One more with extraction doubts...

[pcspinheiro]

Hello!
New here (and to braces) and I'm seeking opinions from those who may have suffered a similar dilema... background first:
I decided to get braces because my crooked upper incisors, combined with an overbite, was leading to wear and pain on my lower incisors. The crooked part never bothered me aesthetically and I also had one canine out of place due to lack of space. Ortho immediately diagnosed the crowding, overbite/skeletal class II malocclusion (underdeveloped mandible + under-erupted lower molars). Her plan (which is really not entirely known by me, as she leaks info in small bits...) involved getting 2 upper first bicuspids extracted + 2 remaining wisdom teeth, then pulling upper teeth back to meet lower ones + extruding molars with elastics. Uninformed about extractions I dully agreed to them and had one done (on the crowded side first, as a last minute decision) and, after that, my teeth have pretty much gone into place already, in just 2 months. She insists I must have the other bicuspid removed, otherwise I will get an asymmetric smile, but my crowding is gone at the cost of that one extraction and partly filed the gap, so extracting on the other side WILL still give an asymmetric final result if the teeth are pulled back, as there will be more space to fill on one side anyway. I have since read a lot about bicuspid extractions and I'm really fearful of not liking the end results. After 40 years of living with my face I'd rather pay for an implant to fill the remaining gap than to end up with a face I don't like (not than I'm pretty to begin with, and making my largish nose more visible won't help...) plus deal with the possible airway complications, of which I'm already a sufferer... Should I hold my ground on that second premolar extraction and have her work her way around that?

She also says I will still have class II molar relation in the end, which makes me think it will solve nothing regarding my mandible trapped back in an uncomfortable position. I'm also having a hard time trusting certain things she says, like "moving my front teeth back will not affect the bone, they will move sideways"... That can only be rubbish, if they were to be moved sideways they would create a gap in the middle! Bone MUST recess too.

Oh, one more thing; It appears that, after retracting my upper teeth she also intends to angle them outward to make more room for the lower ones... Not with my face, no...
I have a good understanding of things, I'm a research scientist with a Biology background, but no matter how much I try to know from her, her approach still does not make full sense to me... Am I overreacting to all this?

Any comments or feedback are greatly welcome!

Cheers,
Paulo.

[Dureena]

Get a second/third opinion.

You might find this useful
http://kevinobrienorthoblog.com/correct ... -profiles/

[tonyk]

So you had 1 upper bicuspid removed (and none on the bottom?). I thought they usually tried to pair up extractions so you don't end up with more teeth in one arch that the other.

My problem is not dissimilar from where you are now. I have a congenital absence of one lower bicuspid so the midline moved over slightly and the molar tipped forward into that space as I was growing up. My ortho uprighted the tipped molar. He offered me the option of having 3 other bicuspids removed (one on the lower arch and 2 on the upper arch) to that the teeth would by symmetrical. I elected to not extract any teeth (I had only mild crowding), but I can tell you that correcting that midline deviation is still not complete, my bite is still not right, and I'm nearly 2 years into this. I really think that it would have been quicker to do the extractions and move the teeth to close the gaps.

I don't think there's an obvious answer. Extractions are sometimes needed to relieve crowding, and if you don't do it there may not much in the way of good alternatives to make the room you need for all your teeth to align correctly. If you're really reluctant, get another opinion from an orthodontist. I think that having only one bicuspid extracted could cause symmetry problems like I have, and they're not easy to fix.

[pcspinheiro]

