symmetrical or asymmetrical extractions?

[brace33]

My ortho gave me two options for extractions.

1. to extract one whole set of pre-molars, totally 4, which is the traditional way.
2. to extract only two on the left side, since I have a localized issue on the left, as you can see in the picture. It's kinder to the roots. But my mid-line will be ~4mm off, which is about half tooth width.

Does anyone have any asymmetrical extractions and be able to share some experiences? Thanks,


By brace33 at 2011-12-23

[MATTWOOD]

My centre line is off by 3mm and no one has ever commented.

My situation is that I lost the left front tooth in an accident at 11, then before I got it replaced I lost the front right in another accident. This went uncorrected until 18 when I had the wherewithal to do something about it. As a result of doing nothing for so long the 2/2 had both moved into the gap and also as a result of an accident one of them which was damaged inside and could not support a bridge and so had to be removed, this left me with no option to have the other No 2 tooth removed and hence I was left with a slightly smaller then usual 4 tooth gap, in which I am currently wearing a plate with 4 teeth on it.

I should also mention that in the meantime one of the top wisdom teeth had come through the other was impacted, hence the gap being off centre by 3mm.

Anyway that's the position I speak from. I won't go into the work I'm having done here, but suffice to say I'm going to some length to open up the gap to full size, (it get's centralised in the process) and impact the bottom front teeth which have over erupted back into be jaw so that future implants can be full length as well as width.

Having made the decision to get a permanent fix - I could have had implants done a year ago into the existing gap - I saw no point in doing half a job and fixing the problem with what I knew to be a compromise, by which I mean accepting smaller front teeth than I could achieve through orthodontics. Hence all the work.

My advice therefore is to consider what you want to get out of the whole process. If you would be happy to accept the off centre centre line (and I really don't think there'll be a problem with it, I'm 33 now and have lived with an off centre centre line for 15 years without it ever once being an issue) then just get the one taken out. If however you think you'll think back and wish you had gone the extra mile then go for both.

I speak from an aesthetic perspective really. Like you say there is more potentially for gum related issues with the greater amount of work but I can't really comment on that.

All the best,

[Amanda6]

If it we me I wouldn't do either of those options and search for an orthodontist who can expand the upper arch instead and keep all the teeth.
I had 4 premolars extracted as a child, and I wish it hadn't been done as it has caused TMJ dysfunction due to the fact that extracting 4 premolars narrows the upper arch. I am currently having orthodontics to treat my TMJ by expanding my upper arch.

[ArchWired28]

Amanda6
I am sorry to hear that you suffer from TMJ issues. However, orthodontic extractions in growing children is the whole different story. Children who are still growing can and should use the interceptive orthodontics instead of teeth extractions. This being said, I personally know several adults who had their premolars extracted as kids and have had no issues whatsoever.

brace33
I am very sensitive to midlines. My own midline has become ~3-4mm off and it bugs me every day, can't wait to start elastics to fix it. So if I were you, I would have opted either for 4 extractions or none. However, it is up to you. If having an off midline would not bother you, go for 2 extracted premolars. But you have to be absolutely sure that you will be in peace with this decision as much in 10 and 20 years as you are now.

[sirwired]

If it we me I wouldn't do either of those options and search for an orthodontist who can expand the upper arch instead and keep all the teeth.
I had 4 premolars extracted as a child, and I wish it hadn't been done as it has caused TMJ dysfunction due to the fact that extracting 4 premolars narrows the upper arch. I am currently having orthodontics to treat my TMJ by expanding my upper arch.

There is no magic formula to stably and easily expand the upper arch of a fully-grown adult. If the arch isn't big enough, it isn't big enough. SARPE and/or LeFort I is appropriate for some of those cases, extractions appropriate for others. If the adult arch is simply cranked outwards with a palatal expander (perfectly appropriate treatment for a child), it won't be stable.

Extractions can be appropriate and indicated for a case. They do not inevitably lead to TMJ issues.

It is a mistake to shop for orthodontists by simply excluding every one that calls for extractions. They ARE appropriate in some cases, and if you simply exclude all those that want to extract, you run a very high risk of ending up with an ortho that wins your business by telling you what you want to hear. No, no ortho wants your result to collapse after treatment, but neither doctors nor patients are completely immune to wishful thinking.

There are certainly orthodontic techniques that reduce the need for extractions, and accordingly overall extraction rates have trended downwards over the years. But until there is some sort of magic appliance that will grow bone, they won't go away entirely, especially in adults.

[benj]

I had two premolars extracted from the one side only. I was naturally missing one premolar on the opposite side, so I still have five premolars and an odd number of teeth, but since I started with an odd number that is all the orthodontist had to work with.

I had several consultations and all of them told me I would probably still have an odd number of teeth after treatment, other wise my lower face would recede too far inwards. But my end result has been very good, they still managed to get my midline centered and the smile looking even. My orthodontist even referrers to people with one or two extractions versus four as "non extraction cases". With the use of TAD's to close the extractions they can get results like never before.

[brace33]

Thank you all for your kindly replies. When I look at my pictures, it looks like all teeth will perfectly fit my arch if I have one extraction from each arch (top and bottom). Not too crowded, not too loose. But it will shift my mid-line and my mesh won't be ideal.

Four extractions (2 on top and 2 on bottom) are symmetrical. But I am concerned that my teeth would be pulled back too much. Does anyone have similar case?

