Lower Front Tooth Extraction for Braces

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#1 Post by **madbadger2000** » Wed Apr 15, 2009 10:35 am

I am a 28 year old with mild-to-severe crowding of my lower front teeth and rotaional/shifting on my upper teeth. My dentist and dental hygenist have told me for years that I should consider braces as preventitve maintenance for complications that may arise in the future due to these issues. Finally, I am going to take their advise.

I just returned from an orthodontic consultation this morning and was informed that correction of the overcrowding will require extraction of my lower front right tooth. This course of action alarms me. However, I reviewed a few internet biograpghies/diaries of braces that included this method of correction and the authors reporteded apprehension at first as well. After treatment, the authors seemd happy with the results of their treatment. Nonetheless, I am still frightented at the thought of this process.

A few questions and concerns I have are as follows:
1) How painful is tooth extraction?
2) Is it truly necessary?
3) What types of complications can arise from tooth extraction immediatley and decades down the road?

Ultimately, I am looking forward to the end result of healthy and straight teeth, eventhough I need to take 'the ride' to acheive these results. For comfort sake, please provide your personal experiences and support if you had a similar path to straight teeth. Thanks alot!

#2 Post by **kilikena311** » Wed Apr 15, 2009 10:41 am

That is the exact tooth that I had extracted last wednesday. My doc said there was absolutely no way for him to work that tooth into my arch. It stuck out in front of all the others by quite a bit and also the gum had receded on it quite a bit. For looking pretty iffy it was really difficult for my dentist to pull, he had to work at it for what seemed like forever. Thankfully I was nicely numb and had the laughing gas because of my anxiety. All in all it wasn't too bad. After braces I am a little concerned about how it will look with only that one gone, but in the grand scheme it is on the lower arch which doesn't show when I smile

#3 Post by **Megan11** » Wed Apr 15, 2009 11:34 am

#1. Extractions, to me anyways, are not painful at all. I had two extractions after already being braced and did not run into any problems.

#2. I STRONGLY recommend you get another opinion. Sometimes one ortho recommends extractions while another it extremely confident that they can get the desired result without extractions. So if one says yes and one says no, I would get two more opinions

#3. The only complications I can think of is a narrower arch ( which really isn't a complication, but rather an aesthetic issue). I know that I would want to make 100% sure I NEEDED to take out a healthy tooth before I just went ahead and did it. The teeth I had extracted were baby teeth that had never fallen out so I had no choice.

I have seen pictures of people who have had the same thing done and you can't tell at all. So if you did go with that treatment plan you'd be the only one that noticed.

#4 Post by **lorimar** » Thu Apr 16, 2009 2:04 pm

I had a lower central incisor extracted in October. It was not painful at all and came out quite easily. It did bleed a little more than I expected when I got home. I saw two orthodontists who both told me that I needed to have the extraction as there was just no room to straighten my teeth. That was good enough for me, but I was still apprehensive to have it done
and felt self conscious at first about the gap.

The good news is that the gap is nearly closed and my orthodontist couldn't be more pleased with the way things are proceeding. When all is said and done, I'm happy I decided to go for it and will now have a straight bottom arch.

#5 Post by **kristi1003** » Fri Apr 17, 2009 8:39 pm

i would get a 2nd opinion. usually orthodontist/dentist do not want to pull your teeth out. i would just make sure there is nothing else they can do. we need all of our teeth!!!

#6 Post by **terra85** » Fri Apr 17, 2009 9:09 pm

Get a second (or even third or more) opinion. My dentist told me that orthos are concerned mainly with the functional aspects of aligning teeth; in other words, they are not thinking as much about how extraction will affect your face, but how it will better your bite. Maybe you need an extraction, or maybe not. There might be other orthos out there that can straighten your teeth without extractions. If so, I would go the non-extraction route. Good luck to you.

#7 Post by **starzz** » Fri Apr 17, 2009 9:30 pm

I agree with getting a 2nd opinion -- always a good idea when extractions or other complicated treatment is recommended. Ask what the alternatives might be? Whether you really need this may depend how severe your crowding is and the size of your bottom versus top jaws. Have you been told you have any sign of gum disease or gum recession or other problem with that tooth? Have you discussed the possibility of IPR (or tooth stipping) on several of your bottom teeth to gain space instead of extraction?

The major cosmetic issue is that your midlines would not line up.

