Orthodontics has changed dramatically in the past 20 years. Through the 70’s and 80’s, most orthodontic cases, for a variety of reasons, required the extraction of permanent teeth. Unfortunately, extracting teeth resulted in long-term detrimental effects on many patients’ facial structure and the health of their gums and bones. One of the common questions patients ask when seeking orthodontic care is if they need to have teeth extracted. Nobody wants to go through the extraction of teeth if they don’t need to. Having a full complement of teeth often results in fuller, more beautiful smiles.
So, what has changed to allow orthodontists to no longer rely on the extraction of so many teeth?
As more and more people were treated with braces, orthodontists were able to see what happened to these patients as they became adults and aged. What they saw was not encouraging. Orthodontists realized that as people age, their lips tend to flatten out naturally. In patients that had permanent teeth extracted, this flattening was magnified dramatically due to the lack of support for the lips because of the decreased number of teeth. As orthodontists began seeing this negative aging process caused by extractions, they began seeking other ways to treat. Awareness of the long-term negative effects spurred changes in treatment.
In the 80’s, The University of Michigan began researching what caused people to have crowded teeth. Many times people were told by their orthodontist their teeth were just too big to fit. Were people’s teeth too big? Interestingly enough, the research showed this was not the case at all. In fact, virtually everyone had the same size of teeth, but those that had crowding had much smaller dental arches than those that did not have crowding. The conclusion from this study was that orthodontic treatment options should focus more on creating additional room for crowded teeth instead of removing teeth (extractions).
Do you remember those rings around your teeth with braces? These are called bands. Until the late 70’s, that was the only way to connect braces to the teeth. Then a process called bonding came along. Bonding allowed orthodontists to use a thin layer of adhesive to connect a brace to the front surface of a tooth. Bands were no longer needed. Placing bands around each tooth in the mouth added about 5mm of material between the teeth. Because of this, even in mildly crowded cases, there just was not enough room to fit all the teeth in the mouth.
Materials that have been tested by NASA in space are now incorporated into the wires used in orthodontics. These wires deliver a force on the teeth that is much lighter and gentler on the teeth than the stainless steel wires used with traditional braces. Due to this gentler force, teeth are now able to move in a way that allows the bone to adapt and change with the movement and orthodontists are able to treat more cases without tooth extractions.
The final piece to the puzzle arrived on the scene in the new millennium. Braces traditionally have required something to hold the wire in the brace. This was done either by small wire ties (also known as “tightening” the braces) or those fun little colored elastics. These ties kept the wires in place but caused friction and kept the teeth from sliding freely. Around the year 2000, a new type of brace was invented that does not require ties (bungy cords) to hold the wire in place. Instead, a door or clip opens and closes to hold the wire in place. There is no friction against the wire so the teeth are free to slide and the orthodontist does not need to push as hard to get the teeth to move (which means less pain!). Remember those space age wires you read about earlier? Now these space age wires can be made to push even more gently and the bone adapts to make room for the teeth without extractions or expanders. This technique makes more space for the teeth just as the University of Michigan recommended. The perfect formula was finally available to orthodontists.
Extractions of permanent teeth is not a pleasant experience. Patients are seeking ways to avoid this. Long-term results have shown that permanent teeth extractions can result in unwanted aging changes. Research proved that peoples teeth are not too big and the current recommendation is to make more room to accommodate the teeth rather than remove them (extractions). The perfect combination of technology has arrived, allowing orthodontists to accomplish the desired non-extraction treatment.
Extractions are no longer needed in over 99% of orthodontic patients. As a prospective patient, you need to advocate this for your own treatment