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HomeAnswersOrthodontistorthodontic treatmentMy four teeth need to be extracted for placing braces. Why?

Why should four teeth be removed for orthodontic treatment, and how long does it take for the expander to work?

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 January 6, 2023
Reviewed AtOctober 10, 2023

Patient's Query

Hi doctor,

I put on braces last month for my upper teeth. I notice that if I am put on an expander, I will not need extraction. They want to extract four teeth. I want a second opinion. How long does it take for an expander to work? I only have 17 months left on my duty station.


Welcome to icliniq.com.

Hope you are doing well. I thoroughly read your query and understand your concern. Orthodontics has changed a lot since its inception about 120 years ago. Previously, it was a non-extraction protocol that was in the trend, followed by extraction protocols in the 1970s era, and now again, non-extraction protocols are preferred. Along with this, there has been a high impact and importance on the face esthetics that are given along with dental conditions. Coming to your case, we can see that there is a mild crowding that is present, which is evident by the presence of a canine tooth outside the arch as compared to other teeth. This situation can be dealt with in three possible ways with braces. First, extraction protocol wherein two premolars from the upper arch will be extracted. The teeth do not have brackets for the same purpose. Second, non-extraction with IPR. In this method, we do not extract the teeth but instead do something called interproximal reduction, IPR (grinding the teeth so that their width is reduced and some space is gained). Once IPR (interproximal reduction) is done, we will utilize the space and align the teeth in those spaces. Third, expansion with Damon's self-ligating system. In this method, Damon braces are used, which have shown expansion potential to some extent, and we do not need extractions. If expansion happens, we do not require IPR as well to gain the space. To decide on the extraction or non-extraction protocols, there are other factors to be considered as well. Age of the patient, severity of crowding in the jaws, face profile, etc. Expansion is more successful in younger ages till growth is present. Growth completes by 16 years for females and 18 for males. The severity of the crowding: Your case is not severe and can be managed without extraction (This is based only on the basis of attached occlusal photo) (attachments are hidden to protect the patient's identity). Face profile: Sometimes dental conditions can be managed non-extraction, but face profile demands extraction to improve it. Hence, this is an aspect I cannot say now. The reason why four teeth were told to be extracted is to maintain symmetry in the jaws. One tooth per arch will be extracted, and space closure will be done evenly on all four sides. To help you decide on the treatment plan better, I would require some extra details to assess and formulate a precise treatment plan for you. Feel free to reach out for further queries or related information clarifications. Hope I have answered your query. Regards. Regarding follow-up: Kindly share certain photographs for assessment. You can search on the internet how those photos look to assist you with photo clicks. Please send side profile of the face, frontal face, frontal teeth, lower occlusal, right and left lateral teeth.

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

Dr. Mayank Khandelwal
Dr. Mayank Khandelwal


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