Why OrthoWorks Strives to Avoid Permanent Tooth Extractions

At OrthoWorks Orthodontics Group, one of our core treatment philosophies is to preserve all of a patient’s natural permanent teeth whenever possible. While extractions are sometimes appropriate for very severe orthodontic problems, today’s advanced techniques allow us to successfully treat most patients without removing healthy teeth. Avoiding extractions helps maintain natural facial balance, promotes better airway health, and results in more stable long-term outcomes.

Why We Prefer to Avoid Extractions

Each permanent tooth contributes to proper function, balance, and appearance. In traditional orthodontics, removing teeth—especially premolars—was commonly recommended to create space. We now understand that extracting teeth can lead to several unwanted effects, including:

• Flattening of the facial profile
• Reduced lip support
• Narrower, less full smiles
• Greater risk of orthodontic relapse
• Gum recession in some situations

And importantly:

Impact on Airway Health

When permanent teeth are removed, the dental arches can become smaller, and the front teeth are often pushed backward to close the extraction spaces. This backward movement reduces the amount of room inside the mouth and forces the tongue to sit farther back toward the throat. A retruded tongue position can partially obstruct the airway—especially at night when muscles relax. Over time, this reduced airway space may increase the risk of developing sleep-disordered breathing, including snoring and obstructive sleep apnea later in life.

For growing children, maintaining a healthy tongue space and airway is essential. For adults, preserving the natural volume of the mouth can help maintain clearer breathing and healthier sleep patterns as they age.

Modern Techniques That Allow Us to Avoid Extractions

At OrthoWorks, we utilize the most effective and up-to-date orthodontic methods to avoid permanent tooth removal whenever possible:

1. Palatal Expansion
   Expanding the upper jaw broadens the dental arch, creates space for crowded teeth, improves nasal airflow, and supports healthier facial growth. This approach is highly effective for growing children and often eliminates the need for later extractions.
2. Early Interceptive Treatment
   Following the American Association of Orthodontists’ recommendation, we evaluate children around age 7. Early monitoring and guidance of jaw development allow us to prevent severe crowding before it becomes difficult to manage.
3. Advanced Invisalign® and Braces Systems
   Using 5th-generation iTero scanners and digital treatment planning, we can widen arches, align teeth efficiently, and reduce crowding—all without extracting permanent teeth.
4. Posterior Tooth Movement to Create Space
   By orthodontically moving the posterior teeth back incrementally, we can create additional room in the arches. This newly created space allows the crowded front teeth to de-crowd and align properly without extracting permanent teeth. This controlled, gradual movement is one of the most effective modern techniques for resolving crowding while preserving the full dentition.
5. Shaping the Arches to Their Ideal Form
   Many cases of crowding are due to narrow or constricted arches. By gently broadening the arches to their correct, natural shape, we can create space while enhancing the patient’s smile width.

When Extractions May Still Be Necessary

Although our goal is always to preserve the natural dentition, extractions may be recommended in rare cases of severe protrusion, extreme crowding, or significant skeletal imbalance. In these situations, removing teeth may provide better function and long-term stability. Even then, we carefully plan treatment to maintain facial balance and avoid unwanted changes.

Why Families Trust OrthoWorks

With over 40 years of experience and more than 10,000 Invisalign patients treated, OrthoWorks has a long history of successfully managing even complex cases without removing permanent teeth. Our non-extraction philosophy supports:

• Natural, fuller smiles
• Healthy airway development
• Balanced facial aesthetics
• Long-term stability
• A less invasive experience

If you or your child has been told that permanent teeth must be removed, we welcome you to visit OrthoWorks for a second opinion. Many patients who were advised to extract elsewhere can be treated successfully—and beautifully—without extractions in our office.