Doctor, just don’t remove my teeth
However, we cannot always avoid removing teeth during orthodontic treatment. Why? Orthodontic braces are only able to move the teeth within the area of the alveolar bones – this means that they are not able to increase the size of the existing bone in which the teeth are located. Sometimes the size of the teeth is too large in relation to the bone in which they are located, resulting in significant congestion. In this situation if we simply fixed braces without removing teeth, teeth would become significantly bent, and the so-called “horse smile effect” could be produced, and, what is worse, such a large bending of the teeth would cause their displacement beyond the alveolar bone, i.e. beyond the bone in which they are located.
Another indication for extractive orthodontic treatment, apart from a very large crowding of teeth, is orthodontic camouflage. What is orthodontic camouflage? As I mentioned earlier, braces are only able to move the teeth, they are not able to move the jaw bones relative to each other. In adult patients with malocclusion – e.g. distoclusion (retraction of the lower teeth in relation to the upper teeth) with a large gap between the upper and lower teeth, there are two treatment options. The first option is orthodontic-surgical treatment, in the case of distoclusion consisting in the orthodontist’s preparation of teeth for extension of the mandible forward or just treatment with camouflage. As the name suggests, in the latter situation we camouflage the patient’s defect by moving their teeth. We then have no influence on improving the position of the patient’s chin, which in the case of a distoclusion is small and retracted.
Below I present a case of significant crowding, where 4 teeth were removed – we are in the process of treatment, the patient is very satisfied with the effect, despite the initial resistance to extraction