5mths in - ortho suggest extraction but I'm against the idea

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#1 Post by **gracey82** » Mon Nov 02, 2009 11:19 pm

I'm 5 months in my braces now. I have agreed with the first ortho to adopt conservative method - to go ahead without extraction and 6 months in to evaluate whether or not I need extraction.

I don't have overcrowded teeth, just protruding few front teeth and maybe lower. The only reason I went for braces is to push back my front teeth a little. Ortho agreed to do IPR to gain spaces.

I have changed to another ortho 2months ago, due to some conflict issues with the first ortho. Now the 2nd ortho just throw me the news that she think I will need extraction, to gain spaces. But she leave the option to me. Orthodontic speaking, she says I will need to. From the x ray, it looks protruding to me. But in real life, I'm happy with my smile, maybe just little IPR to push back the teeth. As she know I like the full teeth smile, she said I have 2 months to think about it whether or not I want extraction. She said I have more than enough teeth.

Yes I have more than enough teeth now. Not when I grow old and only left with few teeth, the extracted 4 teeth would be big difference, isnt it?!!

I really believe the teeth are there for a reason!!! Teeth not aligned because you have narrow jaw, or whatever reason. I mentioned I would want IPR to gain spaces but she doesnt seem to like the idea and said the only reason she would do IPR for me is to reduce the black triangle on my front 2 teeth.

But at the same time, my friend said if you are paying so much for it, why go for comprimised result??

Though , I'm not sure if I would like my smile better with 4 teeth lesser. I would think you have narrower arch, smaller smile???

What do you think?!!

#2 Post by **drrick** » Tue Nov 03, 2009 8:06 am

How much further back to yo want them to go?
That is really the question you need to ask yourself. If a few mm's is enough go for the IPR if you want mor than that go for the ext?

If your case is bimax-protrusion/flaring teeth then exts are often done to bring the teeth back, give you lip competance, imporve protruding profile, etc.

You just need to decide what result you want and then choose the option that wil get you there.

Good luck w/ your decision!!!

#3 Post by **diesel** » Tue Nov 03, 2009 12:05 pm

i had a similar thing with protruding teeth. My lips didn't close at rest. It would always look like my lips/mouth area were stretching around the teeth.. That's probably the negative part about expansion. They were crowded before and invisalign spread them out. Also the final bite had me whistling when i said my S's. :O Now i've extracted 4 and in braces hoping the extractions don't do any facial damage.

#4 Post by **drrick** » Tue Nov 03, 2009 12:32 pm

if you cant close your lips ext's can only help your face.

#5 Post by **gracey82** » Sat Nov 14, 2009 10:20 am

Thanks everyone for the opinons. Thanks Dr Rick for your advice.

I'm fearful of extraction because I do not know what it would turn out to be like. Etc will I have narrower arch and smile. And worst is extraction is not reversible. Best if there is a software or something that can show how you will look like and your facial profile would be at the end results if extraction is done, so you can go compare.

I have get compliments on my smile, so I can live with teeth being pushed back some mm. Ideally of course pushed back to be a straight set of teeth. But because I cant predict how my smile would be like ( though I know from orthodontic point of view, I will have a perfectly aligned and straight teeth), I'm fearful of what extractions will do to my smile or facial profile.

Am posting a pic here for better illustration.
From front view, I'm happy and ok with my smile. From side, not so. And to better illustrate my protrusion, look at the right most pic, which orthodontic speaking, it's not good enough.

http://lh3.ggpht.com/_S5HB-JlF6nM/Sv7ml ... itled2.jpg

I'm so torn!

#6 Post by **gracey82** » Sat Nov 14, 2009 10:21 am

Sorry, error in posting.

#7 Post by **braceface418** » Sat Nov 14, 2009 11:34 am

I heard different things from the consults I went on -- extractions, no extractions, etc. I made a point to not mention the things that made me unhappy before the consults, which happened to be excessive flaring of my upper teeth, among other things. The ortho I chose mentioned that he would recommend extractions to deal with the crowding and flaring of my upper teeth, so that's who I went with.

Maybe you could do something similar... tell an orthodontist you haven't seen before that you think you might almost be finished, but aren't sure if there's anything else that should be fixed before the braces are removed... see what they say. Not sure if they'll charge for that or not though.

#8 Post by **khrystal1968** » Sat Nov 14, 2009 1:10 pm

Personally, I think they look fine. Thats exactly how mine looked before extraction. I wanted IPR but they would not do it.

