Invisalign Protruding Mouth Extraction Orthodontics: Replacing Missing Wisdom Teeth Without Implants

Hello,

This is Apgujeong Invisalign Orthodontic Clinic.

How nice would it be if, when a tooth is lost due to cavities or other reasons, orthodontic treatment could be used to replace the lost tooth?

Especially if the lost tooth is a molar? A wisdom tooth can be used to replace a molar.

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Today, I’ll talk about an orthodontic case in which a protruding mouth was improved by using the wisdom tooth space without extracting the premolars, while at the same time moving the wisdom tooth to replace the missing molar.

See for yourself how Invisalign can now do more than just premolar extraction orthodontics.

23.10

This is a patient in their 30s who came in for orthodontic treatment in October 2023.

The front teeth are protruding, and there is a missing space on the left molar side.

The lower front teeth are crooked and need space for alignment.

The first upper molar has been extracted on one side, and on the other side it has not yet been extracted, but an extraction diagnosis has already been made.

This patient actually came in for an orthodontic consultation four months earlier.

23.06

Looking at the panoramic X-ray from that time, the upper molars were in poor condition, so extraction had already been diagnosed.

In the meantime, the patient returned after having the teeth that needed to be removed extracted.

Considering the patient’s protrusion, premolar extraction orthodontics would have been appropriate, but the patient did not want premolar extraction.

Non-extraction protrusion correction using only the wisdom tooth space, without premolar extraction, may not have a dramatic effect, but when two molars have already been lost to cavities, premolar extraction can feel like a burden.

Taking the patient’s wishes into account, we developed a treatment plan.

For the upper jaw, we planned to remove the two first molars that needed to be extracted, close the spaces, move the front teeth backward, and bring the wisdom teeth forward to the molar position to replace them.

This way, the missing molar spaces can be finished orthodontically without implants, so it is a two-for-one solution.

For the lower jaw, we planned to extract both wisdom teeth and move the teeth backward using the wisdom tooth spaces to bring the front teeth back.

When premolar extraction orthodontics is done with Invisalign, we usually explain that it takes 2 to 2.5 years, but because the molar extraction spaces are more than 1.5 times larger than premolar extraction spaces, we explained a treatment period of 3 years.

In the end, thanks to the patient wearing the aligners well, treatment was completed in under 2 years.

The first set consisted of 49 aligners.

An orthodontic screw was placed, and the lower jaw was moved backward.

For the upper jaw, attachments were placed in various locations to minimize molar tipping, and space closure continued.

While wearing aligner 38, the molars tipped significantly, so treatment was paused and new aligners were made.

This is how it looked at the time of remaking.

24.07

The front teeth alignment improved.

The extraction spaces for the molars had decreased significantly, but

molar tipping was visible.

In Invisalign extraction orthodontics, when tipped molars need to be uprighted, braces and wires are sometimes used, but if possible, I prefer to finish the case through remaking.

24.07

The treatment plan was revised, and from August 2024, additional aligners began to be worn.

The number of additional aligners was 31.

This is the condition after wearing all 31 additional aligners from August 2024 to April 2025.

25.04

The midline is well aligned, but there is still a small gap between the front teeth.

Also, the black triangle between the upper front teeth is noticeable.

The extraction spaces have been cleanly closed.

The alignment looks good.

25.04

The tipped molars have been uprighted well, but one side still needs further improvement in molar occlusion.

To resolve the small gap, black triangles, and improve molar occlusion, a second round of additional aligners was made. After wearing all 14 additional aligners from May 2025 to August 2025, treatment was completed.

25.08

The midline matches and the bite is good.

The tooth in the position of the second molar, indicated by the blue arrow, is actually a wisdom tooth.

The tooth now in the position of the first molar in front of it is actually the second molar.

Now let’s look at the before-and-after comparison.

The total treatment period was 1 year and 10 months, and remaking was done twice.

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The extracted molar spaces were seamlessly replaced by the second molars and wisdom teeth behind them.

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Now let’s look at the facial comparison.

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Being able to close the lips comfortably is one of the major functional effects of protrusion correction.

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A neater smile

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The teeth were aligned well without tipping, and the root parallelism is good.

There is no root resorption.

Invisalign orthodontic treatment seems to cause less root resorption than Clippy-C orthodontic treatment, by feel, less than one-tenth as much.

As the protruding front teeth improved, it became much easier to close the mouth.

Invisalign extraction orthodontics is a treatment that works very well, and even molar extraction spaces can be resolved without problems. Of course, this is under the assumption that the patient wears the aligners well. I hope this post is helpful to those who are upset about losing molars.