Needing orthodontic treatment after a tooth extraction is common. Whether a tooth was removed years ago or is planned for removal just before starting treatment, the resulting gap introduces specific considerations for the orthodontist. Having a missing tooth, or even multiple missing teeth, does not prevent a person from getting braces. The entire treatment plan must simply be designed to account for the resulting space.
Is Getting Braces After Extraction Possible?
Getting braces after a tooth has been removed is possible and is often a planned part of the overall strategy to achieve a straight smile and a healthy bite. The feasibility of treatment depends on the reason for the original extraction and the condition of the remaining dental structure. An orthodontist will first distinguish between a therapeutic extraction and a non-therapeutic one.
A therapeutic extraction is performed specifically to create space for orthodontic purposes, such as alleviating severe crowding. Conversely, a non-therapeutic extraction is one done previously due to trauma, advanced decay, or impaction. The orthodontist will assess the existing dental arch, the size of the remaining space, and the health of the bone and gums to determine the best course of action.
Why Tooth Removal is Part of Orthodontic Planning
Tooth removal is a calculated step in orthodontics, primarily employed when there is a significant discrepancy between the size of the teeth and the jaw. The most frequent reason is to relieve severe dental crowding, where the jaw does not have enough room for all the permanent teeth. Removing a tooth, often a premolar, creates the necessary space for the remaining teeth to align properly without pushing them forward.
Extraction is also a solution for correcting protrusion, which occurs when the front teeth or lips flare too far forward, impacting the facial profile. By removing a tooth behind the canine, the orthodontist gains space to retract the front teeth, bringing them into a more balanced position. This retraction can significantly improve the soft tissue profile, leading to a more harmonious aesthetic result.
A third major reason is its use in “camouflage orthodontics” to address moderate skeletal discrepancies, such as a large overbite or underbite. When the upper and lower jaws are mismatched in size, extracting specific teeth helps shift the dental arch to compensate for the jaw difference. For instance, removing upper premolars in a patient with a Class II bite allows the upper front teeth to move backward, effectively reducing the overjet without requiring jaw surgery. This strategic removal of teeth is a powerful tool for achieving a stable and functional occlusion.
How Orthodontists Utilize Existing Space
Orthodontists manage the space created by an extraction in one of two ways: space closure or space preservation. The most common approach in therapeutic extractions is space closure, where the gap is eliminated entirely by pulling the adjacent teeth into the empty socket. This is achieved by applying continuous, light orthodontic forces through the braces’ wires and auxiliary components.
Space closure often involves retracting the front teeth and moving the back teeth forward, with the precise mechanics determined by the patient’s bite and aesthetic goals. Closing a substantial space can be a slow process, with teeth typically moving at a rate of approximately 1 millimeter per month. The final position of the teeth is carefully planned to ensure the remaining teeth meet correctly and provide a stable bite.
Conversely, space preservation is chosen when the missing tooth is to be replaced by a dental restoration, such as an implant or bridge, after orthodontic treatment is complete. The orthodontist uses the braces to maintain the exact width of the gap, ensuring adequate room for the prosthetic tooth. Sometimes, a socket preservation procedure using bone grafting material is performed immediately after the extraction to maintain bone volume for a future implant.
The Critical Healing Period Before Braces Begin
After a tooth is removed, a healing period is required before orthodontic forces can be applied to the surrounding teeth. This waiting time allows the extraction site, or socket, to stabilize and begin the natural process of bone and tissue regeneration. Applying pressure too soon can disrupt the blood clot that forms, increasing the risk of complications like a dry socket.
Initial healing for the gum tissue usually takes a minimum of two to three weeks, but this timeframe fluctuates based on the complexity of the extraction. A simple removal heals faster than a complex surgical extraction. Orthodontists may recommend a longer period, sometimes up to a few months, to ensure the underlying bone has sufficient density to support the forces of tooth movement.
While the site is healing, the orthodontist may place braces on other teeth to begin preliminary alignment that does not directly involve the extraction area. However, the main force application to move teeth into or around the extraction site requires that the bone is stable and free of swelling or discomfort. Following all post-extraction care instructions ensures a smooth transition into the active phase of orthodontic treatment.