Hi,

sorry but I've been rather busy... I only had one upper premolar removed because I decided I should not get the other one done. Her plan was to have me remove both upper premolars (1 on each side). I just came back from a consultation and I'm still very divided between extraction and no extraction of the other tooth. I regret having the first one taken because more and more I feel that I'm not being listened to. On the very first consultation I told her, and I quote myself "I want to fix my crooked upper teeth to stop them from contacting the lower ones and causing pain and wear", and I added "I don't care about a Pepsodent smile, just to keep my teeth from wearing out" You can't get more clear that that, I guess! After a lot of reading I now know that what I have is considered a very mild crowding with a 1/2 class ii malocclusion (teeth stacked and NOT fully retracted) and a deep overbite with some overjet. Now, if she had listened to me, about my mandible feeling trapped and all, why on earth would she tell me to extract 2 rather large first premolars??? Today I tried talking to her about my fears of worsening my breathing with all the necessary retraction to close extraction spaces, and she says that my arch will stay the same size because my teeth will move laterally and not backwards. I cannot believe her one bit on this one, otherwise the gap would appear in the front! and since she knew I was not there for aesthetics then she should have taken the more conservative approach of not extracting. The problem is, I TOLD HER THAT!!! She just assured me it was because of the crowding. Today she says that if I was not concerned with the overjet then I probably should not have removed that tooth... UNBELIEVABLE! SO many times I asked her about the real necessity of that extraction... I'm pretty mad at her and I'm only 4 months into the treatment.

OK, so here are my final thoughts/math on this: My "confortable" jaw position is when my upper teeth are protruding what looks like 3 mm (thickness of brackets basically); retracting my upper teeth will cause at least 6mm retraction of the upper arch (my first premolars are a good 7 mm wide). She apparently plans to slightly protrude my upper incisors, but also the lower ones, so I'm still going to end up with a trapped jaw...

Basically my teeth are now strait at the cost of 1mm or less of the extraction space! Maybe there was some protrusion too, but they were retraced anyway.
I know most people do orthodontics because they are unhappy with something about their teeth, but in my case I only wanted them to stop wearing out (if mandible got looser that would be a bonus), couldn't care less if they are all perfectly strait "by the book". My gut feeling is that if I embark on her full plan I will be mostly solving non-existing problems (or rather, problems that caused me no bother whatsoever) to potentially create new, really bothersome ones...

Sorry for letting out steam but I just think she made a bad assessment of things and did not consider my opinion and goals... or I'm just not seeing the point clearly, I'll also admit to that. So today I basically told her that I did not intend to extract the other tooth and would rather get an implant once the rest is done. It's OK to correct my overbite but it never bothered me, if it weren't for the crooked teeth causing unwanted tooth contact.

Anyway, enough of me...
Cheers.

[bi167]

Hi all,
i am new here, and i am 24 years old and decided to get braces, as I have upper right impacted canine. also my lower jaw teeth are severely crowded so I was also adviced that I am needed to get 2 lower premolars (one fron each side) removed to reveal the crawding. I have already taken advice from 3 different orthos, they all say the same.
Is it ok to remove? or i will regret loosing my fine premolars.
also my teeth are weak from start. so all the molars have little but cavity. only these premolars are fine and perfect. so I am not sure that i should loose them over already decaying molars.
On other note, one ortho also adviced to get my 3 wisdom teeth removed by saying they will later undo all the work done by braces. but that's​ thr later case..still if someone can suggest anything it would be very helpful​.
thanks in advance

[bi167]

[quote="bi167"]Hi all,
i am new here, and i am 24 years old and decided to get braces, as I have upper right impacted canine. also my lower jaw teeth are severely crowded so I was also adviced that I am needed to get 2 lower premolars (one fron each side) removed to reveal the crawding. I have already taken advice from 3 different orthos, they all say the same.
Is it ok to remove? or i will regret loosing my fine premolars.
also my teeth are weak from start. so all the molars have little but cavity. only these premolars are fine and perfect. so I am not sure that i should loose them over already decaying molars.
On other note, one ortho also adviced to get my 3 wisdom teeth removed by saying they will later undo all the work done by braces. but that's​ the later case..still if someone can suggest anything it would be very helpful​.
thanks in advance[/quote]

[sirwired]

Hi all,
i am new here, and i am 24 years old and decided to get braces, as I have upper right impacted canine. also my lower jaw teeth are severely crowded so I was also adviced that I am needed to get 2 lower premolars (one fron each side) removed to reveal the crawding. I have already taken advice from 3 different orthos, they all say the same.
Is it ok to remove? or i will regret loosing my fine premolars.
also my teeth are weak from start. so all the molars have little but cavity. only these premolars are fine and perfect. so I am not sure that i should loose them over already decaying molars.
On other note, one ortho also adviced to get my 3 wisdom teeth removed by saying they will later undo all the work done by braces. but that's​ thr later case..still if someone can suggest anything it would be very helpful​.
thanks in advance

Molars are much larger, and extracting them may open more space then necessary. As long as they aren't practically 1/2 filling material, I'd say they'll be fine. Small cavities in your molars don't affect their structural integrity much.

