Ask the Dentist: To Extract or Not to Extract?
When would you need tooth extraction to achieve your ideal smile, and why? We get i.Dental’s Invisalign Provider Dr Pua Hong Ping to clear the air.
If you’re thinking of getting your teeth straightened, whether with traditional braces or Invisalign, chances are, you’re worried about the possibility of tooth extraction. To put your mind at ease, we sat down with smile maker Dr Pua Hong Ping, who is both an accredited Invisalign provider and an Invisalign trainer, to understand why and when extraction may be prescribed.
Why would extraction even come into the picture when I’m just trying to straighten my teeth?
First of all, let me say that tooth extraction is actually less common than most people make it out to be. I like to remind my patients that our end goal is not only a straight smile but a healthy one too. The process starts with a consultation that includes an oral health check-up to understand the condition of your teeth and an open discussion about your definition of the ideal smile. An analysis of the information gathered will determine whether extraction is recommended, but the final decision is best made together with the patient.
Wait, does that mean I can object to tooth extraction?
What it means is that you should always make an informed decision by understanding your condition, the options available to you, and how your decision may affect the treatment process and end results.
In cases of severe crowding or when the front teeth are severely protruded, for example, tooth extraction may be the most effective and efficient way of creating the space we need to move the rest of the teeth into place. In mild to moderate cases, interproximal reduction (IPR) may be sufficient. IPR is basically a procedure where your teeth are ‘filed’ down or reshaped. There is a limit to how much enamel can be removed without damaging your teeth, so it is not a viable solution for severe cases. Other scenarios where dentists may recommend extraction include cases of ectopic teeth (where the teeth have taken an abnormal position) or simply because there are teeth in bad condition.
If you feel strongly about (or against) extraction, it’s best to talk to your dentist about it. Together, you may be able to find workarounds but you should be aware and comfortable with any possible downstream impact on factors like treatment process, time commitment, cost, and other specifics.
Doesn’t it matter if I have fewer teeth?
Think of it this way: having fewer teeth in a good position and with good function is way better than having more teeth in bad position and function. I believe that sacrificing some teeth for the rest to be straight and healthy makes more sense than keeping a full set of 32 but risking damage to all of them due to misalignment issues.
What about wisdom teeth? Do they need to be removed prior to treatment?
That depends. In cases where the wisdom teeth are impacting against other teeth, they can impede tooth movement. It would then be a good idea to remove them before starting any straightening treatment. On the other hand, if the wisdom teeth have erupted well and are in a good position, they can be retained as an anchor to help align other teeth. The need to remove them can be assessed separately after the straightening treatment is completed.
Is there any difference between traditional braces and Invisalign in terms of the need for extraction?
The short answer is no. The principal factors for extraction, as explained above, are dependent on the patient’s condition, not the treatment method.
I’ve heard rumours that Invisalign does not require extraction but that is untrue. Personally, I think the myth started because of two reasons. The first is that Invisalign, in its early days, was not an effective solution for complex cases like extraction. But that was a long time ago. Today, with advances in technology, Invisalign can practically handle all types of cases. In fact, some cases are now easier to complete with Invisalign than with braces. The second reason could be because the complexity of extraction cases typically calls for a certain level of experience and expertise. Less experienced Invisalign providers may avoid such cases in favour of simpler, non-extraction ones, thereby creating the impression that Invisalign does not need extraction.
And there you have it. The question of ‘to extract or not to extract’ is best answered by your dentist after a detailed consultation, and best decided with your agreement. If you would like a professional opinion from i.Dental’s team of dentists, request for an appointment today.
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