The decision to remove wisdom teeth, or third molars, before or during orthodontic treatment is highly individualized. Wisdom teeth are the last set of molars to develop, typically emerging in the late teens or early twenties. Whether they must be removed for braces depends entirely on the patient’s jaw size, the position of the teeth, and the overall treatment goals. This process requires a coordinated assessment between an orthodontist and an oral surgeon.
The Connection Between Third Molars and Orthodontic Space
The primary consideration for third molars in orthodontic planning is their potential impact on space management within the dental arch. Braces shift teeth into alignment, often requiring the creation or utilization of available space. When wisdom teeth develop, they may attempt to erupt into an already crowded area, potentially complicating planned tooth movements.
The presence of developing or erupting third molars influences the overall arch length. If the jaw lacks sufficient space for the wisdom teeth to fully emerge, their presence can interfere with the planned movement of the second molars. Removing them can provide additional space, which orthodontists can use to relieve existing crowding or correct the bite. This is relevant when the orthodontic plan involves “distalization,” a technique that pushes the molar teeth further back.
It is a common misconception that erupting wisdom teeth exert enough force to push the front teeth out of alignment. Scientific evidence suggests that wisdom teeth do not cause significant, late-stage crowding of the front teeth after orthodontic treatment. Late crowding is often attributed to natural physiological changes, such as late mandibular growth and the tendency of teeth to naturally drift forward over time. The decision to remove third molars is based on their local impact on the back of the mouth, not solely on preventing front-tooth crowding.
Clinical Factors Determining If Removal Is Needed
The decision for removal is based on a detailed clinical assessment focusing on the health and trajectory of the third molars. A major factor is the degree of impaction, which occurs when a tooth is partially or completely trapped beneath the gum line or bone and cannot fully erupt. Impaction is classified by the tooth’s angulation, such as vertical, horizontal, or mesioangular, and the depth of the impaction.
Another consideration is the presence of pathology associated with the third molars. Dentists and oral surgeons look for signs of infection, such as pericoronitis, cysts, or tumors, which can develop around impacted teeth. If a wisdom tooth is decayed or causing root resorption (damage to the adjacent second molar), removal is recommended for the patient’s overall dental health. These health risks are often the primary drivers for extraction, regardless of orthodontic treatment.
If the third molars are fully erupted, healthy, and correctly positioned with adequate jaw space, they often do not need removal. However, extraction may be necessary if their root structure interferes with the planned movement of the second molar during orthodontic treatment. The decision is made on a case-by-case basis, utilizing panoramic X-rays to evaluate the position, development stage, and relationship of the wisdom teeth to adjacent teeth and surrounding structures.
Timing of Extraction and Post-Treatment Stability
The timing of wisdom tooth extraction relative to the orthodontic timeline can vary: before treatment, during treatment, or after the braces are removed. Removal is often recommended before braces are placed if the orthodontist needs the space to achieve treatment goals or if the third molars are causing pathology. Removing them beforehand allows the extraction sites to heal completely, with an ideal waiting period of two to four weeks before placing orthodontic appliances.
It is also common and safe to have wisdom teeth removed while wearing braces if the need for extraction becomes apparent mid-treatment. If the wisdom teeth are healthy and not interfering with alignment, they may be retained and monitored by the dental team. Removal is only considered after the braces are off if problems arise.
The concern that erupting wisdom teeth will ruin orthodontic results by causing relapse is a long-standing discussion. Scientific literature indicates that wisdom teeth are not the main cause of orthodontic relapse, despite some suggestions of minor posterior shifting. Post-treatment stability depends on the consistent use of retainers, which hold the teeth in their new positions. Therefore, commitment to wearing a retainer as prescribed is the most important factor in maintaining a straight smile long-term.