Are Extractions Necessary?

This is one of the most commonly asked questions. Though Dr. Ritucci is very conservative in his treatment approach, there are certain conditions where extraction of permanent teeth is indicated. Generally, when there is severe crowding, protrusion or a bad bite, extractions are recommended.

If there is severe crowding and the person is in the late mixed or permanent dental developmental stage, removal of teeth will help in the proper alignment or the eruption of teeth that are blocked out. In some instances, if interceptive treatment is initiated during the early mixed dentition stage (the presence of 10-12 baby teeth), extraction of permanent teeth may be avoided.

In cases where there is protrusion of the upper teeth, the cause is often due to the upper jaw being too far forward. By extracting the upper first premolars, the upper front teeth can be orthodontically retracted to a more desirable position.

When there is a bad bite, teeth have often shifted into an asymmetric pattern. By extracting teeth, ideal alignment and a more balanced bite can often be achieved.

The decision to extract teeth is made after careful review of the clinical, radiographic and photographic findings, which are part of the orthodontic records needed for diagnosis. Only when the anticipated outcome is deemed to be beneficial aesthetically, functionally and dentally is the decision made to extract.

What is Serial Extraction Treatment?

In some instances, the extent of crowding is so severe that the permanent incisors are having trouble erupting. After it has been determined that crowding will remain in the incisor area after all the adult teeth have erupted and profile reduction will be advantageous, a sequence of extracting primary and permanent teeth is carried out to allow alignment of the incisors and unimpeded eruption of the canines. Panoramic radiographs or a full mouth series of X-rays are often needed to evaluate when the extractions should begin. A typical case will involve beginning the extraction sequence at the age of 8. The patient will be followed at least semi-annually for several years until the first premolars begin to erupt, at which time they are extracted or radiographically the developmental stage of other teeth is more advanced indicating a different extraction pattern. Success in such cases is dependent upon careful monitoring of developmental growth, dental development and, in some instances, interceptive treatment.

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