Intro and 3 orthodontic opinions - your thoughts?

[Undecided]

Hello, I’m new to the forum and this is my first post (it’s going to be long…please bear with me!) I’m considering getting braces and I’m trying to do as much research as possible before taking the plunge. All input welcome!

Some background information on me: This is not my first foray into the world of braces. When I was a child I had a fairly significant overjet and a gap in my upper central incisors. I also had wonky lower incisors, although these didn’t concern me. At the age of 11 I started orthodontic treatment for the overjet and the gap (but not the lower incisors) which involved wearing a functional brace for a couple of years, followed by a retainer-type brace. I wore both appliances as directed by my orthodontist and finally finished treatment at the age of 15. Great! Straight upper teeth! Until, ooh, I was about 17. A grand total of two years. In my late teens my upper right lateral incisor started to creep forward (or so I thought), followed, not long after, by the upper left lateral incisor. By my early-mid twenties I was sporting a fashionable vampire look with protruding upper lateral incisors.

So, anyway, I’m now 30. Finally feeling as though I could afford some dental work, and having heard wonderful things about Invisalign, I booked myself a £150 orthodontic consultation at my current dental practice. I had convinced myself that I would be an ideal candidate for Invisalign, having already had orthodontic treatment when I was younger. Not quite. The ortho took photos, moulds and X-rays and then gave me the news. Turns out that I have a significant overbite, a class II malocclusion on my left-hand side despite a perfect bite on my right-hand side, a completely misaligned midline, an overjet (an overjet?! Hey, what about my functional brace?), severe-moderate crowding on my retroclined lower incisors and retroclined upper central incisors that veer slightly to the left. Gosh. Who knew?? When the ortho started to talk about 2-year treatment and extractions I realised that (a) my 12-month Invisalign dream was over, (b) I wanted to get a few other opinions before pursuing this brace idea and (c) I do not want visible braces on my upper teeth. Nope, not even ceramics. I don’t even really want them on my lower teeth. I already did the visible braces thing in my pre-teen/early teen years and don’t fancy going back to that.

So, having absorbed the shock, I booked in a couple of free consultations with orthodontists (all qualified and board-certified) in other practices in London.

What they agree on: All of the above problems. It appears as though my jaw continued to grow and develop after I finished my functional brace treatment at 15. This brought back my overjet problem, although probably not to the extent as it was before. My lower lip is positioned so that it presses on my upper central incisors, forcing them back into a retroclined position. Therefore my front upper lateral incisors are actually correctly positioned. The problem is that my front teeth are too far back in comparison, which gives me the vampire look.

How the different orthos think I should treat the problem:

Orthodontist 1 (Used to working with fixed braces. Took photos, moulds and X-ray.)
- Either extract UR5 and UL5 (upper second bicuspids) to eliminate the overjet, OR don’t extract any teeth but accept a 5mm-6mm overjet after treatment
- Either extract a grossly misaligned lower incisor on my lower arch or two lower bicuspids to reduce the crowding. In her opinion, my lower teeth are too narrow and retroclined to slenderise effectively. Extraction is necessary.
- Invisalign may improve my teeth but will not be nearly as effective as fixed braces. Invisalign would cost £4,000 (approx. $6,300) She does not tend to work with Invisalign.
- Incognito - £9,500 (approx. $15,000)
- Upper ceramics and lower metal - £3,800 ($6,000)
- Upper and lower ceramics - £4,300 ($6,800) but she doesn’t recommend ceramics on the lower teeth with my bite
- Treatment time: About 24 months.

