extractions vs. expander

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#1 Post by **junkee** » Thu May 01, 2008 7:07 pm

After years and years of putting it off, I had my first ortho consultation on Monday. Today i get a call from my regular dentist because she received a letter from the ortho about my treatment. The ortho suggesed i get my 2nd pre-molars out. My dentist strongly advises against having any teeth removed and said that it would actually make my crossbite worse because i have a small upper jaw. She thinks i should get an expander. I did mention my concern to the ortho at the consultation and he showed me some cases that were very similar to my own that had good results with extractions. He's very experienced and reputable so i don't think he would suggest pulling teeth if it was going to make them worse. He did mention that i could choose a more aggressive treatment, surgery + expander, if i was totally against having the extractions. He said that an expander wouldn't do much without surgery and didn't think that that route was necessary to get a good result. My dentist referred me to an ortho who she said can use the expander without surgery. Honestly, i don't like the idea of an expander at all!!! I remember kids in school with them and they slurred with them for the whole time they had them! I need to be professional in my office and i don't know how i would deal with that. I finally got used to the fact that i need to have braces, nevermind the expander!

Anyone else have a crowded narrow upper jaw? What type of treatment did you go with?

#2 Post by **sauerkraut** » Fri May 02, 2008 5:34 am

I have/had a crowded narrow upper jaw and a few other problems besides.

Many years ago in the UK I saw an ortho who wanted to pull teeth and fix braces. For various reasons I didn't go ahead. When, years later, I eventually saw an ortho in Germany he referred me to a surgeon - who was very pleased I hadn't had the extractions. He said it would have made my face cave in and my nose stick right out

Not that I'm saying that would necessarily happen to you, but I would say it's definitely worth getting another opinion.

I ended up with surgery (SARPE) and had an expander for the best part of 7 months. I can understand you not liking the expander idea. I can't say I exactly enjoyed it. But you do adapt and get used to it, including learning how to speak without slurring. Other people don't notice that anywhere near as much as you do.

All the best with your decision-making

#3 Post by **SunnyO** » Fri May 02, 2008 1:06 pm

Hi Junkee - I too have a narrow upper jaw and crowded teeth. This is my 2nd round in braces and I did have extractions the first time around. I had 2 upper and 2 lower molars removed as well as my wisdom teeth (surgically removed before they broke thru the gums). Because of this, my current ortho did not want to remove any more teeth, and neither did I. I have an expander, but I did not have surgery. I have questioned the effectiveness of this compared with SARPE, but have decided to trust my ortho because I've seen his results on other patients. I think most of us figure if we are going to go through all of this, let's make sure it is the best possible plan for the best possible end result, therefore we question everything. I know I have.

I completely understand you not wanting the expander - I hate mine, but I think it will be worth it in the end. If you do end up with an expander, you will get used to it. My speech has improved greatly in the 3 short weeks I've had mine.

Good luck - Sunny

#4 Post by **Printemps** » Fri May 02, 2008 3:20 pm

Hello! If i were you, i would opt for the expander. I know, it does not sound appealing, I'm about to undergo the same thing! Extractions might give you a narrower looking smile or flatter profile. I had extractions from previous orthodontic work with a crossbite and they have complicated my case alot and flattened my profile which has left me one unhappy bunny who might need surgery! But of course, I'm not a dentist so I really don't know, just my two cents! I hope you make the right decision for you. I know, its a little overwhelming! Good luck!

#5 Post by **dugsmom** » Fri May 02, 2008 3:30 pm

If I didn't know better, I'd think I wrote your post!!!! We have almost the exact same problems and was told about the same thing!!!

I went to my first ortho (he was actually a dentist but did orthodontics on the side), and he told me that he could fix my problem with braces only. He didn't mention my crossbite (don't even think he knew what that was), or anything else...just that he could fix my teeth with braces. Later I found out bad stuff about him (plus I wasn't too happy with him to begin with...only stuck with him because he had an awesome hygenist) so I decided not to get braces with him.

