Many people undergoing orthodontic treatment, such as braces, eventually encounter the issue of their third molars, commonly known as wisdom teeth. These teeth typically emerge in the late teens or early twenties, often coinciding with or following active tooth alignment. Managing these late-arriving teeth requires careful consideration of their position and potential impact on the overall dental structure.
Feasibility and Timing of Removal
The presence of orthodontic hardware does not prevent the surgical removal of wisdom teeth. The procedure is routinely performed on patients wearing braces, but the precise timing is a clinical decision tailored to the individual treatment plan. Timing relies on assessing panoramic X-rays, which reveal the wisdom teeth’s developmental stage, angle of eruption, and proximity to neighboring teeth or nerves.
Removal before braces are placed is a common scenario, often recommended if the third molars are impacted or positioned to interfere with initial tooth movement. Preemptive extraction creates a clearer path for the orthodontist and eliminates the risk of problems arising mid-treatment. If the orthodontist needs space to correct severe crowding or a bite issue, early removal allows this space to be utilized immediately.
Extraction can also occur during the active phase of orthodontic treatment if the third molars erupt unexpectedly or show signs of causing harm. Immediate removal is recommended if they cause pain, infection (pericoronitis), or threaten the roots of the adjacent second molars. The procedure is performed by an oral surgeon accustomed to working carefully around the brackets and wires of the braces.
Postponing extraction until after braces are removed and the retention phase has begun is a third option. This is considered only when the wisdom teeth are fully erupted, healthy, and show no signs of impaction or pathology. Specialists usually prefer to address potentially problematic third molars earlier to prevent issues after orthodontic alignment is complete.
Effect on Orthodontic Alignment
A long-standing misconception suggests that wisdom teeth must be removed to prevent crowding of the front teeth after braces are taken off. Scientific research indicates that the force exerted by erupting third molars is insufficient to push the entire dental arch forward and cause relapse in the front teeth. Crowding that occurs in adulthood is more likely due to natural, subtle forward drift of all teeth over time, changes in jaw structure, or failure to consistently wear retainers.
The true concern is the impact of third molars on the second molars and the overall stability of the bite. An impacted wisdom tooth can cause bone loss or root damage to the second molar, compromising the long-term success of the orthodontic treatment. Removing the third molars eliminates this localized pressure and potential for damage, especially when the second molars have been moved into a precise position.
In some cases, third molar removal is an intentional part of the treatment mechanics rather than just a preventative measure. The space created in the back of the mouth can be strategically used to move the entire arch backward, a process known as distalization, to correct a protrusive bite. This intentional use of the space is a beneficial component of the overall alignment plan.
The short healing period following extraction may require a temporary pause in orthodontic adjustments. However, the procedure rarely causes a significant delay in the overall treatment timeline.
Coordinating Care Between Specialists
The decision to remove wisdom teeth in a patient with braces is a collaborative effort between the orthodontist and an oral surgeon. The orthodontist monitors the third molars through routine X-rays and determines if their presence will compromise the alignment plan or long-term stability. Once extraction is decided, the orthodontist initiates the process by sending a formal referral and relevant diagnostic records, such as current X-rays, to the surgeon.
This communication ensures the surgeon understands the specific orthodontic goals and any mechanical constraints imposed by the braces. The surgeon assesses the complexity of the extraction, considering factors like the angle of the tooth and proximity to surrounding structures. Patients should inform the surgeon about their orthodontic hardware, as the surgical team may need to place protective coverings or temporarily remove a wire to ensure better access and prevent damage to the appliances.
Following the extraction, the patient receives post-operative instructions that must accommodate the presence of the braces. Cleaning around the surgical sites is more challenging with brackets and wires present, so meticulous hygiene is emphasized to prevent infection. The orthodontist typically schedules a follow-up appointment soon after recovery to ensure the surgical site is healing well and to resume or adjust the tooth movement plan.