[Health Column] Orthodontic Extraction vs. Non-Extraction: Is Extraction Always Necessary? A Summary of Criteria, Pros, and Cons

 

 

hello, Director Jo Byeong-ju of Shine Orthodontics no see.

 

👋 There are certain questions that people considering orthodontic treatment ask most frequently in the consultation room.

 

These are inquiries mixed with concern, such as, "Do I really have to have teeth extracted?" and "Can a protruding mouth be corrected with non-extraction orthodontics?"

 

There is a lot of information on the internet claiming that non-extraction is always better or that extraction drastically changes one's face, which further confuses patients.

 

However, actual orthodontic treatment is not determined solely by whether or not to extract a tooth, Comprehensive diagnosis of tooth alignment, facial shape, degree of space shortage, etc. You must do it.

 

In this column, I will explain the true differences between extraction and non-extraction orthodontics and provide clear selection criteria in an easy-to-understand manner. I hope this helps you find the right treatment direction for you! ✨

 

 

 

1️⃣ What is the most important key point regarding tooth extraction versus non-extraction in orthodontic treatment?

📐 The essence that determines the success or failure of orthodontic treatment lies in 'securing space' to move the teeth.

 

For both extraction and non-extraction orthodontics, the key to the treatment outcome is how much space can be secured to properly align the teeth.

 

This is because only when adequate space is secured in our mouth can we use it to push a protruding mouth inward and straighten crookedly overlapping extra teeth.

 

Generally, when performing extraction orthodontics Premolars (small molars) with a width of about 7 to 8 mm You will gain that much extra space by extracting the tooth.

 

 

On the other hand, with the recent development of various orthodontic devices non-extraction By utilizing every possible means to the fullest extent through orthodontics, it has become possible to create space comparable to that of tooth extraction.

 

 

Representative techniques for creating space without tooth extraction include Arch expansion (3~4mm) , Interdental reduction/IPR (3~4mm) , Posterior movement of molars (3~4mm) There are methods available, and by combining all of them, it is possible to secure about 9mm of usable space.

 

 

< Case of Posterior Molar Movement >

 

 

📍 Example: If the space for tooth alignment is too narrow, resulting in severe crowding or a situation where a protruding mouth needs to be moved back significantly, securing space through premolar extraction can be a clear solution. However, if conditions allow for the precise application of non-extraction techniques, meaningful space can be achieved without extracting teeth.

 

📌 "Rather than relying solely on extreme online reviews and insisting on a specific method, it is essential to first undergo a precise dental diagnosis to determine the actual amount of space missing."

 

 

 

2️⃣ Can non-extraction space creation methods be applied equally to all patients?

📐 The three techniques for creating space without tooth extraction must be applied strictly and selectively based on the patient's oral and jawbone structure.

 

The three methods for creating space for tooth movement through non-extraction orthodontics are excellent alternatives, but unfortunately, they cannot be unconditionally applied to all patients. This is because each patient has different anatomical characteristics.

 

 

① Expansion of the dental arch : This method is actually Limited use only for patients with a narrow jaw width You must do it.

 

If this procedure is performed excessively on a patient with a normal jaw width solely for the purpose of widening the space, the overall occlusion may collapse or long-term stability after treatment may be significantly compromised.

 

 

② Interdental Reduction (IPR) : The side of the tooth Finely trim by 0.2~0.5mm It is a method of gathering the entire gap space.

 

Generally, if the procedure is performed within 0.5mm per area, there are no problems with dental health, and it is advantageous to distribute the work evenly across multiple tooth surfaces rather than grinding down a large portion of a single tooth.

 

If performed to the maximum extent on all areas, approximately 3mm of space can be obtained per side.

 

 

③ Posterior movement of molars This is a technique that creates space in the front by pushing the entire dentition backward. The most important thing here is Does there actually exist space within the bone for the molars to move backward? no see.

 

In particular, a precise 3D diagnosis must be performed beforehand to determine if there is available space in the posterior area of ​​the mandible (lower jaw).

 

 

📍 Example: If posterior movement is forcibly attempted on a patient who has absolutely no space to push the molars back due to structural limitations of the lower jawbone, the teeth may not move properly or side effects may occur.

 

📌 It is essential to receive a precise diagnosis from an orthodontist to determine whether arch expansion is necessary, or if the tooth structure allows for the safe application of interproximal reduction or posterior movement.

 

 

 

3️⃣ If you are on the borderline between extraction and non-extraction, what criteria should you use to make a decision?

📐 For borderline patients with a space shortage of 4 to 7 mm, the decision is made by comprehensively considering tooth shape, caries activity, type of appliance, and the patient's pain sensitivity.

 

Based on the results of a precise examination, if the required space is significantly lacking by more than 9mm on each side, extraction is easily determined, while if it is slightly lacking by 4mm or less, non-extraction is recommended.

 

The problem lies with 'borderline patients' who have a space deficiency of 4 to 7 mm. In this case, since both methods are possible, you must use the following five detailed criteria as a guide.

 

 

 

① Shape of the teeth: If the shape is close to a triangle, non-extraction treatment is much more advantageous. do.

 

This is because it is shaped to fully utilize Interproximal Reduction (IPR), and the reduction can naturally reduce the 'black triangle,' the empty space between teeth.

