Wondering whether your wisdom teeth need to come out before starting clear aligners? Learn how wisdom teeth affect aligner treatment, when removal may be recommended, and what your clinician will assess.
It is one of the most common questions people ask before starting aligner treatment: do my wisdom teeth need to be removed first? The short answer is — it depends. Some patients can proceed with clear aligners without any issues from their wisdom teeth, while others may benefit from having them removed before, during, or after treatment. This guide explains how wisdom teeth interact with aligner treatment, what your clinician will look for, and how to make sense of the options.
📌 TL;DR
Not everyone needs their wisdom teeth removed before starting aligners. It depends on whether the wisdom teeth are impacted, partially erupted, or causing crowding or other problems. Your clinician will assess this with a 3D scan and clinical examination. In some cases removal is recommended before treatment; in others, wisdom teeth can stay throughout. Never assume — a proper assessment is the only reliable way to know.
Who This Guide Is For
This article is for UK adults who are considering clear aligner treatment and have questions about their wisdom teeth. It may be particularly relevant if you:
- Still have some or all of your wisdom teeth and are wondering whether they will affect treatment
- Have been told you have impacted teeth and want to understand what that means for aligners
- Are researching invisible braces and want to know what assessments are needed before starting
- Have noticed your wisdom teeth are causing crowding or discomfort and wonder whether aligners could help
- Had wisdom teeth removed previously and want to know if that affects your suitability for aligner treatment
⚠️ When to See Your Dentist First
If you are experiencing pain, swelling, or infection around a wisdom tooth, please see your dentist before exploring orthodontic treatment. Acute wisdom tooth problems need to be addressed on their own terms. This article discusses planning considerations, not emergency care.
Key Definitions in Plain English
Wisdom Teeth (Third Molars)
Wisdom teeth are the last set of molars to develop, typically appearing (or attempting to appear) between the ages of 17 and 25. Most people have four — one in each corner of the mouth — though some people have fewer or none at all. They are called wisdom teeth simply because they emerge later than all other teeth, at an age historically associated with gaining maturity.
Impacted Wisdom Teeth
An impacted wisdom tooth is one that does not have enough room to emerge fully into the mouth. It may be completely buried within the jawbone (fully impacted), partially through the gum (partially erupted), or growing at an angle towards the neighbouring tooth. Impacted wisdom teeth are extremely common — many adults have at least one — and they do not always cause problems or need removal.
Pericoronitis
Pericoronitis is inflammation or infection of the gum tissue surrounding a partially erupted tooth, most commonly a wisdom tooth. The flap of gum over a partially erupted wisdom tooth can trap food and bacteria, leading to pain, swelling, and sometimes infection. It is one of the most common reasons wisdom teeth are recommended for removal.
Other Terms You May Encounter
- Mesioangular impaction: When a wisdom tooth is angled towards the front of the mouth, pressing against the tooth in front of it. The most common type of impaction.
- Distoangular impaction: When a wisdom tooth is angled towards the back of the jaw.
- Horizontal impaction: When a wisdom tooth lies on its side within the jawbone.
- Attachments: Small tooth-coloured composite bumps bonded to teeth during aligner treatment to help the trays grip more effectively for controlled movements.
- IPR (Interproximal Reduction): Carefully removing tiny amounts of enamel between teeth to create space for alignment. A routine part of many aligner treatments.
- Refinements: Additional sets of aligner trays produced after the initial series to fine-tune the result.
- Retainers: Custom-made devices worn after treatment to hold teeth in their new positions.
- 3D scan: A digital impression of your teeth using an intraoral scanner, forming the basis for treatment planning.
- Tracking: How closely your actual tooth movements follow the planned movements during treatment.
- Wear time: The recommended number of hours per day aligners should be worn — typically 22 hours.
What Causes Wisdom Tooth Problems
Understanding why wisdom teeth cause issues helps explain their relevance to aligner treatment:
Space
The most fundamental issue is space. Modern human jaws are generally smaller than those of our ancestors, but we still develop the same number of teeth. By the time wisdom teeth try to emerge, there is often insufficient room at the back of the dental arch. This lack of space leads to impaction, partial eruption, or the wisdom tooth pushing against adjacent teeth.
