Protrusion/overjet - Extractions on both arches or just one?

[BraceFace2o1o]

Firstly, I know each case is different...

But I was just wondering, if for example someone had a protruding smile (upper teeth) and upper extractions would help to pull teeth backwards... would they then have to get 2 lower extractions also? Or can you just have uppers extracted rather than both?

I've got it in my head I might need extractions. My Ortho has said no, or that I am a 'borderline extraction case'. My upper central incisors are crooked and tipped in towards my mouth slightly, and the Ortho said once he aligns the front teeth I will have a slight overjet. He mentioned at the 2nd consult IPR may be a possibility if things aren't moving as planned.

Personally, I wouldn't like protruding upper teeth after treatment as I feel my lowers sit back quite far already so that might intesify the overjet when created. I guess I am just thinking how are my teeth all going to fit nicely without protruding without having extractions.

I am hoping the Ortho doesn't move my left central incisor (your right) and my right central incisor outwards so it's at the same angle as the red line 1 is in my picture:

[VA5]

If I were a borderline extraction, I think I would consider ipr more. Or how about the Damon braces system, have you mentioned that to your ortho?

If I am understanding correctly, you already have an overjet. Which makes me think, maybe you don't need the bottom two extractions. I had to get all four b/c my teeth were lined up really evenly.. no overjet, just a protrusion on both lower and upper. There was no way for my ortho to retract my upper w/o retracting my lower, so both top and bottoms needed extractions.

If my uppers had a bit overjet though, I would have insisted on just extracting on the top. My ortho told me that ipr and everything else I asked for (which didn't include damons b/c i didn't know about that) wouldn't work and that extractions would be the way to get noticeable results. That's why I went with the extractions. And, I really don't regret it, but I do have other issues in my mouth (missing molars) that have affected my face that I have to deal with.

[yoginbraces]

I also have an overjet/protrusion issue and opted not to get extractions. My ortho has done IPR, double powerchains (yes, two on each row), and elastics so far and there has been shifting but not drastic which is fine with me.

I wanted my smile to have more symmetry and a contoured look but I don't necessarily need a flattened overall look to my mouth.

The first ortho I saw wanted to extract 4 teeth (2 on top and 2 on bottom) but when I went for a 2nd opinion the ortho told me he could address my concerns by using IPR.

The downside to IPR is your teeth have to be large enough (mine were enormous) and there is only so much shifting that can occur so you have to be okay not having a totally perfect (flat) smile.

I went back and forth many times trying to decide what to do (extractions vs. no extractions) and ultimately decided that I wanted improvement not perfection so I went the IPR route.

I still have moments when I wonder if I made the right decision. Today I feel that my smile is better than what it was and from the looks of things it will only get better so I am happy.

P.S. I should mention that I am 45 y/o and I believe one of the reasons my ortho didn't want to extract is bcuz he was concerned about changing my appearance (i.e., concerned at this age my mouth may droop due to extractions). He was much more polite about it of course.

Good luck.

[BraceFace2o1o]

If I were a borderline extraction, I think I would consider ipr more. Or how about the Damon braces system, have you mentioned that to your ortho?

I'm feel ok with the IPR, although I am worried if he does it on my lower 4 incisors they will look even thinner

The Ortho I am going with only uses normal metal and ceramic braces, not damon so that wasn't an option with this Ortho

If I am understanding correctly, you already have an overjet. Which makes me think, maybe you don't need the bottom two extractions.

I have an overbite currently, but not an overjet (there is no gap between the back of my uppers and the front of my lowers)... unless you can call one half of a front tooth sticking out an overjet.

Here is a picture of my uppers that should have been in my previous post:



I could only find this photo of my teeth with my bite closed:



Because of my overbite I will have my upper braces fitted first, lowers will be fitted later in to treatment (once the overjet is created).

I guess I am just thinking how on earth can my teeth move into place when there isn't any room to move them! ... and if I am totally honest, still a part of me doesn't like the thought of shaving enamel off my teeth (although the Ortho reassured me it wont harm my teeth).

