It is recommended to take a delay of 7-10 days after extraction for impression making. This is the time in which the soft tissue changes normally occur.

Yes all four extraction case can be treated with aligner. In this case number of aligner sets will be increased compare to the non-extraction case. In case of single tooth extraction 30-35 sets of aligner may be needed and in multiple teeth extraction case 30 to 50 sets of aligner may be required. In extraction case of aligner duration of treatment will be longer it can take 1 to 1.5 years to complete the treatment or it depends on the severity of malocclusion & cost for the treatment will be more for extraction case of aligner.

• Socket preservation procedure have been introduced in order to reduce the amount of bone & adherent gum loss in the three dimensions. Socket preservation has shown to be a very valuable procedure. Severe crowding, thin periodontal tissues and dental protrusion are common condition that can lead to teeth extraction for orthodontic treatment success.

• Oral surgery standard extraction procedure have always advocated that, due to the labial position of the dentition in alveolar bone any tooth should be extracted following a pathway towards the thin buccal cortical bone , because lingual  cortical bone is  always wider and harder to allow root dislocation during an extraction procedure.

• In case of bicuspid extraction, first step consist of removing the mesial and distal contact point of the bicuspid.

• Secondly, elevator is placed, in the distal contact point of the bicuspid in order to loosen the tooth in a forward anterior direction.

• Only after the tooth has shown some root dislocation and mobility, the tooth can be loosened in backward posterior direction, limiting in way the amount of reaction force applied to the anterior teeth.

• In case of multi rooted tooth extraction, separation of roots is performed, In case of single root, as a lower bicuspid, the tooth is ready to be extracted.

• Special care at this point, is required to not dislocate root towards the labial bone. Clockwise alternated to contour clockwise movements gradually lead to root removal.

Do’s and don’ts after a tooth extraction-

Do’s –

•          Rest – try to do some rest after tooth extraction. You may feel great but don’t exercise for at least 24 hours. When resting keep your head slightly in upright position on the pillow.

•          Let it clot – let the clot be formed on the tooth extraction site, which covers it and allows to heal. After the procedure, your dentist will give you piece of gauze to bite on near extraction site. Try to bite down and keep it in place for at least a 1 hour afterward. This will put pressure over the extraction site and help it to stop bleeding. Make sure you don’t chew on gauze piece. If you can keep it in place longer that’s best but make sure to change the gauze after roughly every 30 to 35 minutes, depending on the amount of bleeding. Once clot forms it becomes dislodge the nerve endings then become exposed. The nerves and capillaries spams and constricts, limiting essential blood supply, which cause delay in healing. If the bleeding persist for a few hours after the procedure then try putting a wet tea bag on site.  Tannic acid in tea helps to aid in the clotting process.

•          Ice packs – apply an ice pack on the site where extraction was performed. This is done to reduce swelling. While on simple extraction swelling isn’t accompanied, in cases requiring severe cheeck retraction swelling can occur after the operation. The swelling after an extraction may not occur immediately but can continue to swell for few days, reaching a maximum at the 2nd or 3rd day. Application of the ice pack is most effective during the day of extraction as after 24 hrs there is no significant beneficial effect. Ice packs should be applied 15 minutes on the 15 minutes off for 1-2 hours’ time periods.

Don’ts

•          Don’t Smoke (the longer you avoid smoking, the better your healing will progress)

•          Don’t drink through a straw

•          Don’t Brush or rinse( from next day onwards you may brush your teeth, but avoid brushing near the surgical site for 3 days. gargling  with lukewarm saline water beginning 3 days after surgery)

•          Don’t spit excessively

•          Don’t drink hot liquids

•          Don’t chew from same side of mouth

•          Don’t eat hard crunchy foods such as a chips or nuts (you should have soft foods on the day of surgery and the day following surgery.)

• Extraction is indicated in certain cases like crowding of teeth, proclination of anterior teeth, and a very severe bite issue such as under bite, open bite or deep overbite. 

• Duration of treatment will be vary from patient to patient it can take 1 to 1.5 year & it is totally depend on the severity of malocclusion. For extraction case of aligner 40+10 sets of aligner may be required and it will depend on the number of tooth extracted. In case of single tooth extraction more than 30 sets of aligner may be needed and in multiple teeth extraction case more than 50 sets of aligner may be required.