Dental Series: How to Avoid Regret

A Case of Regret After Extracting the Fourth Tooth from the Front for Orthodontics

Have you heard of the term “convenience extraction”?

It implies “for convenience” or “out of necessity” and refers to extractions performed during orthodontic treatment to create space.

Typical reasons include:

Improving crowded teeth (malocclusion)
Reducing the appearance of a protruding mouth (protruding teeth)

In these cases, the **fourth tooth from the front, the “first premolar,”** is often chosen. Positioned right next to the front teeth, it makes moving the entire dental arch easier and is considered the most manageable tooth by orthodontic specialists.

Actually, a “Key Tooth”

However, this fourth tooth plays a very important role.

It has two roots and a longer lifespan than molars.
It sits at the transition zone between front teeth and molars, with a shape that helps balance the bite.
It disperses force in a direction that minimizes stress on the temporomandibular joint (TMJ).

In other words, it is the key tooth supporting the bite.

The “extra space” created by extraction

Removing the first premolars on both sides creates approximately 15mm of space.

However, in many cases, this space is unnecessarily large.

As a result, excessive retraction of the front teeth occurs, leading to reported issues such as:

Reduced oral volume, increasing the risk of sleep apnea
Overcorrection of protruding teeth causing a thinner, aged appearance around the mouth
Tooth roots protruding from the bone, leading to gum recession and tooth mobility

While it may look aesthetically pleasing in the short term, it can potentially lead to long-term complications.

Orthodontics ≠ Convenience Extractions

Of course, extractions aren’t always bad in every case.

However, it’s premature to assume “convenience extraction is the only option.”

For example,

Extracting wisdom teeth to move molars backward
Extracting the molar in front of the wisdom tooth to guide the wisdom tooth forward
Using anchor screws (fixed titanium pins) to prevent unnecessary tooth movement

are alternative methods.

At our clinic, we rarely perform convenience extractions of first premolars unless we determine it is truly necessary.

To avoid regret

Orthodontic treatment is not just about appearance; it is a major decision affecting your lifelong bite and health.

Once a tooth is extracted, it cannot be reversed.

That is precisely why it is crucial to carefully assess:

Is extraction truly necessary?
Can other methods address the issue?
What future impacts might it have on facial appearance or breathing?

Summary

The fourth tooth from the front is often “easily extracted for convenience,” but it is actually a crucial tooth supporting your bite.

Casually removing it can frequently lead to later regret, thinking, “I wish I hadn’t had it pulled…”

Understand that orthodontics does not always mean extraction. Before treatment, always confirm multiple options.

We hope you will gain the right knowledge through our “Dental Series for Avoiding Regret.”