HomeAnswersOrthodontistorthodontic treatmentShould I remove my premolar while receiving ortho treatment?

Is it necessary to extract four premolar teeth after undergoing two and a half years of orthodontic treatment?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

Dr. K. Shobana

Published At May 26, 2022
Reviewed AtOctober 9, 2023

Patient's Query

Hi doctor,

I have been on orthodontic treatment for the past two and a half years, and now my orthodontist tells me I have to take out four teeth (premolars) to stop the flare of my front upper teeth. Is that something I can trust? This flare was present during the first year of treatment, and it is back again. Thank you.

Hi,

Welcome back to icliniq.com.

There are certain borderline cases wherein the orthodontist is always in a dilemma whether the case can be finished without extractions or will be required. However, there is also a middle option for the same, that is IPR (interproximal reduction), where certain teeth are ground to reduce their dimensions and use the gained space for front teeth to reduce the flare and take them back (retraction). These scenarios are generally explained to the patient at the start of the treatment. In some cases, a non-extraction case may turn out to be an extraction case after teeth get aligned and space gets reduced, or it could happen when anchorage loss occurs, and the posterior (behind teeth) moves forward, and it becomes inevitable to extract. Coming to your case, as per the photo seen (attachment removed to protect the patient's identity), there has been a flare during the treatment, which is due to anchorage loss (behind teeth sliding forward). Therefore, you will have to go for specific means to reduce the total amount of tooth (by IPR or extraction) and close the spaces. If you do not trust extractions, ask your doctor for IPR and close up the space. That might not give you full results depending on how much retraction is required, wherein if you opt for extractions, 100 % retraction is achieved. However, choosing between both is judged best clinically. IPR and space closure may take about 4 to 6 months to close up space, while extraction will take 8 to 10 months. Consider this as well, considering that you have already been with braces for 2.5 years already. Thanks and regards.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Mayank Khandelwal
Dr. Mayank Khandelwal

Orthodontist

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