Fig.2 Fig.3
Fig.4 Fig.5

Dental Education Lecture: Removing Teeth for Braces

Teeth are important to us, but when we have too many teeth or teeth are too big, we have to sacrifice some of them for the best cosmetic results.

Stephanie is 12 years old.  Her teeth are so crowded (Fig.3: upper jaw) that we have to take out 4 teeth (2 on top, 2 on bottom).  Fortunately these 4 teeth are baby teeth.  Unfortunately she does not have 4 adult teeth to replace these 4 baby teeth.

Let us look at Fig.1: X-ray taken three years ago.   At that time, Stephanie has three baby teeth in the upper right side: C, D and E.  Usually there is one adult tooth to replace each baby tooth.  There are corresponding adult teeth to replace C and D. but there is none for E.  Compare * above C, D and E.   At higher magnification (Fig.2), baby teeth C and D have short roots due to the presence of their adult teeth.  In contrast, the roots of E are relatively long because of absence of its corresponding adult tooth (no pressure).   It is easier to see that there is no adult tooth underneath E in the lower arch (* in Fig.1).  E is called 2nd primary molar. Approximately 1% of children do not have one to four 2nd primary molar(s) by birth.

E is wider than its corresponding adult tooth, which is called 2nd premolar.  In Fig.3, you can notice that E is wider than 1st premolar (the latter's width is indicated by black or red line).  The width of the 1st and 2nd premolars should be the same.  Stephanie's dentition is so crowded and weird that one of her upper 1st premolar turns 90 degree, as indicated by red line.  The other 1st premolar is relatively normal in orientation, as indicated by black line.  The second indication of severe crowding is that the 2nd molars (2) come out in pretty bizarre position.  That is outside and overlapping with the 1st molars (1).

Since Stephanie's dentition is so crowded that it is necessary to take out these four baby teeth to lay out good foundation for braces.  For most children, braces can be done without taking out any tooth.  But sometimes extraction is necessary and helpful. 

If Stephanie's dentition is not so crowded, we may be able to save these baby molar teeth.  Unfortunately, any baby teeth will fall out naturally eventually.  When it happens, we have to place one to four implants for her.  Anyway, after long debate, Stephanie's parents finally agree to take out these four baby teeth today. Surgery is done smoothly in our office. We wish them good luck having braces in other dental office.  In deed, Stephanie has beautiful teeth in two years (Fig.4,5, as compared to Fig.3).  All the teeth are well aligned.

Xin Wei, DDS, PhD, MS 1st edition 06/05/2010, last revision 12/23/2012