Do teeth have to be extracted for braces?
This is the fear that makes people postpone treatment for years. Someone heard from a friend that “they pulled four healthy teeth out of her”, and they do not want to come in at all. So let me say it plainly: in most cases extraction is not needed. But the decision here is not about the orthodontist's convictions or the patient's preferences — it is about millimetres. Either there is enough room in the jaw or there is not, and that is measured.
Where the question comes from
Crowded teeth are not “crooked teeth” but “teeth with no room”. The combined width of all the teeth exceeds the length of the arch they have to fit into. The difference is called the space deficit.
Braces do not make teeth smaller. They move them. So before straightening anything, room has to be found — otherwise the teeth simply tip forwards, the lip becomes fuller and the gum above the front teeth starts to recede.
The deficit is measured from models and imaging:
Up to 4 mm — mild. Almost always resolved without extraction.
4–8 mm — moderate. This is where the real choice begins: several routes exist, and the orthodontist weighs them against the facial profile and the state of the bite.
Over 8 mm — pronounced. Avoiding extraction is rarely possible.
Importantly, the deficit is measured separately for each jaw. Sometimes there is enough room above and not enough below.
Finding space without extraction
There are several methods, and these are what the orthodontist works through first.
Interproximal reduction (stripping). 0.2–0.5 mm of enamel is removed from the side surfaces of the teeth with a fine strip or disc. It sounds worse than it is: enamel on contact surfaces is thick and that amount is imperceptible to the tooth. Across the whole arch this yields 4–6 mm. The tooth stays alive and intact.
Arch expansion. Teeth are tipped outwards and the arch becomes wider. Yields 2–4 mm. It works when there is room in the back segments and the gums are healthy. Children offer more scope: before the palatal suture closes, the bone itself can be widened, not just the teeth tipped.
Distalisation. Back teeth are moved backwards, freeing space at the front. Yields 2–4 mm. It often relies on mini-implants — small titanium screws placed for the duration of treatment and removed afterwards.
Removing wisdom teeth. They do not add space themselves, but they take pressure off from behind and allow work on the back segments.
These methods combine. Stripping plus expansion often covers the same 6–8 mm for which a tooth used to be extracted.
When extraction really is needed
There are situations where every alternative is worse than the extraction itself. Not many, but they are real.
A pronounced deficit — over 8–10 mm. Trying to “spread out” that much ends with teeth pushed beyond the bone: roots become exposed, gums recede, and within a few years the result collapses.
Strongly proclined front teeth. When teeth already tip forwards and the lips do not close without effort, there is nowhere further outwards to give them room. The space has to come from inside the arch.
A marked jaw discrepancy. When one jaw sits noticeably ahead of the other and the patient is not prepared for surgery, extraction allows the difference to be compensated with the teeth.
A tooth that is doomed anyway. Sometimes the arch contains a tooth with a destroyed crown, a cracked root or an untreatable lesion. That is the one to remove, closing the space orthodontically — and it is the best possible scenario.
What is not a reason for extraction: wanting it “done faster”, unwillingness to work through the diagnostics, a one-size-fits-all clinic protocol. If an extraction plan is proposed before imaging and model analysis, that is grounds for a second opinion.
Which teeth are removed, and what happens to the gap
When extraction is genuinely needed, it usually means the first premolars — the fourth teeth from the centre, one on each side.
Why those: they sit in the middle of the arch, so space is freed both in front and behind; they are barely visible when smiling; and functionally the molars compensate for their loss without consequence.
Sometimes second premolars are taken instead, sometimes only on one jaw. Symmetry matters: extracting on one side without the other shifts the midline, and correcting that afterwards is separate work.
The main question patients ask is whether a gap will remain. It will not. The space closes during treatment — the neighbouring teeth move into it, and another tooth ends up where the extracted one stood. Two years later you will not remember which one it was.
The second question is whether the cheeks will hollow. They will not. Cheek shape is held by bone and muscle, not by a premolar. The profile may change, but predictably and in the planned direction: if the teeth were proclined, the lips will look calmer. That is precisely what is being aimed for.
Cost: tooth extraction UAH 2,100–3,650, wisdom tooth UAH 3,650–4,700. A CT scan of both jaws for planning costs UAH 1,290.
How the decision is made
Not by eye, and not in the first minute of an examination.
What is needed: a CT or panoramic image — to see the roots, the bone and the wisdom teeth; a lateral cephalogram — to calculate incisor inclination and the jaw relationship; models or a scan — to measure the space deficit; a photographic record — the face at rest and smiling, because the profile is part of the decision too.
Only then does the orthodontist draw up a plan — usually more than one. A proper consultation sounds like this: “there are two routes; this one avoids extraction, it takes this long and gives this result; this one involves extraction and gives that; the risks are these”.
If you were told “these have to come out” without any imaging, see a second orthodontist. If two independent specialists say the same thing after full diagnostics, it is most likely true.
And about timing: treatment with extraction is longer, usually by 4–8 months, because closing the spaces takes time. Worth planning for in advance — more on timelines in a separate article.
Frequently asked questions
Can teeth be straightened without extraction?
In most cases yes. Space is found through interproximal reduction, arch expansion or distalisation of the back teeth. Extraction is needed when the deficit exceeds 8–10 mm or the front teeth are strongly proclined.
Which teeth are extracted for braces?
Most often the first premolars — the fourth teeth from the centre, one on each side. They are barely visible when smiling, and space is freed both in front and behind.
Will a gap remain where the tooth was?
No. The space closes during treatment as the neighbouring teeth move into it. When treatment finishes another tooth stands there and the arch looks continuous.
Will my cheeks hollow after extraction?
No. Cheek shape is held by bone and muscle, not by a premolar. The profile may change, but predictably: if the teeth were proclined, the lips will look calmer.
What is stripping, and is it harmful?
Removing 0.2–0.5 mm of enamel from the side surfaces of teeth. Enamel on contact surfaces is thick and that amount is imperceptible to the tooth. Across the arch it yields 4–6 mm of space.
Could the jaw simply be expanded instead?
Partly. In adults it is mainly the dental arch that is expanded by tipping teeth outwards, which gives 2–4 mm. Expanding the bone itself is possible in children, while the palatal suture is still open.
I was told to have four teeth out. Is that normal?
It can be justified with a pronounced deficit in both jaws. But that decision has to rest on a CT scan, a cephalogram and models. If there were no diagnostics, get a second opinion.
Does treatment take longer with extraction?
Yes, usually by 4–8 months: closing the spaces takes time. Worth allowing for when planning.
Are wisdom teeth removed before braces?
Sometimes — when they press forwards or interfere with moving the back teeth. By themselves they do not add space at the front.
What does extraction cost?
Tooth extraction is UAH 2,100–3,650, a wisdom tooth UAH 3,650–4,700. A CT scan of both jaws for planning costs UAH 1,290.
Orthodontic treatment for children and adults: brace systems, aligners, bite correction. Modern protocols, thorough diagnostics and individual planning at every stage.
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After imaging and measuring the models the orthodontist will show your space deficit in millimetres and the plan options — with and without extraction. A consultation costs UAH 690.
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Find out whether you need extraction at all
After imaging and measuring the models the orthodontist will show your space deficit in millimetres and the plan options — with and without extraction. A consultation costs UAH 690.
Book now