strongly curved, which sometimes grow together.

extraction sixes usually done in adults patients with a formed bite. Removing these teeth prolongs the period of wearing braces ( 3 to 6 months), since it is necessary to build an even dentition, pulling the remaining teeth to each other as much as possible.

Removal sixth pairs of teeth are held if they:

badly damaged;
can be replaced by other teeth;
interfere with bite correction.

Oral care after tooth extraction

A cotton swab soaked in a hemostatic solution, which the doctor places in the hole after removal, should be kept in the mouth 30-40 minutes to allow the blood to clot.

Remove the swab carefully to do not damage the blood clot.

After removal, you can not do hot compresses or heat the sore spot. Helps prevent swelling ice applied to the cheek.
You should refrain from eating within 2 hours after surgery. After this time, you can eat soft and liquid food without hard pieces.
You need to brush your teeth gently, bypassing the site of the extracted tooth. To avoid damaging the clot, do not rinse your mouth or use an irrigator, as well as spit.
If through 3-4 hours after the anesthesia has passed, pain appears, you can take painkillers ( Analgin, Ketanov, Pentalgin).
In the first days after removal, you should refrain from going to the sauna or bath, physical activity, and also from smoking and alcohol.
Through 2-3 days after removal, you need to carefully rinse your mouth with a warm solution of soda ( 1 tsp for 1 glass of water) or use anti-inflammatory drugs ( Miramistin, Chlorhexidine, Rotokan, Furacilin).

After tooth extraction, you need to limit yourself to smoking and drinking alcohol.

Almost always, orthodontic treatment is not complete without removing teeth before installing braces. For patients, the operation seems unnecessary, but it is necessary for the formation of a correct bite.

Why is it necessary to remove before installing braces?

Before starting orthodontic treatment, the doctor may tell you that some teeth need to be removed. Patients, of course, are frightened by this statement, especially if you have to get rid of healthy units. The thing is, they don't see the big picture.

Extraction before installing braces is prescribed according to strict indications after a thorough examination. This includes lateral radiography, diagnostic casts, and sometimes 3D computer modeling of the oral cavity.

Remove only those crowns that interfere with the alignment of the bite. This is done to:

Free up the necessary space for shifting curves located outside the units arc. If, during diagnosis and treatment planning, it is seen that some crowns will interfere with the correct position of other teeth or will be completely out of line, they must be removed.
Ensure facial symmetry. Along with the alignment of the bite, the appearance of a person also changes. To make it harmonious, they get rid of units, usually paired ones, which can distort the profile.
Eliminate foci of infection. Strongly destroyed teeth that are not amenable to conservative therapy are removed.

Therefore, removal is often a necessary measure. However, you should not immediately agree without considering the proposal. Every orthodontist has different treatment methods. So it will not be superfluous to consult 2 - 3 specialists before deciding on an operation.

When is extraction performed?

Main testimony to preorthodontic extraction are:

small size of the upper or lower jaw (micrognathia);
unerupted or incompletely grown teeth - impacted or semi-impacted;
severe crowding;
excessively large crowns (macrodentia);
asymmetry of the jaws - when one is larger than the other, it protrudes significantly forward or is tilted back;
elements with large carious cavities, inflammatory processes in the pulp chamber or at the top of the root, which are not amenable to therapy.

Additional Information! Extirpation is carried out at least a week before the installation of braces, so that the soft tissues have time to heal. After removal, voids remain, but they will soon be closed by displaced units.

What teeth are being removed?

According to indications, before installing braces, any teeth can be removed. But some extract almost always, others try to save by any means.

Important! Extraction is carried out only with the consent of the patient or, if he is a minor, with the permission of parents or guardians.

"Eights"

The question of almost never comes up. Third molars are vestigial organs. They seldom grow properly, if at all, erupt, hardly participate in the process of chewing, they have a weak root system. Therefore, their extraction is almost always carried out.

Extirpation of "eights" is necessarily prescribed for:

high probability of bite curvature - if they have not yet erupted, then in the future they may again violate occlusion;
dystopia - incorrect position of the crown;
inflammatory processes - caries, pulpitis, pericoronitis and others.

Therefore, when the patient has an underdeveloped alveolar arch, the jaws are incorrectly positioned, or crowding is diagnosed, the extra space is most often freed at the expense of the third molars.

Additional Information! If the "eights" cut through normally, do not interfere with the rest of the units, are needed to replace the lost "sevens" or perhaps they are adequately treated, extraction is not performed.

premolars

Premolars are removed very often. Moreover, they usually take out “fours”, and try to leave “fives”. The "fours" have a weak root system, small size, and a slight chewing load. It is easier to replace them with other units.

Testimony to the extraction of premolars are:

open bite with protrusion - pushing the jaw forward;
distal disocclusion;
cross occlusion;
significant crowding.

chewing teeth

"Sixes" and "sevens" are extremely reluctant to extract. They play a significant role in the primary processing of food, the formation of facial features and diction.

The operation is possible in case of:

severe damage to the unit;
if missing teeth can be replaced by neighboring ones - “sixes” with “sevens” or second molars with “eights”;
molars interfere with the full correction of the bite.

Fangs and incisors

Frontal units, as well as molars, are reluctant to remove. They affect the diction and symmetry of the profile. And the fangs are still the bearing units on which the structure of the entire jaw depends.

Extirpation of the anterior units is carried out if they cannot be saved or in the patient.