3 very different consults (pics) - Edit: Now 6 consults

[mikey]

Hi, I've been lurking on this site for a while, and posted once in the ask a doc forum about the AAO (American Association of Orthodontists).

here are my teeth (note that while you can't really see them in the picture, I have my wisdom teeth):



I've now been to consultations with three orthos, and each recommended something very different. As you can see from the pics, I am class I on the right, and class II on the left (so my bite is half-good). It seems that my upper crowding is considered moderate (though I would have thought it worse than that). 5mm overjet.

Anyway, the first ortho suggested 3 extractions (2 upper bicuspids, and a lower on the right). 24 months estimated treatment. ~$3400 for metal braces (not including extractions).

The second ortho suggested 1 extraction (the bicuspid behind my canine on the upper left). He stated that while he thought it would be possible to treat without any extractions, it would cause my front teeth to push forward "too much". 18 months estimated. ~$4400 for metal.

The third ortho suggested no extractions. Says crowding is only moderate and, while treatment would cause my upper teeth to protrude a little more, it would be only a few mm, and that my face would accommodate it (lips full enough, etc). Says would create a broad smile. Suggests (1) Could do uppers only (not fixing bite but fixing smile) for $3200 and 9 months, (2) uppers and lowers for 9 months for $4500 not fixing bite, (3) uppers and lowers for 2 years for $4500 pulling in overjet with rubberbands, or (4) invisalign ~$5000 and 15 months.

What do you all think? Right now, I'm not really considering the invisalign option (though I was surprised that it was given as an option).

[starryadora]

Being someone that has perfectly straight teeth but bite problems, I would say don't just get the nice smile...get the bite fixed too! Might as well go all the way if you are shelling out the money.

[mikey]

Being someone that has perfectly straight teeth but bite problems, I would say don't just get the nice smile...get the bite fixed too! Might as well go all the way if you are shelling out the money.

Thanks for the comments ... I just took a look at your thread and your teeth really do look nice ... I hope your bite issues are fixed quickly.

It gives me something to think about, but I am currently considering the smile option because my bite seems fine to me. If I hadn't started exploring the option of braces, I wouldn't have known that there was an issue at all.

Has anybody here tried braces for a shorter period of time just for cosmetic reasons? I assume that the smile option would be something like what invisalign tries to do, but quicker and with more control by the ortho (so perhaps more likely to succeed).

[mikey]

Hi KK. Thanks for the comments. I have been keeping notes on each ortho. And their offices and personalities seem as different as their treatment plans. I'm going to go for a fourth consult tomorrow ... maybe that will make the vote 2-1-1 instead of a three-way split.

Good on you for getting three consults mikey ... and you sure got a mix!

Yes I did, it's amazing ... so far the statement about "20 orthos having 20 conflicting opinions" seems to be holding.

[Chris]

Here are my thoughts and I'm just another "braceface" who had different options from different orthos like you and had to make a decision on which route to go.

Personally, I think they can fix the bite better when they do extractions.

Without extractions, they can straighten teeth but you really have to consider whether you want a fuller feel to your teeth.

I went the non-extraction route and its taken me quite a while to get use to the fuller feel (teeth flaring outward). I chew food a bit differently now.
Mind you, even now I'm glad I didn't have extractions, but the feel inside my mouth is really different than before.

Your profile is another consideration. Extractions can make your face look sunk in and cause gaps to reappear (as I've read from others). They look at your nose, chin, etc. to determine which is the best way to go.

This is a tough decision, if you feel you can't make it, go get a 4th and 5th opinion. Ask the orthos to show you before and after photos of their patients and ask for similar cases and what the outcome would look like.

Above all, find an ortho who doesn't mind spending time with you answerings LOTS of questions. You will be "married" to him for awhile, you don't want to leave with "irreconcible differences".

[mikey]

Hi Chris. Thanks for the comments ... you raise a number of interesting points ... I think I will ask for before/after pictures similar to my case once I narrow down my choice a bit more.

Your comments about the "fuller" feel of flared teeth are very interesting. Do you happen to have pictures of your arches? I tried a search for such a post by you ... but you've posted so much!

In your case, did the nonextraction treatment result in a broader smile?

[ingyandbert]

1. Get the bite fixed. If you don't, it's only going to cause you problems down the road. You may be at risk for a painful TMJ problem or at the very least uneven wear on your teeth which may cause premature tooth loss. Who knows? It's not worth the risk.

2. I would avoid extractions. Looking at your photos, your teeth are not that bad overall. If you can avoid losing any teeth, then do so. You don't know what the future holds; keep as many natural teeth as long as you can.

Personally, I would stay away from the Invisaligns. I've heard they're best suited for cases of minor teeth correction, not moderate correction like yours. The bottom line is I'd go back to whichever ortho said he/she would do uppers and lowers and ask them for an estimate including bite correction. If they won't do it, then get yet another estimate that includes that. I can't imagine why any ortho would not want to correct a significantly misaligned bite.

[Chris]

Hi Chris. Thanks for the comments ... you raise a number of interesting points ... I think I will ask for before/after pictures similar to my case once I narrow down my choice a bit more.

Your comments about the "fuller" feel of flared teeth are very interesting. Do you happen to have pictures of your arches? I tried a search for such a post by you ... but you've posted so much!