Next Ortho was board certified and Orthodontics was his specialty. He had been in the business for 30 plus years. He told me I'd either have to get 2 premolars pulled (upper jaw) or get surgery. I, too, have a crossbite and narrow palate. I was going to get the surgery because I've heard that getting teeth extracted and pulling the other teeth back to fill in the gaps can cause some people to have sunken faces. The plan was that I would have the surgery and then wear an expander for like 9 months. Braces would be on for about 2 1/2 years or so.

I moved right before brace day.

I went to another ortho in my new town. My neighbor had recommended him. During the consult, all he did was wiggle my jaw around and looked in my mouth. Then he tells me that I needed 2 premolars extracted. He also mentioned my crossbite, narrow palate, slight overbite (which I've always liked so I didn't really want that fixed), and overjet (which I didn't even know I had). I asked about surgery and he said NO WAY. His gave me 2 options...get the 2 premolars pulled or don't do anything and live with my teeth the way they were. I immediatly crossed him off my list.

Last ortho- This ortho gave me the most thorough consult. They took pictures of my teeth, and smile, took tons of xrays, did a visual exam, and then he sat with me and we talked. He told me that I didn't need surgery or pulled teeth (after I asked about it). I nearly fainted. I told him what the other ortho's told me and he laughed and said that braces alone would fix my problem. He told me that surgery was definitely out of the question and he didn't think I should get 2 perfectly healthy teeth pulled. He then took out a picture (of my profile) of me and drew a line down my lips. He said that's how flat my face would look if I got extractions. Scared the heck out of me!!!

I am now in braces and am soooo glad I saw several ortho's before I made my decision!!

My crossbite is pretty bad (looks like I'm toothless on my right side...that's how far in my teeth are), my palate is really really narrow, overbite is fine (it is out a bit), and I've got an excessive overjet. But somehow braces will fix it...not 100% (Even though braces while widen my arch,I'll still have a somewhat narrow palate but that's never bothered me, and I'll still have an overbite but I like mine anyway so no big deal) but that's okay because I don't have to have surgery or get teeth pulled and that's all that matters to me. My concern in the first place are my bottom teeth (missing molars have caused my teeth to tip and twist) which I think is causing the beginning of TMJ. The crossbite will be completely fixed. Yay!!

So my advice to you so to see as many ortho's as you can. You'd be surprised how different their opinions are. There might even be someone who can do for you what my ortho says he can do for me.

As for the expander alone (without surgery), I've heard (read) both sides to that. Some people say it's tipped their teeth outward while others have said that it worked for them.

Good luck and let us know what you decide

Jessica

#6 Post by **BrandonH** » Fri May 02, 2008 6:32 pm

I've had both.

I initially had an expander. It did some good, but just didn't give my doc the space he needed.

Sooooo, I had 4 premolars pulled today.

If my other option was surgery, I would not have chosen that route.

I anticipated the extractions so it was no big deal.

Now I have a lot of room and the doc says we'll begin getting some really good results really quickly.

#7 Post by **crazybeautiful** » Sat May 03, 2008 1:58 am

I had SARPE, but still need 2 extractions

The SARPE gives great results, and I think if you need a lot of expansion, you'd be better with this to give you more rounded arch rather than just making a bit of room in a narrow arch.

#8 Post by **Jamesyeats** » Sat May 03, 2008 4:22 am

I'm being expanded without extractions. The way my ortho said it to me was "If it rained a lot, and your gutters weren't big enough, would you rather put in bigger gutters or start messing with your roof?"
As long as your teeth are healthy, and not terribly wrong, keep them! They were put there for a reason.
This excludes wisdom teeth by the way, which seem to serve no purpose but to cause pain and need extracted. Why do we even have them? Mine certainly didn't bring any wisdom along with them...

#9 Post by **Miss Smiley** » Sun May 04, 2008 1:34 am

I wasn't recommended to have any expansion done because I had a wide smile with crowding, HUGE teeth, a relatively small head, but balanced facial structure. It didn't help that I had double protrusion and lip strain so I had to lose those teeth. I'm happy with my results but I'm not quite sure what to tell you since your case seems to be quite the opposite.

