Should I have teeth extracted or implanted?

[Neptune]

Hi Ivette.

I must say, I've never known someone to meet soooooo many implant specialists!! lol It's great that they have the best intentions for you, but they have a completely different perspective of your mouth than your orthodontist does.

Regarding the tongue size issue: my lower jaw had NO crowding. If two of my teeth were removed, I could see how significant the change would be in my mouth. But you have A LOT of crowding. Keep that in mind. If you ended up with extractions, once straightened, your arch probably wouldn't be much different than it is right now. (Hope that makes sense...just saying that the jaggedness of your arch would be straightened...)

The annoying thing about orthodontics is that it varies soooo much from person to person, that it's difficult to really give applicable input. I really think you should talk to another orthodontist (NOT an implant specialist) just to make sure you have all the information you need.

But...if you're set on the wanting a larger smile...then you're probably already set on implants. Besides, you already expressed you can afford it. Cost is usually the biggest deterrent for most people. Go for it!

[Horton]

ure top teeths make smaller arch than ure bottom teeths. u have crossbite. wont ure orthodontists need anyway 2 expand ure top arch 2 make teeths bite together?

[Ivette]

Hi Horton,

Yes, a little expansion on the top will be needed. If I don't intend implanting extra teeth on the top, the arch on the top can be opened slightly with the archwire itself. If I take out two teeth on the bottom, the arch would shrink a little to match the narrow upper arch. If I expand the upper arch too much, then more spaces will be opened and I'll need implants.

I keep going back and forth and trying to make up my mind. I think it would look better if I have the implants on the top but my bottom teeth are so crowded...I'm so scared of having an expander for months in my mouth! Not to talk about a surgery...

Neptune, regarding your comment that I can afford the implants - yes, I could by sacrificing other things in my life. If I knew this is the best for my health, I'd make that sacrifice. But if I have any doubts, then why do it?

[starzz]

Hi Ivette,

Congrats on deciding to get braces! You do have a big decision ahead of you and it sounds like you are being thoughtful about it. I agree with the advice on getting more consults. The extraction route is technically easy; you want to ask the orthos if they could do the expansion and implant route and get opinions on feasibility of this kind of treatment.

I think you need to do a bit more research to help you decide. You mention expander and surgery if you go the implant route. Do you mean jaw surgery? Would this be definitely required? Find out risks, costs etc of what would be involved as some are more complex than others. Surgery is not cheap; would your insurance cover it? There is a forum on this board for surgery.

The tongue discussion is interesting. (I have no extractions and my tongue likes to rest behind my top teeth; I don't seem to have room on bottom for it?) And it is true that people with obstructions in their airways (who often snore and/or are significantly overweight) can develop Obstructive Sleep Apnea and this IS associated with heart/cardiovascular and other health problems. Basically people with this stop breathing briefly and their sleep is disrupted so they loose deep restful sleep, but mostly do not wake up when this is going; the cycle repeats many many times per night. So what you dentist said has done science behind it. However I'm not personally aware of issues with tongue versus dental arch size being a factor; but I suppose it could be. I'm not an expert in this area but my impression was the obstruction typically occurs in the region of the throat. There is a test called a "sleep study" where you sleep in a lab and they monitor your breathing and the quality of your sleep. If you have a personal or family history of snoring or sleep apnea or suspected sleep apnea you might discuss your dentist's concern with you physician.

[Neptune]

Wow starzz, that was spot on! I mentioned that my sister was told that she had a large tongue issue. The rest of the story is that when she went to get an orthodontic consultation, the doctor told her that he wouldn't start her treatment until she got a tonsillectomy. As it stands, my sister has had sleep studies performed on her and has been diagnosed with sleep apnea, so his observation was completely in line with what she had been told by other doctors. We were just surprised that issues originating from the throat could affect the outcome of orthodontics.

[starzz]

Neptune-- interesting story about your sister. So it sounds like what the dentist said about sleep apnea is credible, in a general sense. Fascinating how the function of different parts of our bodies is connected.

However, I don't want to scare Ivette. I have no idea how likely or unlikely it would be that she might develop such a condition might be with or without various orthodontic treatments and I am in no way (!) qualified to assess such a thing. My earlier advice stands. Do let us know what you decide to do next, Ivette.

[Ivette]

Interesting topic - I had no idea about the sleep apnea and relation to orthodontics. As starzz said it, the different parts of our body are connected such that it's almost like a domino effect if you mess up one thing, many other parts could be affected!

It was funny - yesterday I shared my story with a friend of mine and he said that if I do the extraction at the bottom and if I do have problem with obstruction of my airway, they could "trim" my tongue! Never thought from that perspective! hehe

I really don't think I should be concerned about my tongue because at the moment I have no problem finding room for it in my mouth and don't think it would be any different after the orthodontic treatment. However, I do think that aesthetically it may look better if I have the full set of my teeth. I have a lot of questions for my orthodontist (hope I can get a hold of him today) and if I still have doubts after talking to him, I will have to seek another ortho opinion. Once I decide what to do, I want to be confident and trust in my treatment plan. I'll keep you posted!

Thanks again for your support! You guys, are amazing!

[princessT]

Hi ivette.my situatn similar to urs.i extractd 1bicuspid from the uper arch a few yrz ago to avoid getting braces..now i have braces to create space for an implant aftr ortho treatment.i didnt go for extractions because you end up with a sunk in,thin face. I hav damon brakets so dont thnk i need palatal expandr.hope i helpd u2dcyd.remembr to choose wisely coz u cant revers it.i hav no regrets so far . .let me know wat u choose

[Ivette]

So you think you'll be able to get space created on the top for two implants only by using the archwires? That would be an interesting option for me too!

