Extractions, conflicting advice

[Crowded]

Hi, I'm a 30 year old from the UK who hates his crowded teeth and has finally decided to do something about them. For various reasons (and I'd be lying if I said vanity wasn't one of them) it's either lingual braces or nothing. So I did a bit of research and had consultations with three reputable/experienced etc orthodontists who specialised in lingual braces. The advice I got from them was basically the same (validity, treatment time, cost) except for one rather major point: extractions.


The first ortho said I needed two extractions on the right side of my mouth, one upper, one lower, most likely premolars, simply because there wouldn't be enough space to align them otherwise.

The second ortho said I wouldn't need extractions; the crowding would be dealt with by expanding the upper/lower arches.

The third ortho said I needed one extraction on the upper right side. In this case they said that removing my first molar would be most practical; to cut a a long story short only half of the original tooth is still there and it needs a root filling (which I have been putting off). So to remove a healthy premolar right next to that would seem a bit silly.


Also, after each ortho had given me their opinion, I asked what they thought of what the previous ortho/s had said. So obviously the first one had a bit of a disadvantage here, but hey.

The second ortho said that they didn't like to extract teeth and that the two extractions recommended by the first were unnecessary and might negatively effect my facial profile.

The third ortho said that the first ortho's opinion (two extractions) was valid and they could understand it, but that the third ortho's advice (no extractions) was very worrying. I think this was basically because after the braces came off, without extractions the teeth would not be able to maintain their straightened state (although there may have been other reasons; didn't get much info in writing).


So basically, seeing how many people here have had all kinds of treatments and the like, I was wondering if anyone had any thoughts on all this as I am not completely sure what to do. Thanks!

[200books]

Well, I am certainly not an expert, but have had a similar experience. I went to one ortho and he wanted to remove four of my front teeth: two on top and two on bottom. Well, no way was I doing this. The second ortho wasn't sure if he wanted to remove four of my back teeth at the consultation. After looking at the x-rays, pics and molds, he decided I wouldn't need any extractions. He said he preferred not to remove teeth in adults if he could help it. I'm 31. I am not sure if it's sometimes just easier to remove teeth. I know there are cases where it is absolutely necessary. I was told at the consultation I would wear braces for about two years. I was once again told this when the braces were put on. The time frame didn't change based on extractions. Just because different dentists have different opinions doesn't mean one is wrong. I say choose the one you are most comfortable with and who you feel will help you achieve the best results.

[Crowded]

Yeah, all three said they wouldn't extract unless they thought it was absolutely necessary.

From what I've read about extraction (on here and elsewhere) it basically seems to come down to whether there is enough space to align the teeth without them ending up too far forward, i.e. without extractions they'll end up looking bad, or that without extractions they'll be unstable once the braces are removed and move back towards the crowded positions relatively quickly/easily. Then there's the whole facial profile changing with extractions thing, but there really doesn't seem to be a definitive answer to that, it's all about your particular case.

I was just hoping I wouldn't get differing opinions, i.e. that it would be easy, should have known that was stupid So yes, like you say, best to go with the one I trusted the most. Although it must be said I was hoping to avoid extractions

[Crowded]

And now after going for a check-up at the dentist and asking their advice they've referred me to another orthodontist. So, I'll make a decision of who to go with after the 4th consultation. Hoping they don't completely contradict all the other ones

[Crowded]

Fourth ortho now seen. His advice concerning Incognito was the same as the last one; one extraction on the upper right.

However, he did suggest something else that hadn't been mentioned by the previous orthos: if I got Damon braces, I wouldn't need any extractions and would end up with a wider smile, although I have to say I'm not totally sure whether this would make a large difference visually or not. But at the same time, I am considering it. Does anyone know if the difference in the result would be that significant>

[lilone]

I don't know about the difference between braces...I always thought it was more about the experience of the ortho than the brand of braces. Many people (even ortho's) think Damon is just a marketing gimmick. Others swear by their Damon's. For lingual, it is very important to have an ortho who has done many cases, so find out how many clients they've used Incognito with.

I tell you one thing though. I would not think twice about extracting the half missing tooth. If it needs root treatment, there is always a chance it would need extraction at some point anyway if the RTC failed. Might as well save the healthy premolars and get rid of the one that could mess things up down the road while making room for your beautiful smile.

[hanibani35]

Hi there, I had my third molars extracted four day ago prior to hopefully getting braces to correct my deep overbite and lower crowded teeth. I must tell you it not the most pleasant thing...especially the numbness of your lower jaws. Am improving but I wish there were other ways of dealing with this without the extractions.

[tinksqueak]

My problem is overcrowding too (you can see pictures here: http://insideimsmiling.wordpress.com/20 ... llo-world/)

I'm seeing a London orthodontist who specialises in lingual braces and he initially said that he thought I'd need one extraction on the top RH side (you can see from the photo that's where the overcrowding is worst and has caused one front tooth to protrude quite badly).

However, after I'd had a full set of xrays he said that he was confident that he could successfully align my teeth without the extraction. Instead he will "gently file" between my teeth once the braces have started to create some space by widening the arch. He also said that he wouldn't do the filing unless my teeth were completely healthy and the enamel was thick. He could only properly tell this once he'd seen the xrays, so it might be worth bearing in mind that your xrays may change the best course of action once you've got that far.

For what it's worth, I got my top lingual brace six days ago (bottom brace goes on next Friday) and am adjusting ok. The speech is the worst thing but there hasn't been any point that I've regretted getting linguals. I'm blogging my journey here http://insideimsmiling.wordpress.com/ so you might like to read a bit more about my experience so far there.

Good luck!