Angle of Eruption
Even when some space exists, wisdom teeth frequently emerge at angles rather than straight up. They may tilt forwards into the neighbouring molar, backwards, outwards towards the cheek, or inwards towards the tongue. An angled wisdom tooth cannot function as a useful chewing surface and may damage adjacent teeth or create areas that are difficult to clean.
Partial Eruption
When a wisdom tooth only partially breaks through the gum, the remaining flap of gum tissue creates a pocket where food debris and bacteria accumulate. This is difficult to clean effectively and frequently leads to recurrent episodes of pericoronitis — inflammation and infection that causes pain, bad taste, and swelling.
Late Development
Because wisdom teeth develop and erupt later than other teeth, they can disrupt an otherwise stable dental arrangement. A wisdom tooth that begins pushing through in someone's twenties can exert pressure on the teeth in front of it, potentially contributing to crowding or shifting — though the extent of this is debated among dental professionals.
Do Wisdom Teeth Affect Aligner Plans? Common Scenarios
How your wisdom teeth interact with aligner treatment depends entirely on their specific situation. Here are the most common scenarios your clinician will consider:
💡 The Crowding Debate
There is ongoing debate within dentistry about how much wisdom teeth contribute to front-tooth crowding. Some research suggests the link is weaker than commonly believed, while clinical experience shows that wisdom teeth can certainly exert pressure on adjacent teeth. Your clinician will assess your specific anatomy rather than relying on generalisations. This is one of many reasons a 3D scan is so valuable — it shows exactly what is happening beneath the surface.
What Clear Aligners Can Do (and What They Cannot)
What Aligners Can Do
- Straighten teeth after wisdom tooth removal: Once wisdom teeth are removed and the extraction sites have healed, aligners can proceed as normal
- Address crowding: Aligners can resolve crowding using a combination of arch expansion, IPR, and controlled tooth movement — with or without wisdom tooth removal
- Work around fully erupted wisdom teeth: If your wisdom teeth are upright and well-positioned, aligners can often be designed to work around them
- Correct bite issues: Overbite, crossbite, open bite, and other bite problems can be addressed by aligners regardless of wisdom tooth status, provided the clinical picture supports it
- Use gained space: If wisdom teeth are removed to create space, the treatment plan can incorporate that space for better alignment outcomes
What Aligners Cannot Do
- Move impacted wisdom teeth into position: Aligners cannot erupt or reposition teeth that are buried in bone. This requires surgical intervention if clinically indicated.
- Prevent wisdom teeth from erupting: If wisdom teeth are developing and have not yet emerged, aligners will not stop them from coming through. Future eruption needs to be factored into the treatment plan.
- Treat infected or symptomatic wisdom teeth: Active infection, pericoronitis, or decay in wisdom teeth are dental problems that need separate treatment — aligners do not address these.
- Guarantee crowding will not recur: Even after alignment, if wisdom teeth later erupt or shift, they could contribute to future crowding. Retention is essential.
- Replace the need for extraction when indicated: If a clinician recommends wisdom tooth removal for clinical reasons, aligners are not an alternative to that recommendation.
How Treatment Typically Works: Step by Step
Here is what the process looks like when wisdom teeth are part of the conversation:
Step 1: Initial Assessment
A comprehensive examination including a 3D scan of your teeth and jaw. This scan reveals the position of your wisdom teeth — including any that are below the gumline — their angle, proximity to other teeth, and whether they are likely to affect treatment. X-rays may also be taken for a complete picture.
Step 2: Wisdom Tooth Decision
Based on the assessment, your clinician will advise whether your wisdom teeth need to be removed before aligner treatment can begin, can stay in place during treatment, or should be monitored and potentially addressed later. This decision is made on a case-by-case basis — there is no universal rule.
Step 3: Extraction and Healing (If Needed)
If removal is recommended, you will typically be referred to a dental surgeon or your general dentist for the extraction. Healing time varies but most patients can proceed to aligner treatment 4-8 weeks after uncomplicated wisdom tooth removal, once the extraction sites have healed sufficiently. Your clinician will confirm when it is safe to begin.
