Serial Extraction

A child who’s new adult front teeth (incisors) are significantly crowded at age 7 or 8 has several options of how to address this problem. One of the most effective and least costly is serial extraction treatment.

The space for teeth in the lower jaw is fixed by age 5. After this time, the jaw will not increase in length in the area of the teeth. So, as the new teeth grow, if they are too large for the space they will overlap, rotate or grow in behind the primary (baby) teeth. If this is the case for your child, see your orthodontist for an evaluation and a plan of care. We call this size 32 teeth in a size 24 mouth.

If the crowding is great enough, and all the adult teeth are present in the jaw, the orthodontist can request the next baby tooth in line on each side (the baby cuspid tooth) to be removed early. This will allow the front teeth to align better as they grow in. The will usually straighten about 80% if given 6 to 10 months.

Unfortunately, this treatment does not increase the size of space available for teeth in the jaw. It does move the problem further back in the mouth. At age 10 1/2 or 11 when the mid range teeth (bicuspids) start to grow in and push out the first of the baby molars, a second evaluation will be done. If it is decided there is not sufficient room for all the adult teeth to fit, one adult tooth (the first bicuspid) can be removed from each side of the arch to allow room for the remaining teeth to grow in. The remaining teeth usually take about 18 months to grow in. It is recommended that braces be used to complete the alignment of the teeth at this point.

There are many complicating factors in the growth and eruption of teeth. This is why it is important for an orthodontist to guide this early part of serial extraction treatment. Complete diagnostic records including panoramic x-ray, diagnostic photos and a cephalometric x-ray are necessary for the orthodontist to provide a proper diagnosis and plan.

The orthodontist will provide a written request to your dentist for teeth to be removed at the most appropriate time.