Orthodontist 2 (Works predominantly with lingual braces. Took photos. I gave him a photo of the X-ray from my visit with Orthodontist 1)
- Extract UR5 (upper second bicuspid) and UL4 (upper first bicuspid) to eliminate overjet. Discrepancy in extractions due to discrepancy in my bite on right and left sides
- No need to extract from lower arch. Use of arch expansion and slenderisation if necessary will suffice.
- Invisalign not even vaguely an option due to the complexity of my case.
- Incognito upper and lower - £8,000 ($12,500)
- Incognito upper, ceramics lower - £6,500 ($10,200). The lingual brace would go on first to create room and the ceramics would go on later.
- Treatment time: 18-24 months

Orthodontist 3 (Invisalign Platinum provider. No photos or anything taken at this visit)
- Extract two upper bicuspids, one on each side, to eliminate overjet OR don’t extract and accept 5mm-6mm overjet after the treatment, but try to disguise it with lower teeth OR don’t extract but slenderise upper teeth to reduce/eliminate the overjet
- No need to extract from lower arch. Space acquired through slenderisation of the teeth
- Invisalign an option if I am very motivated and prepared to wear them correctly for two years. Is experienced with complex cases with Invisalign. Price for upper and lower Invisalign: £4,300 ($6,800)
- Upper Invisalign and lower ceramics - £5,500 ($8,600). I’d never heard of this before, but ortho says he has used this combination effectively in the past.
- Incognito upper and lower - £7,500 ($11,800)
- Does not like to combine Incognito with ceramics, so not an option at this orthodontist
- Treatment time: 24 months

I would be interested to hear your thoughts on these different options. It’s all very expensive as I’m based in London and therefore everything is at a premium. (Orthos 1 and 3 are most conveniently located for me.)

Apologies for the long post. Thanks for reading, if you’ve got this far!

[Corrinne]

Hello undecided.

I don't know much about lingual or incognito braces. But if I were faced with your decision I would bear certain things in mind.

In what ways are incognito braces better than lingual - enough to justify such a massive price difference? (Not in my opinion!).
Is it worth risking the expense of Invisalign for such a complex case that may or may not work? I think that the third orthodontist who said Invisalign was an option is just telling you what you want to hear.

I personally would go with the first ortho and choose upper ceramics and lower metal (or metal top and bottom. For two reasons, price and reliability. But that's just the opinion of a 28 year old, traditional metal brace wearer

[Ciara]

Hi!
Your case sounds a bit like mine: braces to correct an anterior cross bite and gap between my central incisors as a child. This was followed by a retainer which I wore till I was 16. Gradually over the next 20 years I developed a deep bite, way off center mid-line, several rotated teeth, flattened mandibular cordyle) etc. All this started causing problems with my TMJ in my mid-thirties which reached a "peak" about 2 years ago when I couldn't open my mouth at all for 3 weeks! My dentist said I needed braces and I really was shocked - braces again in my early 40s?!!!
I changed dentists last year (my previous dentist didn't treat TMD) and my present dentist was recommended to me by several people. The first time I sat in her chair, she said that I needed braces since I now had 100% deep bite on one side and about 50% on the other (canted maxillary).
I too went for several consultations but in the end, chose the ortho attached to my usual dental clinic. I also wanted something "invisible". I am university lecturer, so have to do a lot of public speaking. However, I was told that lingual braces wouldn't really be suitable and they also cause a lot of speech problems which would be unacceptable in my case. Invisalign wouldn't work in my case (too complex). So, to my horror I was now facing another round of traditional braces.
Anyway, to make a long story short, I how have ceramic braces on my upper jaw and will get the same on my lower jaw on Feb. 18th along with a bite plate. I'm congenitally missing my upper left lateral incisor and my lower right premolar was removed as a child due to overcrowding so I have plenty of space.

What I've learned from all this is that orthodontists vary in their approach, that better control can often be achieved with traditional braces (either ceramic or metal brackets) and that it costs a lot no matter what you choose!!! I've also learned that braces are much more comfortable now than they were when I was a teenager and that ceramic braces are not really noticeable from a short distance. If you feel more comfortable with one ortho than the others, then I would choose that one. It is extremely important to have a good relationship and good communication during this. Personally, I'd probably choose #1 and go with traditional braces (ceramic uppers, metal lowers) due to cost and distance. You don't want to travel a long distance if you have a problem. Also, this ortho seems to have already done quite a work up already.

Oh, I was told 36 months and a retainer for the rest of my life!!!

Good luck!

[Tobilei]

My case is not nearly as complex as yours. My bite is okay, I just had teeth that decided not to grow when baby teeth fell out so with not enough teeth in my head none of them were sitting where they should be. I also had a molar at the back that was grinding into the gum due to there being no tooth underneath so it will be moved forward.

