Hello,
I did post this in the lingual forum last week but didn't get any responses so I'm hoping to get more responses here. Apologies if it looks like I'm spamming the forum.
I'm in my late 20's and have seen a few orthodontists for recommendations of lingual treatments. It has emerged that I have two options available to me. I need to have braces on the upper and lower arch. So my options are to have four teeth extracted to ease the crowding or have the arches expanded. Previously my preferred route would have been to keep as many teeth as possible however now I am a little concerned about possible gum recession/relapse after expansion. I am also concerned that orthodontists do not seem to have a consistent opinion, one insists risks are minimal while another two insist there is quite a lot of risk....
I wondered if any of you may have any experience or advice you can share regarding this?
Thanks :)
Expansion or Extraction?
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TumbleDryLow
- Posts: 999
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- Location: Michigan
Re: Expansion or Extraction?
First off, understand that since you are in your late 20's, an expander is not going to widen your jaw bone. Those bones are fused and only surgery to break them apart and then placement of an expander is going to give you true jaw expansion. What an expander is going to do without surgery is tip or push your molars outward.
That said, I had an expander for a very short while. It was used to push two of my upper molars outward to correct their crossbite. My ortho was able to do this because those teeth were tipped too far into my mouth. The expander pretty much put them where they should have always been. I've had no relapse or gum recession.
In my completely unprofessional opinion, I'd say that if you need a small amount of space, and your jaw can support minor tipping of teeth, then the expander will work wonderfully. If you need more then a little space, well...it's harder to determine if an expander will do the job. Your limited to the structure of the bone. Push teeth and roots too far to the edge of the bone--your in for trouble. If some orthos have suggested extractions, it could be that you need more space then expansion can provide safety. I'm sure each doctor has a different tolerance for how much expansion is safe, which is why you are getting different answers.
BTW, I also had 4 premolars extracted. There was no way an expander alone was going to give me the space I needed to correct the crowding I had. It's never easy to extract healthy teeth, but sometimes it's the only way.
That said, I had an expander for a very short while. It was used to push two of my upper molars outward to correct their crossbite. My ortho was able to do this because those teeth were tipped too far into my mouth. The expander pretty much put them where they should have always been. I've had no relapse or gum recession.
In my completely unprofessional opinion, I'd say that if you need a small amount of space, and your jaw can support minor tipping of teeth, then the expander will work wonderfully. If you need more then a little space, well...it's harder to determine if an expander will do the job. Your limited to the structure of the bone. Push teeth and roots too far to the edge of the bone--your in for trouble. If some orthos have suggested extractions, it could be that you need more space then expansion can provide safety. I'm sure each doctor has a different tolerance for how much expansion is safe, which is why you are getting different answers.
BTW, I also had 4 premolars extracted. There was no way an expander alone was going to give me the space I needed to correct the crowding I had. It's never easy to extract healthy teeth, but sometimes it's the only way.
Re: Expansion or Extraction?
Consider getting multiple opinions before making a decision from both an orthodontist and jaw surgeon.
I went the extraction route and wish I would have researched more into expansion/sarpe. However, my face/smile was already small-extractions, in some people, hardly show a difference and are the better route.
Most orthos I speak with don't want to extract healthy teeth and my ortho did wait to the very end of treatment to decide. Hopefully you can make a decision in a timely manner so your treatment time is not extended too long.
I went the extraction route and wish I would have researched more into expansion/sarpe. However, my face/smile was already small-extractions, in some people, hardly show a difference and are the better route.
Most orthos I speak with don't want to extract healthy teeth and my ortho did wait to the very end of treatment to decide. Hopefully you can make a decision in a timely manner so your treatment time is not extended too long.
Re: Expansion or Extraction?
Extractions with Orthodontics can lead to dysfunction of the jaw joint if the orthodontist is not taking the function of the joint into consideration.
Arch expansion can be achieved in adults using an ALF appliance, which is used by Functional Orthodontists. Functional Orthodontists are also taking the jaw joint into consideration, so worth getting an opinion from this type of orthodontist
Arch expansion can be achieved in adults using an ALF appliance, which is used by Functional Orthodontists. Functional Orthodontists are also taking the jaw joint into consideration, so worth getting an opinion from this type of orthodontist
Re: Expansion or Extraction?