[VA5]

Okay, I get it. He'll straighten your top first which will create the overjet, which I can totally see will happen. You have a decent amount of overlapping and crowding. So, when your teeth straighten, they will be pushed outwards, and then you'll have an overjet. And then, my guess is he'd just ipr the top only, or I would think you could extract only the top and then pull it back to reduce the overjet and protrusion. I am not an ortho so I can't be for certain, however I'm guessing this would be the case.

And, looking at your teeth, I would lean more towards extraction. But, knowing what I do now.. if I could do it all over again, I would have called around to find an ortho who did damon system to see if that could have been an option for me.

[DrJasonKTam]

If you have a large overjet and extract two upper teeth, you will be moving the upper teeth back to meet the lower ones. Sometimes this is a viable treatment option, but if your lower jaw is back, then you will be correcting one problem, but possibly creating another.

As for looking for the "Damon System". Nothing with Damon will do anything that you cannot do with most modern braces. They are just braces, use wires and biology still applies. You simply cannot expand so far out of the bone and still have stability and periodontal support. There is a lot of evidence stating that there is nothing superior about Damon. It is unfortunate that marketing has swayed public opinion so much...

[RedDress]

try to get an ortho that uses a suresmile to see how it will look with and without extractions on a computer model

[Snowglobe32]

try to get an ortho that uses a suresmile to see how it will look with and without extractions on a computer model

RedDress - I was under the impression that with SureSmile, you would see the end results before treatment began. Is this correct?

[MrBear]

VA5 you mean you regretted extractions?

[BraceFace2o1o]

Thanks for the replies! I'll see what the Ortho says at my next appointment (fitting for spacers).

There are 3 Orthos in my town, 2 I've already seen (and 1 of them I've chosen to go with) and the other is an Ortho at my local hospital, so is only in his office to see his private patients 2-3 times a week... I just wasn't keen on someone having less than half the week to fit all his private patients in.

The first Ortho I saw, didnt't like him. 2nd Ortho I am happy with, he just does metal and ceramic.

The next closest Ortho is about 25 miles from me and transport is going to be an issue in the next 6-12 months because I will no longer be able to afford to keep my car. So yes, I am quite restricted. I think to find an Ortho in the UK that does suresmile, I'd have to look near London (or miles away from my home town), which is a good 80-90 miles from me, so not an option really.

I am happy with the Ortho and appreciate his thoughts on not doing extractions as it might effect my face shape. I guess I'd be ok with geting extractions later down the line if needed, but I'm sure I'll be a little annoyed that closing up those gaps will add months to my treatment.

[VA5]

VA5 you mean you regretted extractions?

No, I just wish I looked into the damon braces before I had them, but I hadn't heard of them as an option before I got extracted. BUT... now that Dr. Tam says there is nothing that regular braces can't do that Damon braces can, that makes me feel a lot better.

I don't think IPR would have done enough for my teeth, but for some peopel that is an option. So, no, I don't regret extractions.

[RedDress]

try to get an ortho that uses a suresmile to see how it will look with and without extractions on a computer model

RedDress - I was under the impression that with SureSmile, you would see the end results before treatment began. Is this correct?

There are also other then Sure Smile technologies that make a computer models . I do not remember the name. These are just to help the ortho to figure out the best movements for your teeth. (But surely you will not see how your face will look )
But in in my case they put braces on and waiting for my teeth to get aligned and then they will scan. I am not sure why. I though this should be done in the very beginning of the treatment.
But do not restrict yourself you Damonds and such. any other system is just as good if your ortho is experienced. Just because someone uses damons or such does not indicate that he is better.

[RedDress]

VA5 you mean you regretted extractions?

No, I just wish I looked into the damon braces before I had them, but I hadn't heard of them as an option before I got extracted. BUT... now that Dr. Tam says there is nothing that regular braces can't do that Damon braces can, that makes me feel a lot better. .

That is absolutely true. they are just brackets. They wires are the same.
Besides the good side of regular braces - your ortho usually sees you more often. Mine put my inovations on me and told me to come in 6 weeks.