The question of whether to straighten or remove wisdom teeth arises because these third molars often emerge with complications. Wisdom teeth typically begin to appear in the mouth between the ages of 17 and 25, marking the final stage of dental development. This late arrival means they frequently encounter a jaw that has already accommodated the other 28 adult teeth. When their path of eruption is obstructed or they are angled incorrectly, it creates a misalignment problem that prompts the discussion of potential intervention.
Understanding the Causes of Misalignment
The primary reason wisdom teeth erupt crookedly is a discrepancy between the size of the jaw and the space required to accommodate them. This lack of retromolar space often forces the wisdom tooth into an abnormal position.
The tooth may become “impacted,” meaning it is trapped beneath the gum tissue or bone and cannot fully erupt. Impacted wisdom teeth are classified by the angle at which they grow, such as mesial (angled toward the front of the mouth), distal (angled toward the back), or horizontal (lying completely sideways). Mesial impaction, where the tooth pushes against the adjacent second molar, is the most frequent type of misalignment. The pressure from these misaligned teeth can increase the risk of decay on the neighboring molar and cause chronic jaw soreness.
Straightening: Possibility Versus Practicality
While orthodontic principles allow for the movement of almost any tooth, straightening a misaligned wisdom tooth is rarely the recommended course of action. For the third molars, which are positioned far back in the mouth, this process presents significant mechanical and logistical challenges for both the patient and the clinician. The duration of treatment is a major factor, as the active movement phase to upright a severely impacted third molar can take around 20 months, often followed by a period of stabilization. In contrast, a surgical extraction provides a quick, definitive resolution to the problem, and the cost comparison is also stark, with complex orthodontic intervention far exceeding the cost of a surgical removal.
Furthermore, the high risk of complications generally outweighs the benefit of retaining a wisdom tooth. Even controlled orthodontic movement of a third molar carries a risk of root damage, or root resorption, correlated with the total distance and duration of the tooth movement. The posterior location also makes it difficult for patients to maintain adequate oral hygiene, increasing the likelihood of recurrent infection or gum disease. For these reasons, extraction is considered the practical and standard approach when the third molar poses a threat to the overall health of the dental arch.
When Straightening Wisdom Teeth is Justified
Orthodontic straightening of a third molar is typically reserved for highly specific, unusual scenarios where retaining the tooth offers a distinct long-term advantage. One such scenario is “replacement therapy,” where a healthy wisdom tooth is strategically moved to take the place of a missing first or second molar lost due to decay or trauma. Another justification for intentional movement is to mitigate the risk of nerve injury during a subsequent extraction. If an impacted tooth’s roots are positioned extremely close to the inferior alveolar nerve, controlled movement can safely reposition the tooth away from the nerve, allowing for a safer surgical removal or a less invasive procedure like a coronectomy. These exceptions require careful treatment planning and close coordination between an orthodontist and an oral surgeon, but they are not a practical alternative for the vast majority of patients.