[emilou]

before i tell you my story i just want to say in advance sorry for any spelling mistakes i am english but have lived in spain since i was 11 (am now 24) i dont practice english much and defenatly dont write in english sooo sorry...!
anyway here we go, right i have the same problem, i will tell you my story,
i was told by my dentist when i was 11 i needed braces ASAP, anyway we moved to spain and left it.
anyway over the years i have had problems with carries (decay) (iv got 8 fillings) because my teeth were so crowded for so much time.
anyway when i was about 15 i tried once more to go with gettin braces done here in spain, they started by extracting teeth! i had a lower tooth pulled on my left (first premollar left bottom), i also had my "bottom right second mollar" tooth taken out,
anyway after these extractions i was forsed to leave the treatment because we found out our dentist was a scam she wasnt legal (we´d already paid 2000euros that we havent seen since)
anyway so there i was with too teeth extractions over the years my right wisdom tooth came up and filled the gap from my second mollar and then my bottom teeth shifted about 3mm to my left, so far my top teeth was fine hadnt yet been touched!
i am now 23years old and i have had my braces on for 4months now. yep i finally went for it again i went to go see a new ortodontist,
she said she could put my teeth straight but wont be able to match my top jaw with my bottom (my bottom jaw is further back, and surgery is not a option seeing as its VERY expensive)
anyway she went a extracted another tooth of mine this time it was in the top my right first premollar. anyway so far i am 4 months into having braces and to fill this gap my teeth are shifting to there right i already have a off midline by about 2mm but its very noticeable and i still have about 4mm gap so in the end i will end up with a extream off midline anyway.
ok so imagen my bottom teeth have shifted to there left and my top teeth have shifted and are still shifting to there right! yea so imagen what it must look like!
i dont know what to do because now shes sayin she might have to pull the same tooth on the other side (top teeth) but i have looked up alot of reserch and there are types of braces "damon braces" that dont need teeth extractions they open you jaw wider and make so teeth will fit they are extreamly against teeth extractions because with teeth extractions you mouth gets smaller and causes alot of problems and also tend to make your mouth look "caved in" and about 10 years older than you actually are, now i am mad at my ortodontist for not telling me about these diffrent type of braces! she only does traditional metal braces (i knew nothing about braces i thought these i have were the only type of braces there were, so i went along with it)
i am already so insecure with my chin being further back than my face, and now what? i dont want my top part of my jaw to enligne with my bottom cause that would just look awfull seeing as my bottom chin in too far in as it is! id end up looking worse. im stuck i dont know what do, i dont even know what i could do! im only 4 months into having braces and im just scared if i take another tooth out my upper jaw will cave in and become like my lower! but if i dont take it out ill have a extream off mid line! i wish i would of gone to see another orthodontist in the beginning and been informed about other types of braces!
I was thinking.... becuase i still have my right top wisdom tooth to come down maybe bring it forwards instead of getin it removed to fill the gap where my first premollar was removed! so then it would push my teeth back to the normal places! and my front two teeth to be symmetrical again. and maybe push back my top left teeth slightly backwards, anyhow i have explained this to my dentist and i have said i do not want another tooth pulled and yet she says well see further along! what do i do leave my orthodontist and go see about this damon brace? would that even be fixable? il see if i can put a photo up! cause my storys slightly hard to follow! quick review im missing:
bottom: left first premollar, right second mollar (wisdom tooth in second mollar´s place
top: right first premollar, left wisdom tooth (wisdom removed due to it was coming out above second mollar)
any answers??????????? help

[ArchWired28]

i dont know what to do because now shes sayin she might have to pull the same tooth on the other side (top teeth) but i have looked up alot of reserch and there are types of braces "damon braces" that dont need teeth extractions they open you jaw wider and make so teeth will fit they are extreamly against teeth extractions because with teeth extractions you mouth gets smaller and causes alot of problems and also tend to make your mouth look "caved in" and about 10 years older than you actually are, now i am mad at my ortodontist for not telling me about these diffrent type of braces! she only does traditional metal braces (i knew nothing about braces i thought these i have were the only type of braces there were, so i went along with it)

First of all, don't listen to all that HYPO about damon braces. There is absolutely no research to back up their claims. Think of it, if you have a small jawbone and not all teeth could fit, no type of brace will change the bone at 23 since you are done growing. They might move teeth slightly faster BUT they cannot create additional space.

Now, about asymmetrical extractions. These should never be done on a symmetrical jaw, because you will have the midline shift. Do you want midline shift on your top teeth? I think your ortho knows what she/he is doing so if she says you need the other tooth extracted, you will be better off doing so. You could have refused all extractions from the start, but now you are just too far in treatment and don't really have a choice. Don't worry about your chin, it should be MORE forward after your teeth are aligned and not more retrusive. Your upper lip may become a little smaller because of extractions but the chin will actually win, if anything.

And remember, you can always get a 2nd opinion from another ortho if you are that concerned.

[sirwired]

Extractions, done poorly, can indeed cause problems. Extractions, done correctly and for the right reasons, can fix otherwise unsolvable orthodontic problems.

As archwired28 said, don't believe the hype about Damon braces. They are not magic and do not accomplish anything that cannot also be done with the braces you have now.

It's hard for us to offer an opinion on the skills and plan of your orthodontist, but there is no reason to be mad at your ortho because Damon braces aren't part of the treatment plan. (My orthodontist offers them, along with the equivalent from 3M, but still put me in conventional braces.)

[EbonyQ]

I got damons and I needed extraction. There was just no room for them. Sometimes extractions is the only option