Is it permissible to extract a supernumerary primary tooth and adjust the position of the permanent tooth, or is that considered altering Allah's creation?

There is no harm in extracting a primary (milk) tooth, as it falls under the category of need and is not considered an impermissible alteration of Allah's creation. Necessary and needed cosmetic surgery is permissible in Islamic law to restore the shape or function of body organs, to correct congenital or accidental defects that cause physical or psychological harm, or to remove disfigurement that causes psychological or physical distress. However, purely cosmetic surgeries that are not part of medical treatment and do not alter a person's natural, sound creation are not permissible.