Thank you, this is very helpful. The orthodontist who suggested expansion did not mention an ALF appliance. He explained this could be achieved with lingual (Incognito) braces. Is it possible to expand the arch with a lingual appliance? I shall look up some functional orthodontists in the mean time.
Re: Expansion or Extraction?
I'm in a similar situation as you. I'm 27, and I consulted eight orthodontists, which even my periodontist thought, err, was a bit much. But the reason I went to so many is that I *thought* everyone was giving me differing opinions. Some said extract one from the front, two from the top, two from one side, extract four, extract 0! Gah. After talking to so many people, I did detect that the common theme was that my mouth could not ideally hold in alignment my current number of teeth. I also realized that the extract 1 and 2 crowd were just wacky, and that my choices were really 0 (am I willing to live with less than ideal bite) or 4 extractions (ideal bite). In the end, I decided to go with the orthodontist who had the most experience treating adults in his practice. I also checked many references by former patients; I couldn't find anything bad about him, I only found glowing reviews.
My orthodontist gave me the option of 4 premolar extractions or none. He said if I opted for no extractions, the risks were slight. But he gently told me that I probably would be happier with the aesthetic results if I went with extractions. I also drilled him with questions at three separate consults (two were preliminary, one was the actual review with xrays). I asked him everything down to the mm of where he estimated the arches of my new bite would be. From talking to all these orthodontists, I learned I do have a severe overjet (5mm+) and my left bite is completely misaligned, especially because of a crossbite. My midlines are also off by 4mm. When I asked about the possibility of shaving, most of them said that they were uncomfortable shaving off more than .5mm per tooth, and that in my case, I wouldn't make it with just shaving.
My orthodontist showed me my x-ray records, and I was shocked by the angle of my front teeth. I can see that over time, the pressure of chewing, wasn't going to help the longevity of the teeth and the gums behind them (I plan to have my teeth until I'm 90!). I don't know if this is helpful, but my doctor explained that you can only get away with so much tipping. If there's too much tipping, the teeth are more prone to relapse because they want to move back to original positions. He said you want to ideally have the tooth itself at a good angle (well, usually straight) so that it can take the pressure of chewing. I asked if extractions would make me more likely to relapse because of the distance the teeth have to go--he said, no, the culprit of relapse is not wearing retainers and too much tipping. So please ask your orthodontist a lot of questions until you feel comfortable. Every case is different. My case is centered around the fact that I have a deep overbite. My teeth are too forward in my jaw, and my genetics and my anatomy makes it so I can't move them back. I did have one other orthodontist, who had taught at Harvard dental, look me in face and say that I *had* to have the extractions, and anyone else who said otherwise was just after my money--I wouldn't see a noticeable difference in my overbite.
Anyway, I came to the decision regarding extractions in early February after my ortho and I looked at my xrays. I just put on braces on Feb 18. I'm scheduled for extractions on March 3 (apparently, all that brace pressure on the teeth make them looser and easier to extract). I still have feelings of nervousness, but I don't have second thoughts about my decision much. In a way, I'm at peace with myself. Certainly, the horrible feeling of indecision I've been experiencing for four months has largely subsided.
I guess my main advice is to ask questions until you feel comfortable with your decision. Find an orthodontist that you can trust. If it's any help, I did talk to my periodontist, dentist and hygienist beforehand. They aren't orthodontist experts, but it helped to get reassurances from them that I was unlikely to make my situation worse by extracting teeth, and that some other dental professional that's not my ortho will be monitoring what's happening in my mouth every three months.
Good luck! Hope this helps!
My orthodontist gave me the option of 4 premolar extractions or none. He said if I opted for no extractions, the risks were slight. But he gently told me that I probably would be happier with the aesthetic results if I went with extractions. I also drilled him with questions at three separate consults (two were preliminary, one was the actual review with xrays). I asked him everything down to the mm of where he estimated the arches of my new bite would be. From talking to all these orthodontists, I learned I do have a severe overjet (5mm+) and my left bite is completely misaligned, especially because of a crossbite. My midlines are also off by 4mm. When I asked about the possibility of shaving, most of them said that they were uncomfortable shaving off more than .5mm per tooth, and that in my case, I wouldn't make it with just shaving.
