Dr. Amanda’s Position on Premolar Extractions- 2025 for Braces and Invisalign

 

  1. Introduction
  • If you’re still automatically reaching for extractions in tough ortho cases, it might be time to reassess.
  • The conversation around premolar extractions has evolved, and so should your approach.
  • Whether you’re new to orthodontics or a seasoned pro, understanding when extractions are truly necessary can elevate your treatment planning.

 

  1. Rewind: Why You Might Be Over-Extracting
  • Years ago, many of us were trained to extract by default—especially in crowded cases.
  • You might have been taught that over 50% of patients needed extractions.
  • But let’s be honest: most of those cases didn’t really need it.
  • Often, it was because we missed the window for early intervention.

 

III. Why Early Intervention (Phase One) Changes the Game

  • If you’re seeing a child early—while they’re still growing—you have more tools and options.
  • Starting Phase One treatment on time can drastically reduce the need for extractions later.
  • No major airway issues? No intense oral habits? Then you’re probably good to go without pulling teeth.
  • Catch it early, and you can shape the arch naturally.

 

  1. When Extractions Are Still on the Table
  • Sometimes, you’ll meet patients who are done growing and have limited space.
  • Thin tissue biotype? Minimal bone? Non-surgical options may be limited.
  • If expansion or proclination isn’t safe, extractions might still be your best route.
  • Just be sure you’re not defaulting to this without exploring all your options first.

 

  1. What You Should Be Doing Now
  • Use your CBCT tools (like those in the Invisalign portal) to evaluate bone and space.
  • Don’t rely on guesswork—use imaging to guide decisions.
  • Review your non-surgical options: arch expansion, distalization, proclination, IPR, etc.
  • Not sure how to use all five methods? Go refresh with some training or tutorials.

 

  1. The Bottom Line
  • Stop treating all cases the same.
  • Start early when you can—it’s your best shot at avoiding extractions.
  • And if you must extract, do it with confidence knowing you’ve explored every alternative.
  • Your patients (and their smiles) will thank you.