 

 

② Number of prosthetics and dental caries (cavity) activity: If you have a lot of dental prosthetics in your mouth or an environment where cavities form easily, extraction orthodontics is actually better.

 

This is because it is difficult to adequately perform interdental reduction, which involves finely grinding the sides of the teeth, in such an oral condition.

 

 

③ Type of calibration device used: Invisalign achieves arch expansion much faster, but traditional brackets (wire devices) perform molar posterior movement better. do.

 

Therefore, even for patients who appeared capable of non-extraction posterior movement based on brackets, insisting on using Invisalign may actually lead to a situation where extraction becomes necessary.

 

 

④ Anatomical spatial limits: Regardless of whether wisdom teeth are extracted, it is necessary to determine how much bone space remains behind the molars that can actually be moved, and whether the jawbone is capable of accommodating arch expansion.

 

If both non-extraction pathways are structurally blocked, it is advisable to choose extraction for a clean result.

 

 

⑤ Discomfort and pain felt by the patient: This is a point that many people misunderstand, In fact, the tooth extraction treatment itself is almost painless. 

 

In fact, arch expansion devices or posterior movement devices used in non-extraction orthodontics often cause greater discomfort and pain in the mouth.

 

Therefore, if you prefer a slightly more comfortable and less cumbersome process during the orthodontic treatment period, we recommend tooth extraction.

 

 

📍 Example: If a borderline patient with square-shaped teeth and significant traces of cavity treatment finds it difficult to tolerate the pain and foreign body sensation of complex non-extraction devices, choosing to extract premolars rather than forcing a non-extraction procedure may be advantageous in terms of both the treatment process and the outcome.

 

📌 "When you are teetering on the edge, that is precisely when in-depth communication with medical staff truly shines. Please share your lifestyle and pain tendencies with the medical team in detail."

 

 

🔍 FAQ (Frequently Asked Questions)

 

Q1. Doesn't interproximal reduction (IPR) cause significant tooth sensitivity during non-extraction orthodontics?

 

A1. No, you don't need to worry too much. 🙅‍♂️ Common tooth sensitivity usually occurs when the neck of the tooth (cervical area) is worn down.

 

During interdental reduction, the area that is ground down very finely is the outermost 'proximal enamel' region of the tooth, where sensory nerves are not distributed. Since the amount removed is also very minimal, you do not need to worry about side effects such as sensitivity.

 

However, if not performed precisely, food particles can get trapped between the teeth, creating an environment where cavities (dental caries) are likely to develop, so the procedure must be performed accurately by a skilled specialist.

 

 

Q2. After having wisdom teeth extracted, will space naturally form to push the molars back?

 

A2. It is half right and half wrong. 💡 When extracting a wisdom tooth that has erupted straight into the mouth, available space is created to push the molars backward by utilizing that opening.

 

However, for impacted wisdom teeth that are completely buried in the gum bone, simply extracting them does not automatically create space for the tooth to move.

 

In this case, the limit of the practically usable posterior space is determined by the anatomical boundary between the soft tissue and bone behind the tooth, rather than the presence or absence of wisdom teeth.

 

 

 

📋 Conclusion

 

Today, we have taken a detailed look at the key criteria for tooth extraction versus non-extraction, which is the biggest concern for those facing orthodontic treatment.

 

Having operated an orthodontic clinic in Nowon for a long time and personally treated countless cases, there are certainly tricky cases where even I, as an expert, agonize deeply over which approach—extraction or non-extraction—will bring the most perfect results to the patient.

 

This is because orthodontic treatment is a precise medical field that must encompass not only visible gaps between teeth but also the condition of the gums, the overall treatment duration, changes in facial shape, and even the anatomical limitations imposed by the appliance.

 

 

⚠️ Please make sure to remember this!

 

📌 Rather than blindly deciding on a treatment method based solely on rumors such as "non-extraction is better" or "extraction is faster," the first step is to thoroughly examine your precise diagnostic condition.

 

📌 The wise choice at the borderline may vary depending on the shape of your teeth (whether they are triangular), the activity of cavities, and your sensitivity to pain.

 

Above all, the most important key to success is to accurately align your desired aesthetic and functional goals through constant communication with medical professionals, and for the doctor and patient to move forward step by step while looking toward the same goal.

 

As this is a significant journey that determines your smile and dental health for a lifetime, I sincerely hope you find a trustworthy orthodontist to discover the right solution that fits your oral structure perfectly. 🦷

 

 

 

 

 

 

Shine Orthodontics

Director Cho Byeong-ju

Graduated from Seoul National University Graduate School of Dentistry / Doctor of Dental Surgery

Catholic University of Korea Seoul St. Mary's Hospital Department of Orthodontics Intern / Resident

Graduated from Catholic University of Korea Graduate School of Medicine with a minor in Plastic Surgery / Master of Medicine

Visiting Professor, Department of Orthodontics, Catholic University of Korea Seoul St. Mary's Hospital

Visiting Professor at CHA University Gangnam Hospital

Invisalign Official Faculty

Regular member of the Korean Association of Orthodontists (KAO)

Member of the Korean Society of Clinical Orthodontists (KSO)

2019/2020/2021/2022 Awarded the Excellent Case Presentation by the Korean Association of Orthodontists