[classII]

Definitely go for a third consult, or at least ask the ortho about that. The dentist's explanation, well sounds like a dentists explanation (remove teeth, shrink arch=cramp tounge). Massive difference between an orthodontist and a dentist - for a reason.

Seriously raise it with the ortho he'll probably illusrtate for you how you maybe lose 1mm or so in reduction, hardly cause for concern for your tongue. Not even sure your tongue supposed to be sitting down below the bottom gumline. Other than making the smile wider what is the benefit to go through seems like 2 surgeries, expansion plus implants. Ask him to illustrate that to you. The difference in the two smilles. Again is so fractional no one including you would notice it unless pointed out.

[Ivette]

Today I had a chance to talk to my ortho (over the phone only) and to "shower" him with all my questions from the past couple of days (yeah, some of the questions that you, guys, raised here, I asked my ortho about).

First I tried to explain what that dentist pretty much told me about the tongue and potential negative effect on my health if I go with the extraction. My ortho knew right away what I was talking about and assured me that it's a marginal concern and he could argue that in my case, even taking out the crowding on the bottom would help "free" more room for the tongue as some of you pointed too

Then aesthetically - he couldn't say that "definitely" the implants would give me a better look because I may end up having my upper teeth sticking out so they provide more room for the implants and hence, the "horse smile"

However, it's likely that it would look better if I broaden the upper arch. He didn't think that a palatal expander would be efficient at my age because the bone development has been completed. So he offered that we try making some room for the implants on the top only by using the archwire. He said that we can start by applying braces on the upper first and see how I respond. I'm a little uncomfortable with this experiments but I also understand that it may be worth trying. He also may need to make new models and we'll look at it from many angles. He did confirm that if we are able to make room for the implants, it won't be before I complete with the ortho treatment when they will put the implants. Meanwhile I'll be with something like flippers attached to the braces.

On Thursday, March 19 I have an appointment with my ortho to go over this new idea and what the plan would be. I'm really happy that I may be able to resolve this without extractions on the bottom (or probably just one tooth will be taken out), without palatal expander and without arch surgery! I hope so much it would work without all those scary procedures. On the other hand, I told my ortho that I don't want to eliminate options just because I'm scared and I don't know much about them. For now I'm not seeking another ortho specialist for opinion because I think my ortho is looking into this seriously and also I trust that he has sufficient knowledge to resolve this case in the best way possible. At the moment I feel any hesitation, I may see somebody else for opinion.

I'll keep you posted

[Ivette]

Hi princessT!

I'm interested to hear about your case. How did you have room made for the implants on the top? Does it look good after opening up the space? I'm really curious to hear about your case.

[starzz]

The update sounds encouraging. I still think it would be a good idea to get another opinion before you commit financially to treatment with this ortho. Best case you find a new ortho you like better, worse case they confirm what the first ortho said and make you more confident in your decision.

FYI other adults on this board have used expanders successfully. Which tooth might they remove on bottom? Do you know about IPR (interproximal reduction or tooth slenderizing or shaving)? It's becoming a really common way to gain a bit more space when teeth are crowded and in some cases prevents the need for extractions. It is like sanding off a very small amount of enamel on each side of some teeth. I started with "moderate crowding" on bottom and most likely will have a little IPR eventually.

By the way, I agree that widening your upper arch however that is achieved, would be an enhancement aesthetically.

[Ivette]

Hi starzz,

Yes. My ortho mentioned about the option of IPR on the bottom to help the crowding. He also mentioned that although an expander may work at my age, the chances are low (I don't know any statistics and didn't ask).

When I got the idea about getting braces (BTW it occurred suddenly one night, I woke up at 3 am with this determination to do it finally), I thought that it'll be very important to find a good ortho that I trust completely. So I spent a fair amount of time researching, asked many people at work for a recommendation and ended up seeing 2 orthos - one of them I found online occasionally but I was really impressed when I had my visit with him (felt the good vibes as he answered my questions thoroughly with a nice science approach); the other one was highly recommended to me by two of my colleagues but once I met him, the expectations didn't meet the reality. So I went ahead with the one I found occasionally on the internet but whom I really trusted. I really didn't have anything to point my finger at as a concern with him except the fact that he wasn't recommended by someone I knew. However, his assistant showed me many of his cases and I was really impressed by the results.

So I did commit to him, had my records taken and already made my down-payment. BTW the other ortho I saw also said that most likely I'll need extractions at the bottom and didn't encourage the implants. I still think my ortho is doing his best in this situation. It's actually me who is hesitant. At the very beginning he gave me the two options and I chose to go with the extractions. Then that other dentist indicated that I'm making a "big mistake" and made me hesitant about my treatment plan. Now I need to meet my ortho in person (today we just spoke on the phone) and go over the alternative options again. Seeing another ortho at this point may only add to the confusion because they''ll be more factors involved, such as gaining the trust of that other person. At the end, I don't want to get frustrated and just give up the idea of fixing my teeth because I can't make a decision.

If after my appointment on Thursday I'm still lost, I may set up an appointment to seek another ortho opinion but most likely I'll have to pay for the consultation because in contract with the free initial consultations, in this case I want to bring my records and openly discuss the situation as it is.

starzz, thanks a lot for the additional info you gave me and also for the good questions you suggested. It helps me build my list of questions for the ortho!

[starzz]

Hi Ivette,

You're welcome. I think you're doing all the right things. By having this dialogue here we can help others learn who may be facing similar issues.