#8 Post by **zeira** » Tue Apr 21, 2009 9:28 am

Hi!
I have a similar treatment plan. I'm missing one of the first premolars on the top (it was impacted and got it out last year), so we'll have to take out one on the other side for symmetry and because of crowding. Then on the bottom my ortho said either get two premolars out or one of the front teeth. He showed me some other cases where he did the same extractions (quite a few, I guess he likes it), and it looks fine, but my boyfriend keeps bugging me about the midline. I'd prefer giving up one tooth to giving up two seemingly more important ones for eating but I'm torn on this one.

For now we're waiting to see how my expasion surgery will go and how the lower jaw will realign once it's not locked into the top. Please let us know what you decide and how your case progresses! Good luck!

#9 Post by **melliemoo** » Thu Apr 23, 2009 1:13 am

I had a lower incisor extracted due to severe overcrowding. Aside from surgury on both my upper and lower jaw, this was the only option. I just had my braces removed on Monday and will try to get a photo posted this week of the finished product. The extraction did not hurt. I think the lower teeth look pretty good.

#10 Post by **zeira** » Fri Apr 24, 2009 6:45 am

Hi, melliemoo!
I would love to see your evolution. I saw some final results with removal of lower incisor in the ortho's office, but now I feel like I didn't have enough time to study them. I'll bug them next time to let me study that album more

#11 Post by **madbadger2000** » Wed Apr 29, 2009 4:24 pm

I am getting both a second and third opinion. I did not feel comfortable with the absolute certainty for tooth removal that the first orthodontist recommended. If all orthodontists recommend the same thing, then I will go for it.

On a side note, my friend is a dentist and thought extraction of only one tooth sounded unusual. He further went on to say teeth are almost always extracted in pairs.

Also, I recently found out that a friend of mine had the same tooth removed for braces. So, maybe it isn't the worst idea in the world.

It just might be that I am in mental shock about having a tooth removed. If I give it more time, perhaps I will realize that this is the best option. But first, I will go to the other consultations.

#12 Post by **DrJasonKTam** » Wed Apr 29, 2009 4:55 pm

Lower incisor extraction treatments can be very successful under the right conditions. The main complication is that there is now a smaller arch permieter in the bottom than the top. A certain ratio of the top teeth and bottom teeth is required for the jaws to fit together properly in both the posterior bite and also with ideal overjet (what most people refer to as overbite). This is known as the Bolton ratio.

Therefore, when a lower incisor is extracted, there is often a residual overjet. This can be corrected by interproximal reduction of the upper front teeth. The bottom teeth can also be proclined and upper teeth retroclined to minimize this overjet. It is particularly ideal in situations where there are small upper lateral incisors (relatively common).

If the back teeth fit together in an ideal bite, and there is good overjet with overcrowding in the lower anterior region, a lower incisor extraction may be be the most ideal treatment indicated. Often times, in overcrowding of the lower anteriors, one or more of the teeth may have excessive gingival recession, giving more weight to its extraction.

Keep in mind that the upper midline will now match up with the centre of the middle lower incisor. This is an extremely acceptable treatment that will not greatly change the profile, but can provide optimum alignment and occlusion. There is an example on our Markham Centre Orthodontics office webpage, Before and After, under patient #9.

#13 Post by **beachbum** » Wed Apr 29, 2009 5:49 pm

I am nearing the end of treatment after having a bottom tooth removed and braces for about a year and a half.
My major disappointment is that I have two large 'black triangles', or empty holes on either side of the front tooth.
Also, I have a tooth in the center, instead of a midline that matches up but that doesn't bother me very much.

#14 Post by **Inova** » Thu Apr 30, 2009 3:30 am

Hi
I'm having my L1 tooth pulled out tomorrow (I think that's the lower left middle incisor), then 2 premolars at the top next week, then braces following Monday, then a further lower tooth at some point. The reason he's doing this is firstly due to overcrowding which has caused quite serious gum recesion in my front lower teeth. So he's taking one out, fitting braces then looking at the gums and will make a decision about which one goes next. So perhaps you're ortho might do this as well? Hopefully everything wll line up in the end!

#15 Post by **Inova** » Thu Apr 30, 2009 4:30 am

P.S I will let you know how it goes and hopefully put your mind at rest. To be honest this is the only option for me so I'm not particularly worried as there's no decision to make! My ortho has said he's never done it before but I trust him completely

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Lower Front Tooth Extraction for Braces

Lower Front Tooth Extraction for Braces

a very viable treatment plan

Lower incisor extraction tomorrow!