Q. Can orthodontic treatment be done without extracting teeth?

Answered by
Dr. Tooba Qazi
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Feb 17, 2019

Hello doctor,

I am 18 and currently have all teeth (except wisdom teeth) and braces for 10 months. My teeth are straight at this point but a few very small misalignments that will easily be fixed soon. I have an impacted tooth above my right-side second pre molar on my top row of teeth that is facing the wrong direction and needs to be removed. The problem is that my orthodontist wants to take out the tooth below it, the parallel second premolar on the left side of my top row and the two teeth on my bottom row matching where the top two are to balance out my mouth so it is not asymmetrical. (After these, the removed the braces would continue to close the gaps).

Do I really need to get four teeth taken out (five including the impacted one) in order to fix this issue? Not only does it seem like such a large amount of teeth to lose at a young age but I have also heard many scary stories about how this will change the permanent shape of my face and jawline. Do you agree with this decision? My orthodontist does seem knowledgable but I have never heard of someone personally who has had to get five teeth on all sides of their mouth removed for one impact. I am just really scared that my face will look terrible.



Welcome to

Actually, by book, this is the only way the Orthodontist can make your face look symmetrical. Ideally, only four teeth are extracted as described by your dentist on each side of the jaw in crowded teeth but unfortunately, your fifth one is impacted so it has to go too. He is absolutely right according to his treatment plan.

But now looking up to a broader aspect, I want to offer you a second treatment option too that many patients go for because they do not want to prolong ortho treatment too much and want to avoid many extractions. This second treatment plan has an extraction of 2 or 1 tooth only. If the maxillofacial surgeon is able to remove the impacted tooth only without touching or removing the tooth below it, it is best. Then you do not have to go for any extractions. Your case will simply end up as it is. But if the below tooth and impacted tooth both are removed, there will be space left for one socket. In this socket, implant screw can be placed and once it gets firmer with bone in 4 to 6 months then a cap will be placed on it. First, get ortho done and keep this space of socket intact through space maintainer, you do not need orthodontist to move teeth here to close the gap. End up treatment and then place the implant in this socket. That is simple, no more extractions will be needed then.

The third treatment plan is that get extracted both impacted and the below tooth. Keep space of socket intact till your braces get off, then get a bridge of three units done here. Two teeth of support and one missing tooth will be covered. That is the most economical option to go for. Implant and prolonged ortho treatment both look costly and time taking as compared to it. The only cons of this is that slight 2 mm grinding of natural teeth is done that is not harmful at all. I would suggest you personally for the third option. Rest you can decide well.

Hopefully, you would have got a clear idea of all treatment plans. If you can afford, then for you, the second treatment plan will be best as no adjacent natural teeth will be involved, only a single implant will be placed in bone directly.

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