Honestly, my ortho told me I was a good candidate for invisalign but that even with experience, the end result is often not as good as it is with traditional braces. It would be awful I think, to be in invisalign for 2 years only to find you need to have regular braces at the end to fix anything that can't be moved with the invisalign (from what I've read, this can happen).

Incognito's weren't an option for me. I have 3 kids who all also need braces. I personally wouldn't spend that much. Trying to pick food out of braces is bad, I cannot imagine how hard it would be if those brackets were behind my teeth.

Personally I would also choose the ceramic uppers and metal lowers. I know it feels like forever but in the grand scheme of things 2 years to have everything fixed really isn't so long.

[sweetcynic]

My case is somewhat similar to yours, (5 mm overjet, 4mm overbite at start, only mildly crooked teeth). I looked around, and ended up choosing what's closest to your option #3. I got 2 upper premolar extractions as I wanted (and am seeing) my lip incompetence improve. I am 4.5 months into 20 months of invisalign, which may be followed by a few months of braces. As in your case, he is experienced in treating complex cases with invisalign. So far I'm happy with my progress, though I have a long way to go. Lingual braces were not an option for me due to cost, plus I've heard that they hurt more than regular braces. Look at the thread in my signature for more info on my case.

Also, I saw one that was close to your #1 and one that was close to your #3. In my case, ortho #1 just looked in my mouth and said I needed 2 years of braces and 2 extractions, while #3 took photos, took the time to explain, warned I may need 2 extractions but didn't commit to saying that until he'd seen my x-rays. Both could fix my teeth, but I felt the one I chose was much better at explaining things, which was also a factor in why I chose him.

Summary: Choose the orthodontist first, then the method.

[Undecided]

Hi, thanks for all your replies!

I feel I may have done ortho #3 a disservice - he also offered traditional ceramic and/or metal braces but I explained that I didn't really want to go down that route. I meet a lot of different vendors and clients from all over the world in my job and even though I know upper ceramics aren't that visible, they would be visible enough to make me uncomfortable. This in addition to my other feelings about having done this already!

Ortho #2, on the other hand, specialises in invisible orthodontics.

Who did I feel most comfortable with? Either #2 or #3, I think. I was a bit taken aback by ortho #1 because she seemed a bit pushy. Maybe because she was telling me about stuff so far removed from what I was expecting! I didn't like her insistence on removing the lower tooth.

Ortho #2 showed me lots of his case studies and explained things very clearly. I liked his manner.

Ortho #3 was also very clear. I wasn't sure about his suggestion of filing down my upper teeth as an option, but I appreciated the variety of options he could give me.

[Bezza]

OMG, you have just described the exact situation of my teeth before I started with braces!!

I haven't met anyone yet who has exactly the same scenario.I had retroclined upper central incisors due to strong bottom lip, "vampire" upper lateral incisors, retroclined lowers due pressure from retroclined uppers. I had the worst deep bite my ortho has seen for a long while but my lateral incisors had a 8mm overjet!

I had both my upper first premolars extracted but nothing from the lower. I have ceramic upper and metal lowers. Estimate 18-21 months.

I am now almost 8 months down the line and very happy so far.

I can't wait to see what you decide and some photos. I'm actually quite excited to see exactly how similar our teeth are!

I have some pics on the braces stories section you might want to look at.

[katsface]

I have similar issues, though probably a bit more severe than yours.

I was told by one orthodontist that I was lucky... my problems are complex but only 'dental' not 'skeletal' so I wouldn't require surgery. Then she told me I needed extractions, and I became suspicious. If my teeth won't fit in my mouth properly, and they're of normal size, how can it be that my problem isn't skeletal?

I went to another ortho who did a 3D iCAT scan and said I was one of the most clear cut cases for surgery (actually two surgeries) he's seen. If I only had extractions/braces, my teeth would be straight but my bite would still be off, and it would have a very negative effect on my facial features, giving me a sunken in look. He also told me that since the bite wouldn't be perfect, my teeth would likely relapse and become crooked again, even with use of a retainer.

