Tooth extraction for braces

Page updated October 22, 2026.

Sometimes an orthodontist recommends removing one or more teeth before braces. The usual reason is space: if teeth are crowded, removing some can give the rest room to line up (Cleveland Clinic). It isn't always needed. Here is why it's done, which teeth are usually removed, what the research says about results, and what recovery and cost look like.

Why teeth are removed for braces

Crowded teeth are one of the reasons Cleveland Clinic lists for taking a tooth out (Cleveland Clinic). In orthodontics, Cleveland Clinic explains that when too many teeth contribute to a bite problem, you may need teeth removed before braces, which creates more space to position the remaining teeth correctly (Cleveland Clinic). Dentists and orthodontists prefer to keep natural teeth whenever possible (Cleveland Clinic), so it's worth asking what the alternatives are.

Removing a baby tooth is a different situation, for example to help a blocked adult canine come in; see impacted canine.

Which teeth are usually removed

The teeth most often studied are the first premolars, the teeth just behind the canines: the 2024 meta-analysis on this page compared four first premolar extraction (one from each side, top and bottom) with treatment without extractions (Elias et al., Angle Orthod). Your orthodontist chooses which teeth, if any, for your case.

Wisdom teeth are a separate question. Removing them is a decision for your dentist or oral surgeon and isn't the same as extraction to make room for braces.

What research says about extraction treatment

A 2024 systematic review and meta-analysis of 30 studies compared four first premolar extraction with non-extraction treatment (Elias et al., Angle Orthod). Most of the studies were retrospective and the certainty of evidence was low or very low, so treat these as tendencies, not guarantees:

The worry many people have, that extractions will flatten the face, isn't supported as a general rule: the measured lip changes were small and the smile scores didn't differ (Elias et al., Angle Orthod). Retainers matter either way, because teeth can keep moving after any treatment (AAO).

Extraction cases can be treated with aligners too, but in a 2023 review of premolar extraction cases, braces gave better tooth angles and bite contacts in a shorter time (Jaber et al., Cureus).

Alternatives to extraction

• Interproximal reduction (IPR). Removing small amounts of enamel between teeth, usually no more than 0.5 mm per tooth, to create space; Cleveland Clinic calls it less invasive than extraction. It's permanent, and the main risk is removing too much enamel (Cleveland Clinic)
• Expansion. A palate expander widens the upper jaw by widening the underlying bone, and the AAO lists crowding among the problems expanders treat (AAO). See palate expander and, for adults, MARPE
• Moving teeth back. TADs can be used to move back teeth backward (molar distalization) (Patel et al., Cureus)

Which option fits depends on how much space is needed and on your bite and face, so ask your orthodontist why they recommend one approach over another.

Recovery after an extraction

Extractions are done with local anesthetic to numb the tooth and gum, and sedation is an option if you're anxious (Cleveland Clinic). Cleveland Clinic says most people can return to routine activities within 48 to 72 hours, although the jawbone takes several weeks to heal completely, and up to 4 months for a large tooth such as a molar (Cleveland Clinic).

• Protect the blood clot that forms in the socket; it prevents dry socket (Cleveland Clinic)
• Don't drink through a straw, which can disrupt the clot (Cleveland Clinic)
• Don't smoke or vape, which shrinks blood vessels and slows healing (Cleveland Clinic)
• Watch for complications such as delayed healing, dry socket or infection, and call your dentist if you notice them (Cleveland Clinic)

How much do extractions for braces cost?

We haven't found a reliable published price for orthodontic extractions, so we don't give one. Insurance often helps: Delta Dental says most of its plans with orthodontic coverage include orthodontist-recommended extractions (Delta Dental), and in Delta Dental of Virginia's plans, teeth that need removing before braces may be covered under your basic or major dental benefits, or under the orthodontic benefit if they're needed for orthodontic reasons (Delta Dental of Virginia). Check your own plan, and ask whether the extraction is done by your dentist or an oral surgeon, because that sets who bills you. The AAO advises asking what an orthodontic fee includes (AAO).

Questions to ask your orthodontist

• Why do I need extractions, and what would happen without them?
• Which teeth, and who will remove them?
• Could IPR or expansion give enough space instead?
• How will extractions change my treatment time and my profile?
• Will insurance pay for the extractions under my dental or orthodontic benefit?