#10 Post by **walkabout** » Tue May 06, 2008 5:12 pm

I saw three orthos before I started my treatment - two suggested palate expansion without surgery and one suggested and extractions in my lower jaw so it would "match" my top jaw. The thought of making my bottom jaw smaller didn't feel right to me so I went ahead with the expansion.

After reading a lot of posts on this board regarding palate expansion many are against expansion without the surgery in adults (I am 30). Dental tipping can occur with both surgical and non-surgical expansion. For me it worked, I had the before and after films to confirm this, got the gap between my two front teeth. I wont say it wasn't without pain - my teeth themselves did not hurt but I had terrible pain throughout my nose a day or so before the gap appeared. I can only speak from my own experience though.

Below is an article regarding RPE in young adults without surgery. Like the person in the article I started off with one turn a day for around two weeks and then switched to two turns a day.

http://www.cda-adc.ca/jcda/vol-69/issue-6/374.pdf

Good luck with your treatment.

#11 Post by **walkabout** » Tue May 06, 2008 7:47 pm

Meryaten wrote:Great piece.

Out of curiosity are you willing to share your (approximate) age? And was your doc looking to go surgical if the non-surgical approached failed you?

I am 30 year old female. When I first saw my ortho I brought up SARPE after the research I had done and she then showed me her own evidence (from her other patients) that she could do it without surgery. And that is the last time surgery was mentioned. Personally I feel that there would be no other choice but to have surgery if it did not work, but thankfully I won't have to find out. The non-surgical approach may not be for everyone but I wish more orthos out there would give it a go.

#12 Post by **BrandonH** » Wed May 07, 2008 6:02 am

My ortho said that I'm one of the 5% of his adult patients that didn't expand properly with the RPE.

His theory was that my bones may have become a lot more dense than normal due to my bad bite.

He said my bite was so bad it caused trauma in the roots of my premolars. We were both a little surprised at how short and blunt the roots were when he pulled them out.

I have a friend at work who used the same ortho as an adult and she had the rpe --- she expanded perfectly.

I had to be difficult

#13 Post by **Jamesyeats** » Wed May 07, 2008 12:49 pm

It does seem odd that so few orthos seem to know about, (or maybe recognise) this - perhaps too few clinical studies (they KNOW that SARPE works), or maybe they are unwilling to take the chance? 1 in 20 patients coming back angry might be too much. In my job we work to 98% satisfaction, maybe the same applies to orthos?

Edit: we work to 98% satisfaction by using tried and tested methods that we KNOW will work - there are fancier and cheaper methods out there, but we want happy customers, so we do things the "old" way, until the "new" way becomes the norm and is totally proven. I keep totally up to date on new technology, but I won't use it until I can guarantee both myself and my clients that it will work better than anything else. Perhaps a lot of orthos don't want to try this, just in case?

#14 Post by **BrandonH** » Wed May 07, 2008 7:32 pm

He told me from the beginning that if the RPE didn't work, we'd have to compromise by pulling teeth.

If money were no object, I'd have gone the SARPE route. However, money is a big deal.

The results I get will be fine. I'm simply looking for straight teeth and a better bite

#15 Post by **acd** » Wed May 07, 2008 9:40 pm

I've had three ortho consultations in my life. The first one in 1978 recommended an expander, headgear and full band braces for two years+. My next one in 1979 recommended extracting 4 pre-molars, high pull headgear and full band braces for two years+. My last one (and the one I ended up going with in 2006) didn't require extractions or an expander, used self ligating brackets and gave me the option of going with upper ceramics (which I did although I should have probably gone with metal) and didn't require headgear. I'm about 18 month in at this point and don't know how much longer I have but if I had known that braces could be this easy I would have gotten them a lot sooner than I did.

Make sure that you feel completely comfortable with the treatment plan that they lay out for you and that you are willing to comply with it. For what it's worth the anticipation is much worse than actually living with braces.