My orthodontist showed me my x-ray records, and I was shocked by the angle of my front teeth. I can see that over time, the pressure of chewing, wasn't going to help the longevity of the teeth and the gums behind them (I plan to have my teeth until I'm 90!). I don't know if this is helpful, but my doctor explained that you can only get away with so much tipping. If there's too much tipping, the teeth are more prone to relapse because they want to move back to original positions. He said you want to ideally have the tooth itself at a good angle (well, usually straight) so that it can take the pressure of chewing. I asked if extractions would make me more likely to relapse because of the distance the teeth have to go--he said, no, the culprit of relapse is not wearing retainers and too much tipping. So please ask your orthodontist a lot of questions until you feel comfortable. Every case is different. My case is centered around the fact that I have a deep overbite. My teeth are too forward in my jaw, and my genetics and my anatomy makes it so I can't move them back. I did have one other orthodontist, who had taught at Harvard dental, look me in face and say that I *had* to have the extractions, and anyone else who said otherwise was just after my money--I wouldn't see a noticeable difference in my overbite.
Anyway, I came to the decision regarding extractions in early February after my ortho and I looked at my xrays. I just put on braces on Feb 18. I'm scheduled for extractions on March 3 (apparently, all that brace pressure on the teeth make them looser and easier to extract). I still have feelings of nervousness, but I don't have second thoughts about my decision much. In a way, I'm at peace with myself. Certainly, the horrible feeling of indecision I've been experiencing for four months has largely subsided.
I guess my main advice is to ask questions until you feel comfortable with your decision. Find an orthodontist that you can trust. If it's any help, I did talk to my periodontist, dentist and hygienist beforehand. They aren't orthodontist experts, but it helped to get reassurances from them that I was unlikely to make my situation worse by extracting teeth, and that some other dental professional that's not my ortho will be monitoring what's happening in my mouth every three months.
Good luck! Hope this helps!
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seriousthinker
- Posts: 115
- Joined: Mon Mar 29, 2010 6:41 am
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Re: Expansion or Extraction?
Hi,
In your case I'd say try to get as many opinions as possible. Tooth removal is major work and if it can be avoided then surely that's the best option. I have been really lucky. When I was 12 my dentist said I'd definitely need extractions. We never went ahead with any plans and now at 26 having had my upper wisdoms through to add to the equation my teeth are straightening up with no extractions!!! Goes to show that I could have lost 2 healthy teeth with no need.
I may, however need IPR down the line.
Good luck!
In your case I'd say try to get as many opinions as possible. Tooth removal is major work and if it can be avoided then surely that's the best option. I have been really lucky. When I was 12 my dentist said I'd definitely need extractions. We never went ahead with any plans and now at 26 having had my upper wisdoms through to add to the equation my teeth are straightening up with no extractions!!! Goes to show that I could have lost 2 healthy teeth with no need.
I may, however need IPR down the line.
Good luck!
Re: Expansion or Extraction?
I am about to have SARPE surgery and I saw a few ortho's for their opinion first and the common opinion between all of them was 'thank god I didn't have any teeth removed prior'. I have had braces twice before and now have a bad open bite, they said it would have caused so many problems if I had had teeth removed. My unprofessional opinion would be to keep your teeth and go with the expansion.
Re: Expansion or Extraction?
In my case (28, when I had the braces put on), we had to extract 4 teeth (well 3, since I lost a molar 10 years ago). Even if I was pretty iffy at first with getting good teeth out, it worked nicely, since I really have HUGE teeth and small arches. My teeth have aligned nicely on the arches and it's super OK. It's good to get various opinions though if your crowding is not as big as mine, maybe it's good to find out more about this than extract teeth too easily.
Orthodontics patient from 2007 to 2010.
Orthodontic Braces
Orthodontic Braces
Re: Expansion or Extraction?
Go the expansion route.
From my experience this is a no-brainer. I had 4 pre-molars extracted as a teenager and then braces.
Roll forward 20 years and I slowly noticed the start of a whole bunch of seemingly bizarre and unrelated symptoms;
mouth breathing, forward head posture, really worn down incisors, pressure feeling on one side of my face, jaw clicking, stiff neck and headaches.
