Fix crowding in adult with no extractions - realistic plan?

[MrCrowded]

Now in my 30s, I am finally in the coming months definitely going to have braces to straighten my crowded upper and lower arches (there are no issues with my bite). The reason I have waited so long is to get a treatment plan I am happy with. I would appreciate any thoughts anyone has on the following.

When I was younger, the only treatment plans offered were extraction of 4 teeth and braces for c. 2 years. I rejected (and still do) that option, for the loss of teeth, narrower arch it would create and the flattening of facial profile.

About 6 years ago I consulted with specialist orthodontists in London's Harley Street. One said I would have to have 4 teeth pulled. One said he could do it with no extractions, expand the arches and use IPR to make all my teeth fit (fixed braces for 6 months upper, 12 months lower). There might or might not be a need to lose one lower front tooth for it all to fit, but probably not. One general dentist was of the opinion I would need extractions but he was mainly trying to sell me cosmetic dentistry. The plan with no extractions sounded ideal but I eventually decided not to proceed as I was concerned (due to the other opinions I'd received) that I was being sold what I wanted whether or not it would be finally possible. It may not have anything to do with how feasible the plan is, but I subsequently found out this year that that ortho has recently been reprimanded by the British Dental Association for his standard of care.

I have just recently consulted with two dentists. Neither are specialist orthodontists. However, it seems things have moved on and the non-extraction route is more prevalent nowadays or more practitioners are comfortable with it. The first one told me he can do no extractions, have me in fixed braces for 6 months upper arch and 12 months lower arch. He would use some IPR and that lower front tooth could probably stay but there is always a risk it might not fit. He recommended clear braces, he personally thinks Damon are harder for final fine tuning. Sounds like the exact same plan as the one above, which gave me some confidence this *might* in fact be possible. Another dentist I saw is apparently more into cosmetic dentistry but he seemed sceptical the above is possible. Although he talked about braces, he actually wanted to sell me Invisalign, which I myself believe could not possibly rectify my problems. He actually said get a third opinion and see a specialist orthodontist and that if they say it’s possible then it could be.

Overall the only plan I'd consider is no extractions (I could lose the lower front if absolutely necessary, but not 4 teeth) and it needs to be fixed clear braces. So on that basis, should I just go with this plan that has been offered as there is really no other that I would consider? I am just worried whether it is actually possible, but whatever happens perhaps it would be better than my teeth as they are (crowded and not straight)?

Also, do you think a general dentist speacilising in braces/cosmetic dentistry is "as good" as a specialist orthodontist for this? (My bite is perfect so no issues there).

Thanks for any thoughts.

[BellaBraces]

I have opted for Six Month Smiles with a general dentist. I am happy with my bite and my teeth are slightly crowded. I had 4 extracted as a teen and a lot of orthodontic work. The teeth became crowded later when my wisdom teeth came in. As I have already had 4 out I am not prepared to have any more out.

I am very comfortable with the dentist I have chosen (in the South East of England) and I feel he is confident and good. We will be using IPR to make the necessary space. I thought he would be all gung ho and do the IPR at the beginning but in fact he is doing a little bit at each adjustment so that the absolute minimum is done to achieve the movement needed.

I see no reason not to have a consultation with a specialist orthodontist. However, your perception of there being no issues with your bite may not marry with the perception of a specialist orthodontist. I am completely sure that an orthodontist would tell me I need more treatment. As I do not have pain or issues with my bite that I am aware of, I am not interested in perfection; I want teeth that look nice.

Good luck with whatever you decide.

[MrCrowded]

Thanks very much for your thoughts!

[quote="BellaBraces"] However, your perception of there being no issues with your bite may not marry with the perception of a specialist orthodontist.[/quote]
On this point, all the dentists I have met including the specialist orthodontists said my bite is fine. Actually they said, be sure you want to proceed with treatment to straighten your teeth as your bite right now is excellent! ;)

[OldBikerBag]

I am also adamant about refusal of extractions. In addition, I am extremely averse to any type of "sanding" to make room. My bite is not perfect. I have about a 6-7 mm overjet. However, I believe that is due to a narrow upper arch and forward flared incisors. I think the overjet will be corrected by simply widening the arch and moving the teeth into a flatter plane. I have minor crowding with one tooth on each arch that is turned just a wee bit.

I went to an orthodontist who opted for the Damon system. I have Damon 3 brackets, mostly metal, with the upper front six being clear. It is difficult to tell I'm braced except when I open my mouth wide or pull my lips back with my finger.

My goal is to reverse the upward arch of my lower teeth, straighten the teeth and achieve an overall reduction of the overjet. I will be happy if all is accomplished with a bit of overjet remaining. My bite is functional, just not perfect. Perfection is not necessary for me to consider the treatment successful.

Besides, lots of people think a little overbite is sexy. I mean, c'mon....who can look at "Fiona" (Gabrielle Anwar) on the American TV show "Burn Notice" and think she is anything but HAWT?