The decision to proceed with braces before or after the removal of third molars, commonly known as wisdom teeth, is a frequent dilemma for orthodontic patients. This sequencing is a careful planning step necessary for comprehensive dental care and a successful alignment outcome. The ultimate timing is determined by a thorough diagnostic assessment, which evaluates the growth and position of the third molars relative to the jaw structure and planned tooth movements. This ensures that the orthodontic treatment proceeds efficiently without being compromised by the later emergence of these teeth.
The General Rule: Is Timing Critical?
Timing is important in coordinating orthodontic treatment with third molar development, but the sequence is highly individualized. While most cases involving problematic third molars require removal, the specific moment for extraction depends on the orthodontist’s professional judgment. This assessment is primarily based on panoramic X-rays, which show the developing third molars and the available space in the jaw.
Often, removal of the third molars is recommended before braces are applied to clear the path for the other teeth to shift into their desired positions without interference. If extraction is performed first, a waiting period is required to ensure the surgical sites are fully healed before the application of orthodontic forces. Typically, patients are advised to wait approximately two weeks following the procedure before beginning their braces treatment. This pause allows the soft tissues to recover and prevents complications.
The Role of Wisdom Teeth in Orthodontic Treatment
Third molars become relevant to orthodontic treatment because of their potential effect on space management within the dental arch. The human jaw has evolved to be smaller over time, meaning that when these last molars attempt to erupt, there is often insufficient room for them to settle properly. An orthodontist may determine that the space occupied by the third molars is required to achieve the desired alignment of the front teeth.
Removal of the third molars is sometimes necessary to create the required distal space, allowing the existing teeth to be moved backward. This technique can relieve severe crowding in the front of the mouth without extracting other functional teeth. Even if the wisdom teeth are not actively pushing against other teeth, their presence can complicate orthodontic movement. Therefore, removal is often a calculated step to ensure the treatment plan is physically achievable.
While the long-held belief was that erupting third molars directly cause crowding of the front teeth, this mechanism is debated in modern orthodontics. Current consensus suggests that the pressure exerted by third molars is not solely responsible for late-stage front-tooth shifting. However, their removal remains a common practice when they are impacted, are causing pressure on the second molars, or when their absence is required for the overall space management of the orthodontic plan. The focus is less on preventing an unproven force and more on ensuring adequate health around the adjacent teeth.
Potential Complications If Wisdom Teeth Erupt During Treatment
Starting orthodontic treatment while third molars are actively developing or positioned for future eruption carries several specific risks. If these teeth begin to emerge mid-treatment, the physical pressure they exert can disrupt the planned alignment of the dental arch. This can lead to a relapse in the corrected positions, potentially undoing months of progress. The disruption can necessitate a temporary halt to the treatment or an adjustment of the entire orthodontic plan.
A more serious concern is the potential for damage to the roots of the adjacent second molars. As the third molar attempts to push its way through, it can press against the root surface of the second molar, leading to external root resorption. This process gradually wears away the root structure, which can compromise the stability and longevity of the otherwise healthy tooth. An erupting third molar can also create a localized area that is difficult to clean, increasing the risk of infection, such as pericoronitis.
Infection occurs when a partially erupted third molar creates a flap of gum tissue where bacteria can easily accumulate. This often requires an emergency removal, which is more complex to manage while orthodontic brackets and wires are already in place. Therefore, proactively addressing problematic third molars minimizes the risk of physical and biological complications interrupting the alignment process.
Cases Where Extraction Is Not Required Before Braces
Despite the common association between third molars and extraction, removal is not a universal prerequisite for starting braces. There are specific scenarios where the orthodontist may decide to proceed with alignment therapy without first removing the third molars. One such case involves deeply impacted third molars that are fully encased in bone and show no radiographic evidence of movement or the potential to develop pathologies like cysts. These teeth may be left in place and simply monitored over time.
A patient whose jaw size is large enough to comfortably accommodate all 32 teeth in a proper, functional alignment may also be spared the extraction procedure. In this scenario, the third molars erupt fully and vertically without causing any pressure or crowding on the adjacent teeth. Additionally, if the third molars have already fully erupted and are correctly positioned and healthy before the patient seeks orthodontic care, they are often left alone.
Finally, some orthodontic treatment plans are focused on minor adjustments or corrections that do not require any change in the total amount of available space in the back of the mouth. In these specific cases, the third molars do not pose a threat to the movement, and their removal is deemed unnecessary. The decision to retain the third molars is always made on a case-by-case basis when no immediate or future complications are expected.