Our bodies are designed to have 28 teeth (32 if you include the wisdoms). Removing 4 and retracting the bite back changes all the biological inter-relationships. Remember we are not just retracting teeth here but the bones they are attached to as well which in the case of the upper dental arch is the maxilla, the main paired bones in the mid face.
Furthermore the stability of the dental arch is maintained by the inwards action of the facial muscles counteracting against the outward action of the tongue. If you narrow the dental arch the tongue can't fit in it's normal rest position on the roof of the mouth and the facial muscles will gain the upper hand causing the dental arch to collapse. The tongue ideally should function like a 'shoe tree' maintaining the ideal arch form. Retraction will also cause the base of the tongue to move backwards and block the airway leading to mouth breathing and sleep apnea
I'm in ongoing treatment to walk me back to how I should have been. I've had to wear an mandibular repositioning appliance, then have my TMJ discs surgically repositioned and now I'm wearing an ALF to expand my upper arch and correct the cranial distortions. Its been 4 months and I can see major movement already. The dentist explained that the ALF doesn't move the teeth but the bones they are attached to by stimulating growth at the sutures.
An extremely high % of orthodontic cases are not stable over time because facial function is ignored (tongue position when swollowing).
Our bodies were designed to be a certain way and if you allow somebody to meddle around you run risks which in my experience are unacceptable
From my experience this is a no-brainer. I had 4 pre-molars extracted as a teenager and then braces.
Roll forward 20 years and I slowly noticed the start of a whole bunch of seemingly bizarre and unrelated symptoms;
mouth breathing, forward head posture, really worn down incisors, pressure feeling on one side of my face, jaw clicking, stiff neck and headaches.
Our bodies are designed to have 28 teeth (32 if you include the wisdoms). Removing 4 and retracting the bite back changes all the biological inter-relationships. Remember we are not just retracting teeth here but the bones they are attached to as well which in the case of the upper dental arch is the maxilla, the main paired bones in the mid face.
Furthermore the stability of the dental arch is maintained by the inwards action of the facial muscles counteracting against the outward action of the tongue. If you narrow the dental arch the tongue can't fit in it's normal rest position on the roof of the mouth and the facial muscles will gain the upper hand causing the dental arch to collapse. The tongue ideally should function like a 'shoe tree' maintaining the ideal arch form. Retraction will also cause the base of the tongue to move backwards and block the airway leading to mouth breathing and sleep apnea
I'm in ongoing treatment to walk me back to how I should have been. I've had to wear an mandibular repositioning appliance, then have my TMJ discs surgically repositioned and now I'm wearing an ALF to expand my upper arch and correct the cranial distortions. Its been 4 months and I can see major movement already. The dentist explained that the ALF doesn't move the teeth but the bones they are attached to by stimulating growth at the sutures.
An extremely high % of orthodontic cases are not stable over time because facial function is ignored (tongue position when swollowing).
Our bodies were designed to be a certain way and if you allow somebody to meddle around you run risks which in my experience are unacceptable
Re: Expansion or Extraction?
I have to get (1) second bicuspid on the top right removed before my top braces go on and I'm concerned that my smile is going to be off because of that. He would remove 2 but I have gum recession on my front 4 and he is afraid that too much space may leave small black holes in between my teeth. I'm going to ask him on my next visit if that is going to affect my midline at all, because I'm kinda concerned.
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jellybeans
- Posts: 6
- Joined: Thu Apr 21, 2011 10:19 pm
Re: Expansion or Extraction?
[quote="Eurodude"]Go the expansion route.
From my experience this is a no-brainer. I had 4 pre-molars extracted as a teenager and then braces.
Roll forward 20 years and I slowly noticed the start of a whole bunch of seemingly bizarre and unrelated symptoms;
mouth breathing, forward head posture, really worn down incisors, pressure feeling on one side of my face, jaw clicking, stiff neck and headaches.
Our bodies are designed to have 28 teeth (32 if you include the wisdoms). Removing 4 and retracting the bite back changes all the biological inter-relationships. Remember we are not just retracting teeth here but the bones they are attached to as well which in the case of the upper dental arch is the maxilla, the main paired bones in the mid face.
