Very Different Consultations????

[jmflynny]

I'll try to keep it short...so please forgive any seeming abruptness!

I am a 41 female with all four wisdom teeth and a missing lower front tooth (hypodontia). Little crowding below, medium crowding on top. Gums and teeth in good condition. 2mm overbite in front. No crossbite. No facial deformities.

Consult #1:

Very experienced, highly rated/reviewed ortho who explained that a missing lower incisor would make the process more complicated in that straightened uppers would create a 7-8 mm overbite.
Recommendation: Clarity braces, upper and lower with the removal of two upper bicuspids. 2 years of treatment at $4900. Limited retainer afterwards

Consult #2:

Recommended by my dentist, 30+ years of experience, no internet reviews available.
Recommendation: IPR on my upper teeth to limit any increase in overbite. No extractions. Metal braces lower. Clarity braces upper. 9 months with braces at $2800. Consistent retainer use required afterwards.

Now. These are very...VERY different results.

I did not mention to DDS #2 that I had already recived a consult from DDS #1 until the end of the consultation. His explanation for the differences: 'overkill'. He did nothing whatsoever to diminish or disparage the reputation of DDS #1, but simply stated that I do not require such a lengthy and extensive process.

Now, I will admit that well before receiving the estimate from DDS #2 that I was already in favor of having him perform the procedure due to the noticable improvement in hygiene and sense of calm within his office as compared to DDS #1.

One more small thing...

I have a history of heart murmur.

DDS #1 simply asked if I typically require antibiotics prior to receiving dental cleanings and then said nothing more about it.

DDS # 2 requires a letter from my cardiologist or M.D. before performing any invasive procedure. No ifs, ands or buts about it.

Could these consults be any more different?!

I am so confused...and so concerned. Clearly, I don't care for working with DDS #1 for the reasons mentioned above, however, does that necessarily make DDS #2 the correct choice?

Should I seek a third opinion?

Please.

Any advice would be appreciated.

Thanks,
JMFlynny

[stRaighteR]

personally, from your description i would choose dds#2...

how did each of them interact with you? who answered your questions better?

but, it doesn't hurt to get a 3rd consult especially if it's free.

[snaggletooth steve]

JMFlynny,

I just went through four consultations and there were differences and similarities in each. Two wanted no extractions, one wanted two extractions and the other wanted four extractions! Three of the offices were similar (Dr spent plenty of time at the consultation and stuck around to answer questions) and one was completely different (Dr. on Safari during consult!). Some had modern computer systems and one had a DOS system! Two took no xrays or photos, one took xrays only and one took full photos and xrays for the consult!

To me it seems these Ortho's pretty much know what they're doing.. they have different ways of getting to the same result. For me it was the overall approach (conservative on extractions) and the use of the latest technology that sold me on #4. Personality wise, he's a nice guy but I doubt we'll go golfing together any time soon! #2 and 3 were cool though. Don't get me started on #1!

Go for another consult or even two. I almost didn't bother with a 4th, but that's the one I ended up choosing.

steve

[jalapeno]

I am in a somewhat similar situation and so far have had four consults. If I were you I'd get a couple more until you see some consensus emerge. I've had four and still don't know what to do... IPR has been suggested for me in two of the four consults whereas the other two want to do one lower incisor extraction.

Seems like the first guy is really planning to take a lot of enamel off so you might want to read up on it and get him to clarify the amount and the limit as he sees it.

Here's a pretty good article that covers IPR in the middle section, has some good technical info on IPR:

http://www.aacd.com/journal/pdf/Hancher ... ng%20mm%22

[jmflynny]

Thank you for your responses.

I have determined at this point, with just the two consultations, that I prefer working with the Doc who provided the second consult.

Bless his heart, I'm a nut for research, and every time I've had a question, he and his staff have been there to answer it. I am still very nervous as my molds (pre IPR) show a lot more flaring than I am comfortable with, but he allowed me to take the molds with me, and after having my dentist look at them, I feel much better. He seemed to understand completely the process and thus it was as if I was hearing the ortho's own words coming back to me yet again.

Apparently, with the IPR, and then the filing down of what my ortho referred to as the "best cap" he'd ever seen, he will be able to move my teeth back with elastics to reduce the overjet without interference from my bottom teeth.

It seems this missing-a-lower-front incisor thing can be quite the bother.

I'm excited, and nervous, but appear to be a great candidate for limited treatment and thus, ony 10 months or so from now, I should have a new smile.

Then, of course, comes the retainer, but I'll worry about that when the time arrives.

Bear with me. It's sure to be a bumpy ride!

[ohmyjaw]

Hi JMflynny,

I think you are right - the 2nd consult sounds better on many points. However, there is one thing that would raise a concern with me - what does "consistent retainer wear" mean? Consistently for a year or two, or consistently for the rest of your life?

Just curious!

[allegro]

It's funny that this post should pop up today because I was wondering something similar about my own treatment. I chose the ortho I felt most comfortable with, though his treatment time was the longest. He is saying up to 24 months, whereas other consults said as low as 14 months. I do have ceramic uppers, but now that I'm seeing how quickly teeth move (my bite has changed quite a bit in just the week that I've been wearing them), I wonder what we're going to do for 24 months. In fact, my ortho has said that my teeth will look straight after about 3 months and I understand that the roots take longer than the crowns to move, but... Ah well, just wondering.

[jmflynny]

Wow, Meryaten, you are just full of information. Thanks.

Ohmyjaw... well, he's a 'worst case scenario' kind of doc, and he's saying 24 hours for the first year, less the next and then while sleeping for the rest of my life. I told him 'I think I can live with that." His response, "Well, it's easier said than done".

Kiwi, thanks for the link. One of my lower incisors never came in and so once my lower teeth are straightened, the arch will be smaller than the top arch where I still have all of my teeth (wisdoms included). My teeth will need to be flared out and then pulled back in to keep from producing a big overjet. And, I have a cap that's twenty-six years old. (Still in perfect condition!) The caps made back then were a bit thicker in the back so it will need to be thinned out in order not to bump up against my lower incisor. So, I'll need to replace it once every thing else is finished.

Whew! No wonder the orthos go to college for so long!

[ohmyjaw]

Hi jmflynny,

I was curious about the retainer because my ortho said 24 hrs a day for the first 6 months, then nights for 2 years, then nothing. I wonder about this because so many on this board will be wearing retainers for life. I think I need to do some research on it.

Good luck and keep us posted!

[jmflynny]

Ohmyjaw...

I don't know your age, but I'm 41 and I'm going through 'limited treatment' for only 9-10 months. I believe that that has something to do with it.

My friend had braces on her bottoms only and was required to wear her retainer for just an hour a day. Of course, she doesn't even do that and now they are starting to turn again.

I guess each case is different, and in my case, my doc likely gave me the worst case scenario.