Invisalign with Extractions

Discussions about treatment with invisible braces that use clear aligners, such as Invisalign, OrthoClear, the Red White and Blue system, etc.

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Invisalign with Extractions

#1 Post by junebugls »

Hey guys!

I have mild crowding in my top teeth and had braces when I was 14 to correct two butterfly front teeth. At the time, my Mom was very against extraction of healthy teeth and urged my ortho to come up with a plan that didn't require extractions. He warned that the results will not be as perfect if I didn't get extractions but we chose to go with no extractions anyway. I ended up getting the top arch expanded to correct the butterfly teeth. The result was that my teeth protruded slightly (not too noticeable) but the ortho was right in that the results weren't perfect.

I'm now 25 and my teeth have been moving back to their original positions, probably because of a lack of space to begin with. The teeth on the side are moving back to the original arch circumference so the two front teeth are going back to the butterfly position. I ended up seeing a new ortho to get invisalign a couple of weeks ago and she told me basically the same thing - that she can realign them back to post braces at 14 or I can get 4 premolars extracted to get a more 'perfect' smile. I didn't want to go through this again so I opted for the extractions (without parental interference this time! :p).

I'm currently on my second set of aligners and have done more research on invisalign with extractions. It seems that very few providers offer invisalign with premolar extractions so I'm just curious whether anyone has done it before on this forum (either finished with the aligners or with some visible progress)? I did raise the concerns with my ortho and she said that she was confident with extraction cases and is a premium provider. She said that orthos who say aligners aren't for extraction cases are usually those who are used to using braces and are more confident with those methods. What do you guys think?

I guess at this point since I've already had the extractions and paid more than 60% of the entire cost it's too late to go back but would really like another opinion in case I need to ask her to change to traditional braces. Thanks!

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Re: Invisalign with Extractions

#2 Post by DrJasonKTam »

Extractions with Invisalign are an advanced movement. It also depends on the initial situation with the extractions, and which teeth are being removed.

For removal of 4 premolars with minimal crowding using Invisalign would be a treatment plan that is one of the highest levels of difficulty. There would be only a small number of doctors in the world who have the proper knowledge and experience to complete such a treatment. Good luck and keep us posted!
Dr. Jason Tam
Toronto Invisalign, Scarborough braces, and Markham Orthodontist
Diamond Plus Invisalign Provider
Thrice Published in the Invisalign Case Gallery

Learn all about Toronto Invisalign at

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Re: Invisalign with Extractions

#3 Post by lilymouth »

Hey junebugls,

I've signed up for Invisalign with 4 2nd premolar extractions. I haven't started the treatment yet but I have committed to it (and paid a lot!).

My orthodontist seems confident that he can do it with Invisalign, but like you I also had some doubts (due to the lack of people doing the same thing). My ClinCheck video show my front teeth straightening, and then my back teeth being moved forward to close the gaps. I was very surprised that this was possible with Invisalign. How are your gaps being closed? How are you getting on with it?

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Re: Invisalign with Extractions

#4 Post by EmbracingFreedom »

Hi Junebugls,

What a coincidence! I also have two butterfly teeth and some upper teeth crowding.

I've been going to numerous consultations and the orthodontist I spoke to today recommended a similar action. Since I really wanted Invisalign, he was confident that Invisalign would be able to provide the same results as traditional braces. He gave me one of two options:

1. Don't extract any teeth. Shave some of the teeth to get the desired size and then go straight to Invisalign for 18-24 months.

2. Extract (4) teeth in the back and make some room. He will then use partial braces at the back (with no invisalign yet) for 4-6 months to shift some teeth, then Invisalign afterwards for 18-24 months.

He did mention that the second option could provide a fuller smile, but an x-ray would be able to give him a better opinion. Looking forward to sharing our experiences together!

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Re: Invisalign with Extractions

#5 Post by EmbracingFreedom »

To specify, for my second option, my orthodontist wanted to remove my second biscupids. My upper right second biscupid was very inalign as well so it makes more sense to remove those too.

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Re: Invisalign with Extractions

#6 Post by junebugls »

Thanks for the replies everyone.

To lilymouth:
I’m currently on my 7th tray and 2.5 months in. I have 43 aligners altogether, which will amount to 2 years of treatment excluding refinements. So far, I can visibly see movement from the 4 canines and the 4 2nd premolars directly adjacent to the extraction sites (1st premolars extracted) to close the extraction gaps. There has been no movement otherwise in the front teeth, which are the problem teeth.

My orthodontist has explained that I would not be able to see much improvement in the problem front teeth until around 6 months in. This is because my treatment plan involves closing the extraction sites first before movement in the front. In my clinicheck, it seems that most of the movement will be drawing my front teeth toward the back rather than pulling the back teeth to the front.

Since I was a little uneasy about the extractions going into this treatment, I asked my orthodontist to show me cases that she’s treated before that involved 4 premolar extractions and invisalign. I’m more confident now that I’ve seen these completed cases, some of which looked like they required much more movement than mine. They were completed entirely with invisalign. I suggest you ask your orthodontist to do the same if you are worried! My concern right now is more about my facial structure and whether that would change dramatically with 4 extractions..... I guess I’m just a worry wart!

To EmbracingFreedom:
Are you Asian by any chance? The reason I ask is because I see a lot of Asian people having this problem and I’m Asian myself.
My first treatment plan sans extractions was also estimated for 18-24 months. If I had not had braces as a teenager then I might have gone with this plan since it’s just so much less invasive. The only reason I chose the extractions was because again, my new orthodontist informed me that it would not be “super perfect” and I really didn’t want to go through any more orthodontic treatments!

I think having a full smile is really important and makes you look so much better. I’d definitely go for whatever plan gives the best ‘full smile’! If your orthodontist is willing to move teeth with braces first and you’re ok with wearing braces for a few months, I’d probably take that option. Let’s see what your ortho says though. ;)
Wish you all the best of luck with your treatments and keep updating me! :)

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Re: Invisalign with Extractions

#7 Post by Melayie »


I just got back from my ortho appointment and I'm really worried about getting my 4 premolars extracted. And having those gap for more than 24 months. Is it very noticeable for you? I made a downpayment and I'm regretting it.

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Re: Invisalign with Extractions

#8 Post by anoopbal »

Those close pretty fast in a few months. How are the teeths closing?

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Re: Invisalign with Extractions

#9 Post by ElJefe »

I had prior extractions of two lower premolars. Thatvwas years ago. I wanted to close the spaces so I consulted with an orthodontist. He said he could close the spaces with Invisalign. I’m on my sixth tray and so far I don’t see much movement. Is this unusual?

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Re: Invisalign with Extractions

#10 Post by kojo »

I have done a extraction but my doc did not recommend invisalign for this kind of treatment.

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