Furthermore the stability of the dental arch is maintained by the inwards action of the facial muscles counteracting against the outward action of the tongue. If you narrow the dental arch the tongue can't fit in it's normal rest position on the roof of the mouth and the facial muscles will gain the upper hand causing the dental arch to collapse. The tongue ideally should function like a 'shoe tree' maintaining the ideal arch form. Retraction will also cause the base of the tongue to move backwards and block the airway leading to mouth breathing and sleep apnea
I'm in ongoing treatment to walk me back to how I should have been. I've had to wear an mandibular repositioning appliance, then have my TMJ discs surgically repositioned and now I'm wearing an ALF to expand my upper arch and correct the cranial distortions. Its been 4 months and I can see major movement already. The dentist explained that the ALF doesn't move the teeth but the bones they are attached to by stimulating growth at the sutures.
An extremely high % of orthodontic cases are not stable over time because facial function is ignored (tongue position when swollowing).
Our bodies were designed to be a certain way and if you allow somebody to meddle around you run risks which in my experience are unacceptable[/quote]
Sorry, this is unrelated to answering the actual topic - but I'd like to ask "Eurodude" - I recently got 4 bicuspid extractions for braces after coming across researches that say TMJ does not directly link to the shifting of jaws due to braces in many cases.. that being said, I also read many horror stories about how people think their orthodontic treatment is what caused their TMJ.
What's your take on this issue? If the orthodontist "does it right", there should be a possibility that I won't have TMJ later on due to extractions.. no? I'm really horrified at this idea, I'm only 20 and while I do want a nice smile, I don't want to get braces knowing that my adult life later is ruined forever due to TMJ... do you know any adults with extractions who don't have TMJ a decade or more after getting braces?
From my experience this is a no-brainer. I had 4 pre-molars extracted as a teenager and then braces.
Roll forward 20 years and I slowly noticed the start of a whole bunch of seemingly bizarre and unrelated symptoms;
mouth breathing, forward head posture, really worn down incisors, pressure feeling on one side of my face, jaw clicking, stiff neck and headaches.
Our bodies are designed to have 28 teeth (32 if you include the wisdoms). Removing 4 and retracting the bite back changes all the biological inter-relationships. Remember we are not just retracting teeth here but the bones they are attached to as well which in the case of the upper dental arch is the maxilla, the main paired bones in the mid face.
Furthermore the stability of the dental arch is maintained by the inwards action of the facial muscles counteracting against the outward action of the tongue. If you narrow the dental arch the tongue can't fit in it's normal rest position on the roof of the mouth and the facial muscles will gain the upper hand causing the dental arch to collapse. The tongue ideally should function like a 'shoe tree' maintaining the ideal arch form. Retraction will also cause the base of the tongue to move backwards and block the airway leading to mouth breathing and sleep apnea
I'm in ongoing treatment to walk me back to how I should have been. I've had to wear an mandibular repositioning appliance, then have my TMJ discs surgically repositioned and now I'm wearing an ALF to expand my upper arch and correct the cranial distortions. Its been 4 months and I can see major movement already. The dentist explained that the ALF doesn't move the teeth but the bones they are attached to by stimulating growth at the sutures.
An extremely high % of orthodontic cases are not stable over time because facial function is ignored (tongue position when swollowing).
Our bodies were designed to be a certain way and if you allow somebody to meddle around you run risks which in my experience are unacceptable[/quote]
Sorry, this is unrelated to answering the actual topic - but I'd like to ask "Eurodude" - I recently got 4 bicuspid extractions for braces after coming across researches that say TMJ does not directly link to the shifting of jaws due to braces in many cases.. that being said, I also read many horror stories about how people think their orthodontic treatment is what caused their TMJ.
What's your take on this issue? If the orthodontist "does it right", there should be a possibility that I won't have TMJ later on due to extractions.. no? I'm really horrified at this idea, I'm only 20 and while I do want a nice smile, I don't want to get braces knowing that my adult life later is ruined forever due to TMJ... do you know any adults with extractions who don't have TMJ a decade or more after getting braces?
Re: Expansion or Extraction?
Hi Jellybeans,jellybeans wrote: Sorry, this is unrelated to answering the actual topic - but I'd like to ask "Eurodude" - I recently got 4 bicuspid extractions for braces after coming across researches that say TMJ does not directly link to the shifting of jaws due to braces in many cases.. that being said, I also read many horror stories about how people think their orthodontic treatment is what caused their TMJ.
