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Questions regarding the removal of permanent teeth in conjunction with orthodontic treatment have been with us for almost 100 years. Orthodontists have taken various positions on this question as the profession has evolved. In the early years of orthodontics, 1900-1940, there was a heavy emphasis on non-extraction treatment. Braces were being used routinely, but teeth were squeezed into the dental arch, no matter how crowded they were. After treatment, the teeth frequently returned to their crooked position. This fact had caused a lot of frustration to the orthodontists practicing at the time and they began to look for a different approach that would lead to more stable results.

By the 1940’s, removal of permanent teeth during orthodontic treatment was becoming quite common after decades of unsatisfactory results with non-extraction treatment. By the 50’s, and throughout the 60’s and 70’s, extraction of permanent teeth during orthodontic treatment was the rule. In the 80’s thing began to change again, and an emphasis on non-extraction treatment began to regain favor จัดฟัน. Today, we are in a period of controversy when both techniques are utilized, but non-extraction treatment is gaining more favor as time progresses. New information from long term studies have concluded that neither type of treatment has proven to be a superior over the other in the long term when one looks only at tooth stability. In other words, will the teeth become crooked again later in life. So what is the best course to take?

The decision is not always easy, but a more conservative approach favoring the preservation of all teeth(except wisdom teeth) will usually result in a situation which promotes the best overall health for the patient. The reasons for this are complex, but must be looked at in a holistic manner. When teeth are removed during orthodontic treatment, it is almost always the bicuspids(pre-molars). Typically four bicuspids are removed, one in each quadrant of the mouth. These teeth are removed to create additional space in the mouth, After the front teeth are straightened, usually 6-9 months into orthodontic treatment, there is space remaining from the previous extractions that must be dealt with. As the space closes up, the front teeth get pushed inward by the braces and begin to encroach on the tongue. The tongue in response will retract backwards toward the throat. This situation is now being looked at as a possible causative factor in the development of obstructive sleep apnea. Apnea or OSA, is a condition which results in labored breathing during sleep as the tongue falls back in the throat and blocks the airway. In numerous studies, sleep apnea has been linked to high blood pressure and stroke. If it is proven that extractions can lead to future sleep apnea, the orthodontic profession will abandon this approach to treatment.

Another adverse effect of extractions during orthodontic treatment, as a result of the pushing inward of the front teeth, is a loss of support to the lips. The lips rest on the teeth, and as the teeth move inward during the orthodontic treatment with extractions, so do the lips. This in turn, accelerates the aging of the lower face and will result in an accentuated appearance of the nose and the chin. This can be quite unattractive, especially in females. Many orthodontists will treat how they were trained during their university days, which in many cases is antiquated. Others will try and do what is best for their patients. Being an educated consumer, is the way to wind up with the best orthodontic treatment result.

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