*UPDATED 20 SEPT* Extraction decision- decision made!

[overseasmel]

Hi guys,

I'm just over 9 months into my braces and things are going well. My orthodontist is happy with the straightening of the teeth and we have made good progress on the bite. But now, after 9 months of sitting back and relaxing and letting my ortho make all the big decisions, I now have to make one.

My ortho says that my teeth (top and bottom) are slightly more "forward" than they should be, due to straightening the teeth without any extractions. He has vested me with the "purely aesthetic decision" (his words) of deciding whether, in order to fix this, I want four teeth removed. These would be all the 5s.

I will upload some pics for your honest view a bit later. My thoughts and questions at the moment though are:

- anyone have any idea how much extraction of 4 premolars costs in Australia these days?
- anyone had good or bad experiences with this kind of extraction?
- I've actually not had a problem with the slight 'forwardness' of my teeth, but at the same time I have come this far and spent this much (15k and counting), so if it really is something that might bother me, perhaps I should get it done.... Hmm.... Anyone made or not made this type of choice (perfection or 95%)? What are your feelings about it now?

Thanks for your help. Will post pics as soon as I find my camera charger!

[SapphireJen]

Hi Overseasemel,

I could have written your post word for word bar a few timing changes.

I first got braces in March 05, and whilst my ortho suggested extractions, I decided to wait and see.

After a year - my teeth had straightened beautifully, but had come forward a couple of cm...This bugged me a little - but not sure if it was enought to warrant extractions. My ortho thought I would have a far more superior result with extractions.

It was a really hard decision, but in the end I decided to do it. March this year - I had my extractions and am so glad that I did!

In response to your questions -

- Each extractions was about $120 but I also heard of dentist charging double that per tooth
- My experience has been good. My gaps have been closing well and I can see the improvement with my teeth coming back. I have also had comments from other people about this as well - so I know it is working!
- I felt exactly the same way. I didn't want my braces off and risk thinking I should have had the extractions to improve the look. I decided to go the whole way....

I know how difficult it is to decide, but you'll make the right decision either way.

If you want to see pics of my story - here is the link:
viewtopic.php?t=17638

Best of luck with your decision, Jen XXOO

[overseasmel]

Thanks Jen. I had a look at your post and it was really useful. It seemed as if your gaps were closing at a rate of about 1mm a month, is that right? So about 9 months to close each gap?

Here are my pics as promised:




I'd really love your opinions on the aesthetics of it all- I am not very good at having an opinion on my own appearance!!

(There are more pictures here: viewtopic.php?t=15058&highlight= on page 5 if these ones aren't clear enough. )

[sjsarre]

Mmmn hard decisions.. Have your wisdom teeth come down yet? If not then that would be another reason to get the extractions. Your teeth move forward when your wisdom teeth come down and your teeth also naturally move foward as you age. This is what my ortho told me anyway!!

[iBorg]

I like your top teeth where they are. I actually hope mine are near that when I'm done. As for the extraction, any way to move your bottom teeth forward?

I had four teeth pulled when I was in my late teens and that is a prime reason I'm wired again in my late forties. If you have the extractions how far back will your teeth move. Also, pulling teeth on both arches would seem to keep the same relationship with your overbite, just move it backward.

I'd ask about what this would do to the visibility of your teeth as well as long term effects.

This is a hard decision. Good luck with it.

Mike

[SandraJones]

overseasmel, is your orthodontist saying that you have a slight class II malocclusion ? If you are not bugged by the "flaw", then you might want to just leave them as-is. I'm of the opinion that teeth don't need to be perfect, you just need to be happy with them. But honestly, yours look awesome ! They will likely look perfect to 99.99999% of the people who see you, the .00001% who don't think they look perfect will be the orthdontists and dentists.

[sjsarre]

I agree with the comments, that you are the person with the teeth and if you are happy then don't have extractions done. However I think its something you need to discuss fully with the ortho. As per my previous post, if you haven't yet got your wisdom teeth and if they do come through then your teeth may be pushed further forward..

I had four extractions. I happy with the results of mine I don't think my teeth would have looked as good as yours if I had kept my teeth in!!

[SandraJones]

Oh I see now, the upper central incisors are flared out just the tiniest tiniest bit. I didn't even notice that the first time I scrutinized the pictures, but now on second scrutinization I see it.