Step 4: Treatment Planning
A 3D scan (or updated scan if extractions changed the dental landscape) is used to design your digital treatment plan. If wisdom teeth were removed to create space, the plan will incorporate that space into the tooth movement strategy. Attachments and IPR will be planned as needed.
Step 5: Active Treatment
Wear your aligners for approximately 22 hours per day, changing trays every 1-2 weeks as directed. Maintain good oral hygiene — particularly important if you have wisdom teeth still in place, as keeping the back of your mouth clean requires extra attention. Attend monitoring appointments every 6-8 weeks.
Step 6: Refinements and Completion
Additional refinement trays may be needed to fine-tune the result. Once your teeth are in their final positions, retainers are fitted to maintain the outcome. If any wisdom teeth were left in place during treatment, your clinician will advise on ongoing monitoring.
Suitability Checklist
This general guide may help you understand where you might fall — but only a clinical assessment with imaging can determine your specific situation:
Timing of Removal: Before, During, or After Treatment
If wisdom tooth removal is recommended, the timing matters. Here are the considerations for each approach:
Removal Before Aligner Treatment
Advantages
- The treatment plan can be designed with a clear picture of the available space
- No risk of infection or complications disrupting treatment mid-course
- Extraction sites are fully healed before aligner forces are applied
- Space from extractions can be incorporated into the alignment strategy
- Simplifies treatment — fewer variables to manage
Disadvantages
- Delays the start of aligner treatment by 4-8 weeks (healing time)
- Involves a separate surgical procedure with its own recovery period
- The wisdom teeth may not actually be causing problems — removal may be precautionary rather than strictly necessary
Removal During Aligner Treatment
Advantages
- Treatment can begin sooner — no waiting for extraction healing first
- The clinician can observe how teeth respond to treatment and make a more informed decision about extraction
Disadvantages
- Post-extraction swelling and discomfort may make wearing aligners uncomfortable for a few days
- May require a pause in aligner wear during healing, potentially affecting tracking
- Treatment plan may need adjustment if extraction changes the dental landscape significantly
- More complex to coordinate — requires communication between your aligner clinician and surgeon
Removal After Aligner Treatment
Advantages
- No delay to starting treatment
- Teeth are straightened first; wisdom tooth decision can be revisited with more information
- May turn out that removal is unnecessary once alignment is complete
Disadvantages
- Risk that wisdom teeth interfere with treatment during the active phase
- If wisdom teeth later erupt or shift, they could displace newly aligned teeth despite retention
- A second round of treatment may be needed if wisdom teeth cause significant changes
Your clinician will recommend the most appropriate timing based on your specific clinical findings. In general, if wisdom teeth are clearly problematic, removing them before treatment tends to produce the most predictable outcomes.
Risks, Side Effects, and Limitations
Risks of Aligner Treatment Generally
- Mild discomfort: Pressure and slight soreness with each new tray — normal and usually settles within 2-3 days
- Initial speech changes: A slight lisp that typically resolves within a few days
- Temporary sensitivity: Some patients experience mild tooth sensitivity during active treatment
- Compliance-dependent results: Treatment relies on wearing aligners for 22 hours per day. Inconsistent wear leads to poor tracking and extended treatment times
Additional Considerations When Wisdom Teeth Are Involved
- Extraction recovery: Wisdom tooth removal involves a healing period. Surgical extractions (for impacted teeth) may cause swelling, discomfort, and limited mouth opening for 1-2 weeks. This needs to be factored into the treatment timeline.
- Dry socket risk: A small percentage of wisdom tooth extractions result in dry socket (alveolar osteitis) — a painful condition where the blood clot is lost from the extraction site. This delays healing and can delay aligner treatment start.
- Nerve proximity: Lower wisdom teeth sit near the inferior alveolar nerve. In rare cases, extraction can cause temporary or (very rarely) permanent numbness or tingling in the lower lip and chin. Your surgeon will assess this risk using imaging before proceeding.
- Unpredictable eruption: If impacted wisdom teeth are left in place, there is no way to guarantee they will not begin erupting during or after aligner treatment, potentially disrupting results.