And yes, pretty much all patients that need braces for overcrowding need the wisdom teeth removed.

[UnhappyCamper]

Hi all,
i am new here, and i am 24 years old and decided to get braces, as I have upper right impacted canine. also my lower jaw teeth are severely crowded so I was also adviced that I am needed to get 2 lower premolars (one fron each side) removed to reveal the crawding. I have already taken advice from 3 different orthos, they all say the same.
Is it ok to remove? or i will regret loosing my fine premolars.
also my teeth are weak from start. so all the molars have little but cavity. only these premolars are fine and perfect. so I am not sure that i should loose them over already decaying molars.
On other note, one ortho also adviced to get my 3 wisdom teeth removed by saying they will later undo all the work done by braces. but that's​ thr later case..still if someone can suggest anything it would be very helpful​.
thanks in advance

Molars are much larger, and extracting them may open more space then necessary. As long as they aren't practically 1/2 filling material, I'd say they'll be fine. Small cavities in your molars don't affect their structural integrity much.

And yes, pretty much all patients that need braces for overcrowding need the wisdom teeth removed.

This is completely untrue. Healthy teeth including wisdom teeth should never be removed unless absolutely necessary.

[sirwired]

If you are already having braces done for overcrowding, it is rather unlikely your wisdom teeth are going fit.

[bi167]

[quote="UnhappyCamper"][quote="sirwired"][quote="bi167"]Hi all,
i am new here, and i am 24 years old and decided to get braces, as I have upper right impacted canine. also my lower jaw teeth are severely crowded so I was also adviced that I am needed to get 2 lower premolars (one fron each side) removed to reveal the crawding. I have already taken advice from 3 different orthos, they all say the same.
Is it ok to remove? or i will regret loosing my fine premolars.
also my teeth are weak from start. so all the molars have little but cavity. only these premolars are fine and perfect. so I am not sure that i should loose them over already decaying molars.
On other note, one ortho also adviced to get my 3 wisdom teeth removed by saying they will later undo all the work done by braces. but that's​ thr later case..still if someone can suggest anything it would be very helpful​.
thanks in advance[/quote]

Molars are much larger, and extracting them may open more space then necessary. As long as they aren't practically 1/2 filling material, I'd say they'll be fine. Small cavities in your molars don't affect their structural integrity much.

And yes, pretty much all patients that need braces for overcrowding need the wisdom teeth removed.[/quote]

This is completely untrue. Healthy teeth including wisdom teeth should never be removed unless absolutely necessary.[/quote]


..yes ..according to my opgs, i have 2 wisdoms still totally inside gum and one is exposed. also all 3 are inclined towards front so more likely they are not going to come out itself and if they come out thay are facing towards the molar before them hence pushing them to get lean forward too..which think may conflict with my braces work.
so I don't want to mess up them with my braces work, but i am afraid to get them out.

also my dentist said that you should never keep any tooth inside gum totally bcs it may create cyst around it and other problems too.
so don't know whether to go forward with removing wisdoms or not!

[sirwired]

..yes ..according to my opgs, i have 2 wisdoms still totally inside gum and one is exposed. also all 3 are inclined towards front so more likely they are not going to come out itself and if they come out thay are facing towards the molar before them hence pushing them to get lean forward too..which think may conflict with my braces work.
so I don't want to mess up them with my braces work, but i am afraid to get them out.

also my dentist said that you should never keep any tooth inside gum totally bcs it may create cyst around it and other problems too.
so don't know whether to go forward with removing wisdoms or not!

Yes, you should totally get them removed. Those teeth are never going come in properly, and they can't be straightened either.