Another thing to consider is the effect on movement (I guess it would be tipping ?) of the upper central incisors on the upper lip protrusion, which looks really good right now, balanced with the lower. Would retruding (correct term ?) the upper centrals cause the upper lip to retrude as well ? I realize it would be a tiny amount, but sometimes tiny amounts are noticeable.

I can say that for me personally, if my teeth end up looking that good I would not have any removed in order to correct such a slight "flaw". That would be too much work for me to net such a small amount of improvement.

[overseasmel]

You guys are awesome. This is why I come here!! It's so hard to get feedback and ideas of things to think about from the people around me sometimes. My ortho isn't the chattiest fellow either and all he said, right at the end of the last appointment, was "your teeth are a bit forward, we can fix that by removing all your top and bottom 5s, but it's a purely aesthetic decision so it is up to you. Think about it for the next appointment".

I am leaning towards not getting it done. It doesn't really bother me but I thought perhaps I was clueless or something- it's nice to know others who are attuned to these things don't see it as particularly noticeable. I will chat to my ortho though about possible long term consequences of extracting versus not extracting.

Oh, and the wisdom teeth were all removed years ago, so no problems there!

*mwuah*

[merrily]

Overseasmel,
I got extractions one year into braces. I was terrified of getting teeth pulled so I wanted the ortho to try first without removing any teeth. The tops straightened but they came forward more than I liked (much more than yours, which look fine in my opinion) but the bottoms didn't straighten, so we decided to go for the extractions.

That's my experience, but I think your teeth look good. I could probably find some pics of the extent of my overjet--it was much worse than yours. And combined with the lack of progress on the bottom, that made me decide to get extractions.

[sjsarre]

Yeah I do think Wisdom teeth have an unfair reputation but I know with mine that they were pushing my teeth forwards... But if you've had them removed then you won't be having an problems with them blighters!!!

[iBorg]

My only concern would be the lips. I agree with Meryaten that removing the bulk of braces would correct this. How's your bite? How close are you to a Class 1? As for aesthetics, (to quote an actress of a long time ago) "Darling you look marvvelloous.

Mike

[SandraJones]

I agree too about the braces impeding the closing of the lips, because mine used to be closed at rest and now with braces they are not !

I was just reading an Angle Orthodontist article about how bimaxillary protrusion normally exists in certain ethnic groups. So depending on the person, it may not be a "flaw" at all.

I'm ever bugged by this trend toward cookie-cutter faces. Too many noses are shaved of their interesting contours, too many lips are plumped to absurdity, too many teeth are veneered and over-whitened to the point where they look absolutely fake ... can we have some variety here ? Including imperfection ? Can less than "perfect" be beautiful/handsome ?

Am I the only one who thinks a retrognathic mandible is attractive ????

I also like upper lateral incisors rotated and tipped a bit so that they ever-so-slightly overlap the centrals. In fact, I'm thinking about having my orthodontist do this for me.

So anyway, overseasmel, I'm glad you feel like you are getting good support here. Your teeth really do look great !!

[overseasmel]

Okay, I spoke with my ortho today and the update is this:

- I asked him the technical word for the issue and he said "procline" (he isn't a wordy man).
- Apparently my front top teeth are too "flared" and thus stick out a bit too much at the bottom.
- He would like to bring them in about 3-4mm (measured from the bottom of the front teeth, inwards), as this would give a much more ideal aesthetic result.
- He says there would be no long term ill-effects from NOT having the extractions.
- He says that my lips may or may not close fully without extractions. Basically it was a "probably" but also a "maybe not". He also admitted though that this was also the case with extractions, as soft tissue movement doesn't mirror hard tissue so you don't know until you try.
- He says I have about 9 months of treatment time left if I don't extract and 15 months if I do. I started with braces 9.5 months ago.

I said I would tell him by the next appointment (3 weeks time). He wants me to decide ASAP as the longer we delay the longer the treatment time will be.

Armed with this information, does anyone have any more thoughts?

[SandraJones]

3-4mm ???? OMG, when I look at your pics I could see maybe 1mm "improvement". I'm with Meryaten, I wouldn't do it.

overseasmel, one thing to consider, even though if you're going to go through with it it's obviously easiest to do now, you can ALWAYS have this done later if you find that later on you are bugged by this "flaw". But honestly, your teeth look great now and I'll bet few people outside of the dental and orthodontics professions would even notice that things aren't perfect.