- Space management: If wisdom teeth are removed to create space, managing how that space closes during treatment requires careful planning to avoid unwanted tooth movements.
Limitations
- Aligners cannot move impacted wisdom teeth into functional positions
- Aligners do not treat wisdom tooth infections or decay
- Some complex cases may require fixed braces rather than aligners, especially when significant space management is needed after extractions
- Results depend on proper retention after treatment — wisdom teeth erupting later can still displace aligned teeth if retainers are not worn consistently
How Long Treatment May Take
Treatment duration depends on the complexity of your alignment needs, not specifically on whether wisdom teeth are involved. However, wisdom teeth can add time to the overall process:
What Can Change the Timeline
- Extraction healing complications: Dry socket or infection after extraction can delay the start of aligner treatment
- Compliance: Wearing aligners for the full 22 hours per day is essential for maintaining the treatment schedule
- Tracking issues: If teeth are not moving as planned, mid-course corrections may add time
- Refinements: Most moderate-to-complex cases require at least one round of refinement trays
- Late wisdom tooth eruption: If a wisdom tooth begins erupting during treatment, the plan may need adjustment
Costs in the UK
The cost of aligner treatment is based on case complexity, not on whether wisdom teeth are involved. However, wisdom tooth extraction is a separate cost that may need to be factored in:
What Drives Aligner Treatment Costs
- Case complexity — mild alignment vs comprehensive bite correction
- Number of aligner trays required
- Whether refinements are included in the treatment package
- Retainer costs (included or separate)
- Provider location and clinical expertise
- Level of monitoring and clinical support included
Wisdom Tooth Extraction Costs
- NHS: Wisdom tooth extraction may be available on the NHS if clinically indicated (Band 2 or Band 3 depending on complexity)
- Private: Private extraction costs vary depending on whether the tooth is erupted or impacted, and whether specialist surgical referral is needed
- Note: These are separate costs from aligner treatment and are typically handled by a different provider (your general dentist or an oral surgeon)
For a transparent breakdown of aligner treatment costs, you can review our pricing. We always recommend confirming what is included before committing to any treatment plan.
How to Keep Results: Retention and Aftercare
Retention is important for every orthodontic patient, but it is particularly relevant when wisdom teeth are in the picture:
Retention Essentials
- Fixed retainers: Thin wires bonded behind the front teeth providing continuous, passive retention
- Removable retainers: Custom-made clear trays worn nightly to maintain alignment
- Combination approach: Many clinicians recommend both for the most reliable long-term stability
Wisdom Teeth and Retention
- If wisdom teeth remain: Continued monitoring is important. If they begin to erupt or shift after treatment, they could place pressure on the aligned teeth. Regular dental check-ups will catch any changes early.
- If wisdom teeth were removed: The extraction sites will have fully healed and should not affect retention. Standard retention protocols apply.
- Retainer compliance: Wearing retainers consistently as directed is your best defence against any future tooth movement — including any pressure from wisdom teeth.
General Aftercare Tips
- Attend regular dental check-ups (every 6-12 months) including monitoring of any remaining wisdom teeth
- Maintain excellent oral hygiene — brush twice daily, floss, and clean retainers regularly
- Report any changes in tooth position, retainer fit, or wisdom tooth symptoms to your clinician promptly
- Replace removable retainers when they become worn, cracked, or loose
- If you notice a wisdom tooth beginning to emerge after treatment, schedule a review appointment
Frequently Asked Questions
Do all wisdom teeth need to be removed before aligners?
No. Many patients keep their wisdom teeth throughout aligner treatment without any issues. Removal is only recommended when the wisdom teeth are likely to interfere with treatment — for example, if they are impacted and pressing against adjacent teeth, partially erupted and prone to infection, or contributing to crowding. Your clinician will assess your specific situation with imaging.
Can I start aligners while waiting for my wisdom teeth to come through?
It depends on the position and trajectory of the developing wisdom teeth. If imaging suggests they will erupt into a position that does not interfere with treatment, you may be able to proceed. If they are likely to disrupt the planned tooth movements, your clinician may recommend waiting or having them removed first. This is a clinical judgement based on your individual anatomy.
