Monday, February 28, 2011

Extraction with braces vs Non-Extraction Orthodontist in Markham

We see a lot of people for free consultations who are considering braces and Invisalign in Toronto. One of the most common concerns with Richmond Hill braces is to be able to have orthodontic treatment without taking teeth out. The fear is out there. In fact, there are Damon braces, from Ormco, that make the claim that virtually all orthodontic treatment can be done without extraction, as a part of direct marketing to the public.

Some of the biggest reasons for not wanting teeth out are:

-don’t want to take out good teeth
-scared of extractions
-worried spaces won’t close
-possible caved in profile or narrow smile
-won’t have enough teeth to chew with

There are three major reasons for needing teeth out for orthodontics:

1. A non-viable tooth
-Generally, there is no debate from our patients about removing teeth when there is a huge cavity or an abscess.

2. Excessive crowding
-There is a certain amount of space required to align all of the teeth in crowding situations. In order to gain space, the teeth can be expanded out in a lateral direction, proclined in an anterior direction, distalized to the posterior, or we can do some interproximal reduction.

-There may not be enough room to distalize teeth due to the presence of wisdom teeth or lack of ridge of bone, and there may not be enough space between the roots to reduce enamel safely.

-In terms of lateral or anterior movement, the support of the teeth within the bone is important. If the expansion is too great, the teeth will be pushed out of the periodontal complex, leading to problems such as recession, mobility, and an unstable result.

3. Overly full facial profile

There are times when crowding can be alleviated without removal of teeth, but the end result would result in an overly full facial profile. This presents with individuals unable to close their lips without strain, or an appearance of bulging lips. To harmonize the appearance, it is important to retract the anterior teeth, and in order to do that, space is required. Otherwise, there is no room to move the teeth back. Keep in mind that the orthodontist can control the amount of retraction since space can be closed by moving front teeth back, or back teeth forward. This means you do not have to have a “dished-in” profile with extractions.

As seen with Patient #2's Before and After Extractions, there is no problem with closing up space, and as described above, sometimes it is actually healthier and will provide better results when taking teeth out than trying to fit teeth where they will not be stable. In this case, the arch is actually wider after tooth removal than prior. There are a lot of celebs with beautiful smiles, and they have had teeth taken out too!

There are many people who do not have full function of all of their teeth, due to malocclusions, or extractions, and they function well. A proper bite with teeth that are in good occlusion with fewer teeth is better than more teeth that do not fit well together.

Each individual situation is different. At MCO Orthodontics, whenever possible, we do not extract teeth. However, there are instances as described above, when tooth removal is indicated and will produce better long term outcomes. To book your own complimentary evaluation, please visit us here.

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