OrthoWorks’ Philosophy: Keeping Your Smile Whole—No Unnecessary Extractions

By David Shen, DMD • OrthoWorks Orthodontics Group

At OrthoWorks Orthodontics Group, our guiding principle is as straightforward as it is patient-centered: preserve every one of your natural permanent teeth whenever possible.

While permanent tooth extractions still play a role in certain severe orthodontic cases, advances in modern orthodontics now empower expert practitioners to treat most patients without removing healthy teeth. Prioritizing tooth preservation isn’t just about what’s left in the mouth—it's about supporting the very best in:

• Natural facial balance
• Optimal airway and breathing health
• Fuller, more attractive smiles
• Long-lasting orthodontic results

Why We Avoid Unnecessary Permanent Tooth Extractions

Every permanent tooth is essential for:

• Proper chewing
• Jaw harmony
• A pleasing facial appearance

In the past, traditional orthodontics often relied on extracting teeth—especially premolars—to address crowding. However, research and experience have shown this approach can result in unwelcome consequences, like:

• A flattened facial profile
• Reduced lip support
• Narrower, less vibrant smiles
• Increased risk of orthodontic relapse
• Potential for gum recession

These changes affect more than just appearances—they can alter function, comfort, and even future oral health. But perhaps most important, there’s another major impact many people overlook:

The Breathing Connection: How Extractions Can Impact Your Airway

Removing permanent teeth for orthodontic reasons almost always means shrinking the dental arches. Typically, front teeth are moved backward to fill these new gaps, which can:

• Decrease the available space inside the mouth
• Push the tongue further back toward the throat

When the tongue is retruded, it may partially block the airway—especially at night when muscles relax. Over time, less airway space can raise the risk of sleep-disordered breathing conditions, including:

• Snoring
• Mouth breathing
• Obstructive sleep apnea

Why This Matters at Every Age

• Growing Children:
  Ample space for the tongue and a healthy airway foster proper jaw and facial growth—so crucial for long-term well-being.
• Adults:
  Preserving arch volume supports clear, healthy breathing and better sleep quality—for life.

For these reasons, avoiding unnecessary extractions is one of the most impactful ways a modern orthodontist can contribute to lifelong health.

Modern Orthodontic Advances: Creating Room Without Extractions

Thanks to today’s technology and a philosophy that favors preservation, most orthodontic crowding and bite issues can be solved without permanent tooth removal.

At OrthoWorks, we employ a range of advanced, evidence-based techniques:

1. Palatal Expansion

What is it?
Palatal expansion gently widens the upper jaw.

Benefits:

• Broadens the dental arch, creating space for crowded teeth
• Can enhance nasal airflow and breathing
• Encourages healthy facial and jaw development in kids
• Frequently eliminates the need for tooth extractions later

This method is especially effective for growing children, whose jaws can adapt and widen naturally.

2. Early Interceptive Treatment

Following American Association of Orthodontists guidelines, we recommend evaluating children around age 7.

Why so young?

• Allows early monitoring of jaw growth and tooth eruption
• Detects crowding and bite issues before they worsen
• Guides jaws to develop in a healthier direction
• Can prevent more severe problems—and future extractions

Early treatment is never about jumping straight to braces. It’s thoughtful, targeted intervention: watchful waiting when appropriate, and timely action when it truly makes a difference.

3. Advanced Invisalign® and Braces Systems

Today’s orthodontic tools give us greater control and precision than ever before.

At OrthoWorks, we rely on:

• 5th-generation iTero® scanners
• Digital treatment planning for both Invisalign and braces

These technologies let us:

• Predictably widen arches
• Efficiently move teeth into alignment
• Avoid or minimize extractions in a wide range of cases

Having treated over 10,000 Invisalign patients, we bring extensive experience in using clear aligners to resolve even complex issues—while keeping permanent teeth intact.

4. Moving Posterior Teeth Back: Creating Space, Preserving Teeth

Instead of pulling teeth to make room, we can:

• Gradually shift back teeth (molars and premolars) farther toward the rear of the mouth
• Open up valuable space for crowded front teeth

This careful, controlled method:

• Preserves every tooth
• Helps maintain facial fullness and lip support
• Delivers a broader, more vibrant smile

5. Shaping Arches to Their Natural, Ideal Form

Often, crowding isn’t about having “too many teeth”—it’s about having arches that are too narrow or constricted.

By gently broadening the arches to their correct, natural form, we can:

• Relieve crowding
• Avoid most permanent tooth extractions
• Enhance smile width and fullness
• Support healthy tongue posture and airway function

Our overarching goal: collaborate with your anatomy instead of removing healthy teeth.

When Tooth Extractions are Still Necessary

Our strong bias is for preservation, but in rare and severe situations, extractions may be considered. Examples include:

• Significant dental protrusion (front teeth flared far forward)
• Extreme crowding without other viable solutions
• Major skeletal imbalances between upper and lower jaws

Even in such cases, we:

• Conduct rigorous, individualized assessments
• Carefully plan to protect your facial balance and profile
• Minimize any impact on appearance or airway health

In short? Extractions are never our default—they’re only a last resort.

Why Patients and Families Trust OrthoWorks for Non-Extraction Care

With 40+ years of experience and more than 10,000 Invisalign cases to our name, OrthoWorks Orthodontics Group is a recognized leader in non-extraction orthodontics.

Our approach delivers:

• Natural, fuller smiles tailored to your face
• Healthier airway development and easier breathing
• Better facial balance with optimal lip support
• Long-lasting bite stability
• Minimally invasive treatment for adults and children

Many families come to us after being told permanent teeth “must” be removed elsewhere. In numerous cases, we create personalized, innovative treatment plans that:

• Preserve every natural tooth
• Solve bite and crowding problems
• Enhance both looks and health

Thinking About Extractions? Get a Second Opinion Before Deciding

If you or your child has been advised that extractions are your only option, it’s smart to explore alternatives.

At OrthoWorks, we offer:

• Comprehensive, thoughtful consultations
• Clear explanations of why extractions were recommended
• Honest assessments of whether a non-extraction strategy would work for you

We’ve helped many patients who thought they had no choice but to lose teeth—only to find a better solution that keeps their smile whole.

Curious about your options?
Reach out to OrthoWorks Orthodontics Group today to schedule a consultation or second opinion. Let’s keep your smile—and your health—intact, with results you’ll love for years to come.