Metal Mouth Message Board

Hi everyone,

First, I just want to say that this message board and the ArchWired site has been a tremendous resource. Thanks so much!

I'm a 26 year old female and have gone to 3 orthodontists so far for initial consultations. Since I was a kid I've had somewhat crooked lower front (4) teeth (which you can't really see until you look closely at my mouth) and a little bit of an overbite. I was ok with this and have always been told I have a nice smile. Over the past year though, I've noticed my 4 upper front teeth have flared out even more and a thin space between my 2 front teeth has appeared, which made me think about getting braces. From the front you can't really tell when I smile, other than my 2 upper front teeth looking a little bigger and more forward than normal, and my arch kind of becomes pointier. But from the side when I smile the upper front teeth look very noticeably horse-like, and with my mouth closed there's a slight protrusion of my upper lip. My other teeth and bite are ok though according to the orthodontists I've seen so far.

Here are pictures of my teeth, bite, and profile: http://www.flickr.com/photos/51888615@N02/4776065997/

The first orthodontist I saw proposed extracting 1 premolar each on the left and right from both the upper and lower arches several weeks after installing either (Damon braces on both upper and lower) or (lower Damon braces and upper lingual braces), which he said will work equally well over a 18-24 month treatment plan (though the linguals may take a 3-4 months longer). This is to make room for my overcrowded teeth due to my small jaw, which has caused rotation of my lower teeth and flaring out of my upper teeth. He actually didn't bring up the lingual braces option until I asked him about it, which he has done a lot of work with (during his training and in his current practice), because he said they are very expensive and require those extra couple of months.

The second orthodontist I saw also proposed extractions either before or after installing Damon braces on both upper and lower teeth for a 24 month treatment plan. He and his head assistant strongly advised against lingual braces. Their office has used linguals a few times from what I understand, but the patients weren't happy with them and have later asked to switch to regular braces. They also said that the Damon system allows for expansion of the arches to get a wider smile.

The third orthodontist I saw proposed only installing Damon braces on both upper and lower teeth for a 12-14 month treatment plan. She said extractions weren't necessary as the Damon system can expand the arches to make enough room for my teeth to straighten. She also said the Damon system will let me get that "better" wider smile. Treatment with her would also cost ~$3,500 less than the first two orthodontists I saw, because I have a somewhat mild case. She also advised against lingual braces, because they wouldn't be able to expand my arches and make more room for my teeth to align properly without extraction and wouldn't give me that wider smile.

I'm so confused and overwhelmed about my treatment options. Right now I'm leaning towards the first orthodontist with the lingual option since it would be really nice to not see the upper braces, and he's done a lot of work with it. He also didn't push the Damon system like the other two did (very sales pitch-y with the wider smile relative to other systems), other than it's probably the most comfortable sytem he's used (less pressure, etc.). However, I'm kind of scared with getting 4 perfectly good teeth extracted. Combined with the cheaper and faster treatment plan, the no-extraction plan with the third orthodontist has added to my indecision and confusion.

I guess my main question is why is there a discrepancy (in terms of getting extractions or not) between the treatment plans that will use the same Damon system? Also, it sounds like if I get teeth extracted and use the linguals I'd end up with a sunken profile and sunken cheeks, and a narrower smile than before? (All of which worry me a lot.)

Any answers, suggestions, and other comments will be greatly appreciated. Thanks so much for taking the time to read my post.

I would personally want to try a non-extraction route first. I would want to know for sure correction wasn't possible without them before I proceeded, but that's just me. The Damon thing is kind of a sales pitch, because it's not so much the brackets as what's done with them that counts, but there are legitimate concerns about linguals, too. It's hard to say what to do, but I would strongly recommend trying treatment without extractions first. You can always have teeth extracted later, but you can't have them put back in.

@evilnel: What did you mean with "legitimate concerns about lingual braces" (i.e., examples)? Thanks so much for your reply!

cottonball wrote:@evilnel: What did you mean with "legitimate concerns about lingual braces" (i.e., examples)? Thanks so much for your reply!

My orthodontist told me that linguals could be used in my situation but he didn't really recommend them as my teeth need the pressure from traditional braces and linguals can't provide the same kind of pressure so they take longer to work and don't work as well.

Lingual braces also cost a LOT more than traditional braces - I've seen quotes of uwpards of $16k for top and bottom linguals.

Linguals are also thought to be harder on the tongue - so more pain, harder to speak etc.

Sounds to me like your docs dont want to do the linguals.

You can "expand" with lingual braces just as you can with labial braces. Most expanders are made to push from the lingual and lingual braces mimick that.

Linguals take an adjustment of the tongue and labials take an adjustment of the lips and cheeks -- something is going to be sore for the first couple/few weeks -- just pick which sidIn regardws to the different treatment plans...if you go to 100 doctors you will likely get 100 different treatment options. You can take many roads and still get to your final destination.

Agreed with Dr. Rick. Lingual braces and wires are actually extremely good at dental expansion. They do require a greater learning curve for the doctor, there is a bigger adjustment required to them than with buccal braces, and there is an increased financial component as well.

Keep in mind that the type of brace is not going to determine whether extractions are necessary or not. Sometimes, extractions are better for individual situations, even if the teeth can be aligned without their removal. The treatment plan, based upon your diagnosis is the most important part. Good luck!

I met with another orthodontist today whose treatment plan involved no extraction and expanding both my top and bottom arches using Invisalign for 1.5-2 years, including elastics for both arches eventually, and then bottom braces at the end to level the bottom arch (currently the bottom front teeth stick out higher). She also does linguals (she's listed as an Incognito Premier Provider), but told me the two systems can do pretty much the same thing. The Invisalign is also tempting because it costs way less than the linguals. But I've read so many things about what Invisalign can and cannot do, so I told her my concerns and she said that it's not really so much the braces but how the orthodontist uses/designs the Invisalign treatment program...What do you guys think?

Again, thanks so much for your replies. The board and the website have been so helpful!

I had sucessful treatment with linguals for an impacted canine which I was told was one of the harder things to treat in adults with any kind of brace, but linguals (Incognito / IBraces) could do anything any other type of brace can do, no meniton of longer time scale although for me as it wasn't visable time scale was not too much of a problem. I found lingual uppers much more comfortable than conventional lowers. I would find an ortho who is comfortable using the type of brace you want.

Sorry no experience re invisalign.

Looking at your pictures i would say no to extractions. Aside from the overjet making your chin a little bit recessed, your profile and lip support still look very good, so you wouldn't really want any changes to that.

As far as treatment goes, just go with the one that you feel is most comfortable.

How did it go? Did you have extractions or not? Please I need answers