Sometimes your orthodontist will recommend the removal of teeth to increase the success of treatment. Extraction of adult teeth is often recommended when the health of the gum and bone supporting the teeth will be compromised if all of the adult teeth are kept. The removal of teeth is only recommended after your orthodontist has done a complete evaluation of your mouth and/or malocclusion and considered all other options for treatment.
Sometimes your orthodontist will recommend starting treatment early (often when some baby teeth are still present) and doing it in two phases rather than a single phase later on. In these situations, the first phase of treatment often begins prior to the age of 10 and is focused on correcting a problem that could lead to damage of the teeth, gums, or bone or will result in more complex treatment in the future. This first phase of treatment does not mean that no more orthodontic treatment will be needed. It simply corrects the immediate problem so that future treatment is less complicated, of shorter duration and/or less expensive.
When problems that are identified in young children are not causing an immediate danger to the teeth or their supporting structures (gum and bone), treatment can be delayed until all of the adult teeth have erupted. In these cases, treatment is done as a single phase from start to finish.
Some malocclusions (bad bites) are the result of disproportionate or asymmetric growth of the jawbones. In these cases, successful orthodontic treatment may not be possible without realigning or correcting the symmetry of the jawbones. For surgical orthodontic treatment, the teeth are usually aligned first using either braces or clear aligners, then surgery is done to correct the position and/or symmetry of the jawbones. After the surgery is complete, the orthodontic treatment will continue to establish the patient’s final bite. In some cases, surgical orthodontic treatment can dramatically reduce the complexity of the orthodontics and the overall time in braces. It can also lead to significant improvements in facial balance and an individual’s confidence.