Will wisdom teeth make my teeth crooked again after aligners?
This is a common concern but the relationship is debated. While wisdom teeth can exert some pressure on adjacent teeth, research suggests they may contribute less to front-tooth crowding than traditionally believed. That said, the risk is not zero — which is one reason why consistent retainer wear after treatment is so important. Retainers hold teeth in position regardless of any pressure from wisdom teeth.
How long do I need to wait after wisdom tooth removal before starting aligners?
Typically 4-8 weeks, depending on the complexity of the extraction and how you heal. Simple extractions of erupted teeth heal faster; surgical removal of impacted teeth may take longer. Your clinician will confirm when the sites have healed sufficiently for treatment to begin. Starting too early risks discomfort and complications.
Can I wear my aligners right after getting a wisdom tooth out?
If you are already in the middle of aligner treatment and have a wisdom tooth extracted, your clinician will advise on when to resume wearing your trays. In many cases, you can continue wearing them within a few days, as aligners typically do not extend back to the wisdom tooth area. However, if there is significant swelling or discomfort, a short break may be needed. Always follow your clinician's specific instructions.
What if only one or two wisdom teeth are problematic?
You do not necessarily need all four removed. Your clinician will assess each wisdom tooth individually. It is common for only one or two to require removal while the others are fine. The recommendation will be based on each tooth's position, condition, and potential impact on your aligner treatment.
Are impacted wisdom teeth always a problem for aligners?
Not always. Fully impacted wisdom teeth that are deep in the bone and not near the roots of adjacent teeth may have no impact on aligner treatment whatsoever. The key factors are position, proximity to other teeth, and whether they show signs of trying to erupt. Your 3D scan and X-rays will provide the information needed to make this assessment.
Can aligners create space for wisdom teeth to come through?
In theory, aligners could be designed to move teeth forward to create space at the back of the arch. However, this is not typically a treatment goal. Aligner treatment focuses on creating a well-aligned, functional bite — not on accommodating wisdom teeth. If wisdom teeth need to erupt, separate management (monitoring or extraction) is the usual approach.
Is wisdom tooth removal painful?
The extraction itself is performed under local anaesthetic (or sedation in some cases), so you should not feel pain during the procedure. Post-operative discomfort is normal and varies from mild soreness for a day or two (simple extractions) to more significant swelling and discomfort for a week or more (surgical extractions of impacted teeth). Pain relief, a soft diet, and following aftercare instructions help manage recovery.
Will my dental insurance cover wisdom tooth removal?
Many dental insurance plans in the UK cover wisdom tooth extraction if it is clinically necessary. Coverage varies by provider and plan. If removal is recommended on the NHS, it may be available at NHS rates. Check with your insurer or dentist before proceeding. Note that aligner treatment costs are typically separate from extraction costs.
📚 References and Further Reading
- NICE — Guidance on the extraction of wisdom teeth (Technology Appraisal TA1, 2000)
- Harradine NW, et al. — The effect of extraction of third molars on late lower incisor crowding: a randomized controlled trial, British Journal of Orthodontics (1998)
- Lindqvist B, Thilander B. — Extraction of third molars in cases of anticipated crowding in the lower jaw, American Journal of Orthodontics (1982)
- NHS — Wisdom Tooth Removal
- British Orthodontic Society — Patient Information
- GDC — Guidance on Advertising
Not Sure About Your Wisdom Teeth? We Can Help You Find Out
Book an assessment and our clinicians will examine your teeth — including your wisdom teeth — using a detailed 3D scan. We will explain exactly what is happening, whether removal is needed, and what your aligner treatment options look like. No obligation to proceed.
Book Your AssessmentDisclaimer: This article is for general information only and does not constitute dental or medical advice. Whether wisdom teeth need to be removed, and the timing of any such removal, can only be determined through an in-person clinical assessment by a qualified dental professional. Treatment suitability, timelines, and costs vary by individual case.
Written by Pro Aligners Team
Medically reviewed by Pro Aligners Team • GDC: 195843