Often teeth cannot be straightened or moved to the "correct"
place without making some space into which the teeth can move. In some cases we use an appliance called a lingual arch to save what we term the E spaces. This appliance needs to be placed before the last of the baby teeth are lost. It can often give us enough space so teeth can be straightened without the need for extractions – but not in every case. Sometimes
"baby" teeth and sometimes adult or permanent teeth are removed.
This is usually done by the dentist under instructions from the orthodontist.
Unfortunately just because we create a space, teeth won’t necessarily move
into it and the most common method of getting teeth to move is "bands"
Orthodontists will sometimes be required to correct teeth adjacent to the space so either a bridge or an implant can be placed. An implant is now often preferred to a bridge as other teeth do not have to be especially prepared. An implant involves a metal titanium structure inserted into the bone with a metal-porcelain crown placed on top