Do you need teeth removed for braces?
Not usually, but sometimes. Extractions for braces are considered when there is not enough room to line the teeth up without pushing them too far forward, for example with severe crowding or protruding front teeth. Alternatives such as enamel polishing (IPR), arch expansion or moving back teeth backwards can often create space instead. At Creative Arts in Dubai, a specialist orthodontist explains whether extractions are needed for your case, why, and what the alternatives would mean.
Who treats you here Dr. Muhannad Kazzaz Specialist Orthodontist · Dr. Valeriia Kozachenko Specialist Orthodontist
Every dentist’s licence can be checked on the DHA Sheryan medical directory.
Why would an orthodontist suggest removing teeth?
Straightening crowded teeth needs space. Imagine trying to line up more books than a shelf can hold: either the shelf gets longer, the books get thinner, or one book comes out. In the mouth, the jaw is the shelf. Its size is largely fixed in adults, and the amount the teeth can safely be pushed outwards or forwards is limited by the bone and gums around them.
Extractions are usually considered when:
- Crowding is severe, so the space missing is more than other methods can safely provide.
- Front teeth already stick out, and creating space by pushing them further forward would make the lips more prominent and the bite less stable.
- The bite needs camouflage, for example when upper and lower jaws are mismatched in an adult who does not want jaw surgery, and removing teeth in one arch lets the front teeth meet properly.
- A tooth is already compromised, such as one with a poor long-term outlook, sitting far out of line or impacted, which can sometimes be the one chosen.
When teeth are removed for orthodontic reasons, the gaps are closed during treatment as the other teeth are moved into the space.
What are the alternatives to extractions?
These methods create space without removing teeth. Each has limits, and the right one depends on how much space is needed and where.
| Method | What it does | Typical use and limits |
|---|---|---|
| IPR (enamel polishing) | Removes a few tenths of a millimetre of enamel between selected teeth | Mild to moderate crowding; the total space available is limited |
| Arch expansion | Widens the dental arch, or in children the upper jaw itself | Most effective in growing children; in adults mainly tooth tipping, with limits set by the gums and bone |
| Distalisation | Moves back teeth further back to make room in front | Selected cases, often supported by temporary anchorage devices |
| Slight forward movement of front teeth | Tips front teeth outwards a little | Only where lips, gums and bone allow; can make lips fuller |
| Accepting a compromise | Leaves some crowding or a small irregularity | When the goal is limited and the patient prefers it, agreed in advance |
Elastics, expanders and temporary anchorage devices are used at Creative Arts where a case needs them. Your plan lists which ones apply to you.
Which teeth are usually removed for braces?
When extractions are part of an orthodontic plan, the teeth most often chosen are premolars, the teeth between the canines and the molars. They sit in the middle of each side, so the space can be used to relieve crowding in front or to pull protruding front teeth back. Depending on the case, the plan may involve one, two or four teeth, in one arch or both.
Sometimes a different tooth makes more sense: one with a large old filling or a root-filled tooth with a poor outlook, a tooth that has grown in far out of line, or a lower front tooth in a very specific crowding pattern. The orthodontist explains why a particular tooth was chosen.
Wisdom teeth are a separate question. They are not usually removed to straighten front teeth, and reviews have not shown that they cause front-tooth crowding. Our guide on wisdom teeth and braces explains when they are removed during orthodontic care and when they are left.
Will extractions change the shape of my face?
This is the worry patients raise most. The honest answer is that extractions can change lip position, and whether that is a problem depends on where you start. A 2024 systematic review in The Angle Orthodontist found very low-level evidence that removing four first premolars retracts the upper and lower lips relative to a reference line from nose to chin, and no significant difference between extraction and non-extraction cases in post-treatment smile aesthetics. Non-extraction treatment had a shorter duration in the studies it included.
In practice, this is why the profile is part of the diagnosis. For someone with full lips and protruding front teeth, pulling the teeth back can give a more relaxed lip position. For someone with a flat profile and thin lips, the same plan could be the wrong choice, and space may be found another way. Claims that braces with extractions always leave a sunken face, or that non-extraction treatment always looks better, are not supported by the evidence.
Told you need extractions and want to understand why? Our specialist orthodontists explain space, bite and profile, compare options in writing and plan fixed braces or aligners around your case.
Braces at Creative ArtsHow are extractions coordinated with braces or aligners?
When extractions are part of the plan, timing matters. Teeth are often removed shortly before braces are fitted, or soon after, so that the space is available when the orthodontist starts to use it. The orthodontist decides the sequence; the extractions themselves are carried out by a dentist, usually under local anaesthetic, and our page on tooth extraction explains what that involves.
The gap then closes gradually as the neighbouring teeth move in. With fixed braces, space closure is often one of the longer phases of treatment, which is part of why extraction cases tend to take more time. Our guide on how long braces take covers this.
Extraction cases can sometimes be treated with aligners, but moving teeth bodily into a large space is demanding for a removable appliance. Many such cases are more predictable with fixed braces; our guide to what Invisalign can fix explains the limits.
What should you ask if you are told you need extractions?
It is reasonable to want to understand the reasoning before a healthy tooth is removed. Useful questions include:
- How much space is missing in each arch, and where?
- What would the result look like without extractions, for the teeth, the bite and the lips?
- Which teeth would be removed, and why those?
- How would the extractions affect the length of treatment?
- Would the same plan work with aligners, or are braces more predictable?
- What retention will be needed afterwards?
At Creative Arts, our specialist orthodontists, Dr. Muhannad Kazzaz and Dr. Valeriia Kozachenko, explain these points in the written plan and are happy to review a plan proposed elsewhere. If you are not yet sure whether you need treatment at all, start with do I need braces?
Extraction and non-extraction are both legitimate
Neither approach is modern or outdated. Each is right for some cases and wrong for others. A plan that explains the space, the bite and the profile, and shows what the alternatives would mean, is more useful than a promise of no extractions.