My teeth are huge, like yours.

#9 Post by **mwic1985** » Sat Nov 14, 2009 2:24 pm

I had 4 premolars out and 2 wisdom teeth, and will probably need at least one more wisdom tooth out since it's growing horizontally(!). I've had braces for about 4 months now.
I just wanted to say that I don't miss them in any way(!) Yes for a few weeks I had large gaps, but the brace is doing its job and closing the gap.
My mouth wasn't especially overcrowded, although it is something my dentist would mention, making it harder to clean. I know you say we have teeth for a reason, but some people have large jaws, some small, yet we almost always have the same number of teeth

If it were me, I'd go with what the orth recommends (I did) - but of course not a light decision since you can't exactly go back on it can you.. so I hope you do whatever you find most comfortable. The photos don't look bad at all, maybe your orth is just a perfectionist?

Hope this helps and good luck

Marc

#10 Post by **braceface418** » Sat Nov 14, 2009 3:16 pm

If your bite is fine and you're otherwise happy with your teeth look, you should probably just make sure that you're diligent about retainer wear. I'd think that they might be more likely to relapse if your ortho pushed the available space to its limits. Do you know what kind of retainers they're going to give you at the end of treatment?

#11 Post by **DrJasonKTam** » Sat Nov 14, 2009 5:21 pm

The teeth definitely look proclined and it appears that there would be some lip incompetency from the photos you posted. As you've mentioned, you aren't too happy with your side profile. In order to correct this significantly, extractions would likely be necessary.

Extractions do not have to result in dished in faces and narrow smiles. The amount of profile reduction depends on how much the back teeth are allowed to come forward during space closure. Smiles do not have to be more narrow either. One particular company has really scared the public about extractions, but when used at the right time and in the right way, they should help lead to better results, not worse.

Beyond the aesthetics, there are a number of issues that can arise with teeth that have been moved a large distance such as stability, periodontal problems, etc. Please speak to your orthodontist to discuss the benefits and risks with respect to health AND aesthetics.

When it comes to aesthetics, there can be a lot of varying opinions. Take your time to discuss your concerns with your orthodontist to communicate your concerns and ideals so that they can help you achieve the best result that you are happy with :).

Best of luck!

#12 Post by **gracey82** » Sat Nov 14, 2009 9:23 pm

Thanks for sharing your experience and input guys! Appreciate it alot

lenoreo@ I'm not sure what retainer I will be wearing yet.And yes they will charge for consultation if you just go in for consultation.I have went to probably 3-4 consultations. All suggested teeth extraction, the easiest way out. I just want to know of other options apart from teeth extraction so I don't want to waste money and time going for another consultation anymore.

Dr Tham, when you mentioned lip incompetency, what does it mean?

I wanted IPR to be done to gain some space and reduce the protrusion but this orthon (my 2nd orthon) doesnt seem so willing to carry out IPR. She mentioned that she will only do IPR to reduce the triangle black holes on my front teeth.

I'm looking at the teeth that need to be extracted and they are huge teeth! And I'm looking at 2 above and 2 below, it's a lot of space to be closed and I cannot imagine how my teeth will move. Hence I imagine a dish in profile because it's a lot gaps to close and my teeth are pretty much aligned now and I dont have overcrowding teeth to begin with.

Dr Tham when you mentioned how much your back teeth are allowed to come forward, meaning to say to close the gap, not only the front teeth will move backwards, the back teeth will come forwards too?

My appointment with orthon is not until next month. Still have time to sleep on it !

#13 Post by **Bellalalala** » Sat Nov 14, 2009 10:42 pm

As I understand it, "Lip Incompetency" means that your lips don't cover your teeth, or are strained to cover your teeth.

It's just a technical term for what you have already described.

#14 Post by **gracey82** » Sun Nov 15, 2009 6:10 am

Thanks for the clarification Bellalala.

Well my lips cant close fully before I wear braces. My lips definitely cant close fully now that I have braces.But I'm not sure if I'm able to without braces now that my teeth been pushed back a little. hmm

Just wondering if there are someone out there who are similar to my case care to share your experience and post some pics?

#15 Post by **Faerydust** » Sun Nov 15, 2009 4:16 pm

Looking at the side profile pic, you would need major IPR on the lower arch in order to bring the upper teeth back without them hitting your lower teeth.