A question that comes up often in orthodontic consultation, diagnosis, and treatment planning is: Will it be necessary to remove premolar teeth to straighten your teeth or to correct your malocclusion (bite)?

The answer is that it depends. There are several factors to consider, including the degree of crowding; flaring; thick versus thin gum tissue; missing, fractured, diseased, or impacted teeth; and the severity of the overbite or jaw imbalance.

A general observation is that about 25 percent of the time extractions are clearly not indicated. These are situations where crowding is mild to moderate, the front teeth are not flared forward, and bite and jaw discrepancies are mild to moderate.

10-25 per cent of the time (percentage varies according to the local prevalent genetic make-up) extractions are definitely indicated. These are situations where the orthodontic patient has either extreme crowding, flaring of teeth, or a significant overbite.

The 50 to 65 percent of patients in the middle of the spectrum are considered to be border line and usually started on a non extraction trial. These days, most folks in this group complete their treatment without removing teeth.

The good news is that, looking at all patients combined, premolar extractions can be avoided about 70 to 90 percent of the time!

Here at Kineret Orthodontics, most extraction cases are started non-extraction. The rationale being that once premolars are removed, you can’t put them back. So if there is a small but reasonable chance of substantial response to wires and rubber bands, it is best to defer extraction decisions until mid-treatment.

Even when it is certain at the outset of treatment that extractions are indicated, I prefer to defer extractions until mid-course. The reason being that by mid-treatment we are in large arch wires, have started rubber bands and can more strategically and efficiently close extraction sites.