What's your take on this issue? If the orthodontist "does it right", there should be a possibility that I won't have TMJ later on due to extractions.. no? I'm really horrified at this idea, I'm only 20 and while I do want a nice smile, I don't want to get braces knowing that my adult life later is ruined forever due to TMJ... do you know any adults with extractions who don't have TMJ a decade or more after getting braces?
I also am in a similar situation to Eurodude. When I was a child I also had the extraction of 4 premolars followed with fixed braces. I later developed TMJ dysfunction, and I am now having orthodontics to correct my TMJ dysfunction, which is using a similar method as Eurodude describes by expanding the upper arch with an ALF appliance.
Extracting 4 premolars in children, and then pulling back the teeth into the gaps with fixed braces makes the arches smaller, and also the fixed braces restrict growth while the child is wearing the braces for approx 2 years. An alternative method of orthodontics used in children is Functional Orthodontics, where appliances are used to expand the arch, so teeth do not need removing.
The method of functional orthodontics is also used in adults, and it is also the orthodontic method used to treat TMJ dysfunction. Not only is it straightening teeth, but it also expands the narrow arches, and takes the position of the lower jaw within the jaw joint into consideration as well. The upper arch is expanded using an ALF appliance. If you want to be sure that your orthodontics isn't going to affect your TMJ, I would suggest seeking the opinion of a Functional orthodontist. I don't think it's necessarily the removal of the 4 premolars that's the issue relating to the TMJ, but more to do with which direction teeth are moved to close the gaps, and most of all where your lower jaw is positioned when you bite, because this will in turn affect the condyle position within the TMJ. If the condyles are too far back within the TMJ when you bite, the discs can displace, and also the condyles can press against cranial nerves and blood supply.
Re: Expansion or Extraction?
I agree with the expansion suggestion.
I had four premolars removed as well as a child (seems common!) and braces to close the gaps. My teeth were perfect when I was 14 years old.
However, as I went through puberty and grew, my lower jaw grew as a result of testosterone and my underbite came back. Additionally, my wisdom teeth came in and caused crowding in my upper arch once again and pushed some teeth out of alignment. I ended up with two crooked teeth on my upper arch (lateral incisor and canine) and an underbite and crossbite... after already dealing with braces for three years as a child!
My upper jaw was far too narrow and underdeveloped. It gave my smile a "forced" look and made my face look chubby because of how wide my lower jaw was comparably (couldn't really see my cheekbones). I had SARPE in November to expand my upper jaw a whopping 10mm. Turns out my old orthodontist had also compensated for my underbite by positioning my lower teeth backwards a bit... not a good idea. Overall I'm extremely unhappy with my old orthodontist and his complete lack of foresight. Anyway, my teeth are almost perfectly back into place now with a wider arch, and the results are great. I still need another jaw surgery to move my upper jaw forward 2-3mm but otherwise my smile looks great, and my face looks much more "balanced" - the change is extremely subtle from the expansion but it is definitely a positive one.
So I would agree with the suggestion to proceed with expansion. It's a pain in the ass, but worthwhile.
I had four premolars removed as well as a child (seems common!) and braces to close the gaps. My teeth were perfect when I was 14 years old.
However, as I went through puberty and grew, my lower jaw grew as a result of testosterone and my underbite came back. Additionally, my wisdom teeth came in and caused crowding in my upper arch once again and pushed some teeth out of alignment. I ended up with two crooked teeth on my upper arch (lateral incisor and canine) and an underbite and crossbite... after already dealing with braces for three years as a child!
My upper jaw was far too narrow and underdeveloped. It gave my smile a "forced" look and made my face look chubby because of how wide my lower jaw was comparably (couldn't really see my cheekbones). I had SARPE in November to expand my upper jaw a whopping 10mm. Turns out my old orthodontist had also compensated for my underbite by positioning my lower teeth backwards a bit... not a good idea. Overall I'm extremely unhappy with my old orthodontist and his complete lack of foresight. Anyway, my teeth are almost perfectly back into place now with a wider arch, and the results are great. I still need another jaw surgery to move my upper jaw forward 2-3mm but otherwise my smile looks great, and my face looks much more "balanced" - the change is extremely subtle from the expansion but it is definitely a positive one.
So I would agree with the suggestion to proceed with expansion. It's a pain in the ass, but worthwhile.