Non-extraction treatment
Straightening crowded teeth without extractions where possible, using gentle forces.
Does this sound familiar
Patients most often come for this with these words:
I have been told I need teeth extracted
My teeth are very crowded, there is not enough space
I worry my face will change if teeth are extracted
My canine is stuck high up and cannot come into place
My child’s permanent teeth are coming in crooked
Crowding, that is a lack of space for the teeth, is one of the most common problems in orthodontics. Many patients come thinking "teeth will definitely have to be extracted". In many cases, however, crowding can be resolved without extractions. In some cases extraction is the better choice for the face and health. I decide only after diagnosis, taking the profile and lips into account.
How this is possible
- Giving the dental arch the right shape and widening it when needed
- Gradually bringing the teeth into place with gentle forces
- Using jaw growth in children. See: palatal expansion
- Moving teeth backwards with mini-screws when needed. See: mini-screws
- In some cases, polishing fractions of a millimetre of enamel between the teeth
One of our patients had severe crowding. Using gentle forces, we completed treatment without extractions and achieved an aesthetic smile.
How the decision is made
| Factor | For non-extraction | For extraction |
|---|---|---|
| Profile | A balanced or flat profile | The lips stick out a lot |
| Degree of crowding | Mild and moderate | Very severe |
| Bone and gums | There is room to widen the arch | The bone is thin, widening is risky |
| Age | Growth is continuing | Growth is complete, there are skeletal limits |
| Smile | A wider arch would improve the smile | The arch is already wide |
According to a systematic review, in treatment with extractions the lips move back more and the profile becomes flatter. This is good for some patients, but in others it may flatten the profile unnecessarily. More: can orthodontics change your face.
How treatment goes
- Diagnosis: facial and intraoral photographs, models, X-rays
- Calculating the lack of space: how much room is needed
- Choosing how to gain space: arch shape, expansion, moving teeth back
- Treatment with braces or aligners
- A mini-screw phase when needed
- Finishing and retention
Limits and risks
Non-extraction treatment is not done at any cost. If the teeth are pushed beyond the limits of the bone, the risk of gum recession may increase and the result may be unstable. In a patient whose lips stick out a lot, non-extraction treatment can worsen the profile. That is why in some cases extraction is the right choice, and I explain the reason openly.
In children
In children, widening a narrow upper jaw during growth and protecting the space after baby teeth are lost can reduce the need for extractions in the future. More: crossbite and early loss of baby teeth.
What the science says
- Systematic review and meta-analysis (2018): treatment with extractions leads to more retraction of the lips than treatment without extractions.
- Cochrane review (2021): there is evidence for the effectiveness of some appliances for widening a narrow upper jaw in children, with low to moderate certainty.
What to ask at the consultation
- How much crowding do I have and how much space is needed?
- How will space be created?
- How will my profile change without extractions?
- How will my profile change with extractions?
- How stable will the result be and how will retention work?
I answer these questions openly and in plain words, and show you on photographs and models when needed.
Frequently asked questions
Is non-extraction treatment possible for everyone?
No. It is possible in many cases, but with severe crowding and protruding lips extraction may be the right choice.
Does expansion make the face wider?
No, widening the dental arch does not change the width of the face. But the smile may look fuller.
Does enamel polishing harm the teeth?
When done correctly, only a very thin layer of enamel is removed and this does not affect the health of the tooth.
Another doctor said I need extractions. Can I get a second opinion?
Of course. Bring your existing X-rays and photographs and we will discuss the options together.
Does non-extraction treatment take longer?
Not necessarily. Duration depends mainly on the degree of crowding and the chosen approach.
How much space does moving teeth back with mini-screws give?
It depends on the bone and the wisdom teeth. In many cases it is enough for mild and moderate crowding.
Read more
Scientific sources
The information in this article is based on the following peer-reviewed scientific articles and systematic reviews.
- Konstantonis, D., Vasileiou, D., Papageorgiou, S. N., & Eliades, T. (2018). Soft tissue changes following extraction vs. nonextraction orthodontic fixed appliance treatment: a systematic review and meta-analysis. European Journal of Oral Sciences, 126(3), 167-179. [PMID: 29480521] | [DOI: 10.1111/eos.12409]
- Ugolini, A., Agostino, P., Silvestrini-Biavati, A., Harrison, J. E., & Batista, K. B. (2021). Orthodontic treatment for posterior crossbites. Cochrane Database of Systematic Reviews, 12(12), CD000979. [PMID: 34951927] | [DOI: 10.1002/14651858.CD000979.pub3]