In your case, did the nonextraction treatment result in a broader smile?

The only photo of my arch I have shows horrible tea stains on my teeth. I'm too embarrassed to post them. My teeth originally were sunken in and the ortho brought them forward with no extractions. I had some rotated teeth like yours and one side of my bite was perfect and the other not, just like yours. Currently, the ortho is still working on my bite.

I like the way it looks when I smile, but as I mentioned, the bite takes a while to get use to. When your "almost 50" like me, you had plenty of time with the "old mouth" no matter how jumbled it was...getting your teeth straight and normal feels awkward. Everyone tells me I look great but the feeling inside feels abnormal. Thats the best way I can explain. I have seen photos of some people where the flare is way too much, I don't have that and the flare I have now should be lessened when the powerchains come into play closing some of the gaps that have been created while straightening the teeth. I'm still a work in progress.

[Chris]

Just a side thought, that fuller smile means you will feel your teeth more against your lips. That is something I never really felt before.

[mikey]

I just had consultation number 4. It was very interesting. This ortho explained a few things very well.

Essentially, the ortho recommended that I have 1 extraction (just like my second consult). However, the ortho explained that the purpose of the extraction would not be to correct my bite. Essentially, the class II on the left is a stable class II. Trying to move my teeth back to achieve class I would take a long time (much longer than the 18 to 24 month estimate the ortho gave me for the normal treatment), and would be difficult due to the fact that I have my wisdom teeth (moving 3 molars takes time).

It seems the goal is to achieve a class I relationship with the canines (while maintaining a stable bite). I'm guessing that this is actually the second ortho's plan as well.

Based on this, trying to straighten my teeth without any extractions would leave my front teeth in a class II (overbite relationship), and this ortho claims that it in this case, it would look like I have buckteeth.

BTW, this ortho claims to try to avoid extractions whenever possible.

[jaswi]

A little bit of a thread hijack here. I went to two orthos and both seemed really interested in the fact that I had my wisdom teeth in good. The ortho I'm going with even went as far as to ask me to open my mouth again to see my wisdom teeth just because he wasn't used to seeing them. I love that guys candidness, at least part of the reason why I went with him.

Oh, I have a close situation to you. Bite is fine on the left, class 3 on the right, with 'barely severe' crowding top and bottom. First ortho recommended extractions right off the bat, second one said he'd like to try to fix without extractions, and think about extracting 1 or 2 on the bottom if it causes too much flaring. Seems to me that if feasable, any good ortho should try the no-extraction approach first. It may lengthen treatment somewhat if you need extractions, but at least you get all your teeth still.

[dbagnell]

It's possible that the ortho who suggested no extractions was planning to hook you up with some damons, you rarely need extractions with damons from what I've heard. Good luck with your decision.

[mikey]

It's possible that the ortho who suggested no extractions was planning to hook you up with some damons, you rarely need extractions with damons from what I've heard. Good luck with your decision.

Thanks Denise.

The subject of damons is something I'm interested in. I also would've thought that perhaps that ortho was going to use damons, but I asked, and my choice is either normal metal or ceramics (both made by 3m). I saw the brackets. I didn't specifically ask about damons however, but it was clear that that ortho did not use them.

It turns out that all four orthos are using brackets with ligs. The only slightly weird case is the first (with the most extractions!), where the ortho is using "light force" techniques which are related to Begg techniques. I googled Begg, and it turns out that he was one of the people instrumental in the shift from nonextraction treatment to extraction treatment. Now the trend has shifted back it seems.

I am going to see an ortho who uses damons on Tuesday, and I'll report back on what I hear.

BTW, anybody have a recommendation for a damon ortho in the Pittsburgh area? So far I've found the AAO website (braces.org) to be the most useful source of information, since it allows you to search by distance and displays the universites attended. However, it doesn't have any information beyond that, such as the types of brackets used. I'm also hopeful that the damon website actually will have an ortho locator after May 1st, like they claim.

[missingu]

I have called Ormco (Damon's parent company) directly and found that people were more than willing to talk to me, and I clearly identified myself as a patient and not an ortho. Ormco's general phone number is 800-854-1741 and their hours are 6:00 am to 5:00 pm Pacific Time, US.

Their web site (www.ormco.com) has a lot of information on Damons, once you get past the main screen. It is very informative, but also exceedingly salesy. However, it is no secret that I was not happy with my Damons so I doubt any one is surprised that I am a bit cynical of their approach to marketing braces. However, the information is good for you to make your decision.

One caveat - if an ortho suggests Damons, ask very specific questions about the retention phase, I mean down to missing just a few nights. This is not my Damon-bashing, this came direct from an ortho who was discussing how Damons work but how the success can be "fragile." Just a head's up.

[Flora2006]

I won't really comment on which ortho sounds better and whatnot just because each has their own reason to do and say what they would do...

I just wanted to say that it's a good thing you are seeing a lot of orthos and get the feel of them and all. My biggest advice is that you chose someone that is nice and who you will feel comfy with.

You will be in braces for a long time thus seeing your ortho practically every month...so choose one that no only are you happy with the treatment plan, but happy with how he/she seems to be.

Good luck with the consultation on tuesday! Report back