What are the implications of extracting my premolars for orthodontic treatment?Orthodontics Dental Invisalign
Hello Doctors! I’m a female in her 20s undergoing Invisalign treatment. In order to create space to fix my overbite, I was informed that I had to remove the first premolars (next to my canines), as my other premolars are needed to support the molars beside them. However, other dentists have informed me that it is in fact alright to remove the second, instead of the first premolars. I would like to find out what are the implications of extracting my premolars, especially with regard to the implications of extracting the first versus the second premolars? Thank you in advance!
Extraction of premolars generally gives the most amount of space for correction of crowding. Whether this is needed will depend on how much space is needed. Space is required for straightening the teeth, leveling the bite, midline correction and to reduce protrusion of the incisors.
The choice whether to extract first or 2nd premolars depends on how much anchorage (resistance to unwanted tooth movement) the case requires and which tooth is compromised (large fillings, root canal-treated, crowns, cracks/fractures, impacted or in a very poor position).
Generally speaking, removing first premolars gives greater anchorage that can allow greater incisor retraction that may be desirable in certain cases. That being said, anchorage can be supplemented with other methods (like mini screws/TADs).
Losing anchorage may sometimes be a good thing, depending on the case.
Ultimately, this is something that the treating dentist needs to have an idea of before starting the case and through analysis of your case's requirements.
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