So, I'm having two surgeries. One on Feb. 18th called SARPE to widen my upper palate, and another called BSSO in about a year to bring my lower jaw forward and eliminate the overjet. Instead of a small arch of perfectly straight teeth, I'm supposed to end up with a big wide smile that Julia Roberts would envy, better facial proportions, and elimination of the jaw/neck/head pain I've had for the past few years.

In light of that, I'm a little surprised none of your orthos mentioned surgery to correct the problems. While your issues seem less severe than mine, I still wonder every time someone mentions extractions if it's the best route. It seems like teeth can be shuffled around in the mouth to fit together, but that doesn't always address the underlying issue: one or both jaws don't fit together properly. Removing teeth from your upper jaw, and pushing the rest of the teeth back will correct the overbite, but it could also have a negative effect on your profile/facial features. Then again, it might not. I'm not a professional and I don't know what you look like, so please take this with a grain of salt!

I don't want to discourage or scare you! But, in my case I was very reluctant to remove healthy teeth. It was clear to me after I saw my iCAT scan that the second ortho was correct, and having surgery to correct my jaws is the best option for me.

There are plenty of people on this board who have been 100% happy with their results after extractions, but there are also plenty who are devastated that their ortho didn't talk to them about the option for surgery or the potential effects on facial esthetics.

Anyway, my point is, I would keep this in mind before making a decision. Maybe talk to an orthognathic surgeon before you commit to anything. And in any case, I would definitely try to go with 'slimming' of the teeth, rather than extractions if possible.

Sorry that was so long! I hope this point of view is at the very least thought provoking.

[Undecided]

Hi katsface - Actually, orthos #1 and #3 did mention surgery. #1 said that I "definitely didn't" need it. #3 said that he had to tell me about all my options and mentioned surgery as one option out of several. However, he said that it would only be the thing to do if I were really unhappy with my profile at the moment. When I said that I wasn't desperately unhappy with my looks overall, he said "ok, let's talk about alternatives". He didn't push the issue.

[katsface]

Hi katsface - Actually, orthos #1 and #3 did mention surgery. #1 said that I "definitely didn't" need it. #3 said that he had to tell me about all my options and mentioned surgery as one option out of several. However, he said that it would only be the thing to do if I were really unhappy with my profile at the moment. When I said that I wasn't desperately unhappy with my looks overall, he said "ok, let's talk about alternatives". He didn't push the issue.

Ok, good! I only get worried when not all options are on the table. But it sounds like you've been through a really thorough process.

[Corrinne]

I don't think 'surgery' or 'extractions' are mutually exclusive. I've had/having both. I thought I'd point that our for any future readers. Some people may need one or the other, some will need both.

I've had supernumerary teeth and I had a small upper arch. I have had loads of teeth extracted (ive had 7 adult teeth removed as well as all four wisdoms removed- I currently have 26 teeth). I had a quadhelix fitted for 16 months to expand my upper arch. I'm due to have bimax and genio surgeries this year.

@Undecided- I'd recommend you dont immediately rule out the surgery, you may not have experienced any adverse effects from bad jaw alignment yet- but if they do appear TMJ symptoms can be quite debilitating and very painful. People with bad jaw alignment are also at additional risk of arthritis in their jaws. If it was recommended, you ought to mull it over.

[katsface]

I don't think 'surgery' or 'extractions' are mutually exclusive. I've had/having both. I thought I'd point that our for any future readers. Some people may need one or the other, some will need both.

I've had supernumerary teeth and I had a small upper arch. I have had loads of teeth extracted (ive had 7 adult teeth removed as well as all four wisdoms removed- I currently have 26 teeth). I had a quadhelix fitted for 16 months to expand my upper arch. I'm due to have bimax and genio surgeries this year.

@Undecided- I'd recommend you dont immediately rule out the surgery, you may not have experienced any adverse effects from bad jaw alignment yet- but if they do appear TMJ symptoms can be quite debilitating and very painful. People with bad jaw alignment are also at additional risk of arthritis in their jaws. If it was recommended, you ought to mull it over.

That's a very good point. I was posting under the assumption of a normal number of normally sized teeth, but if you have baby teeth that didn't fall out, supernumerary teeth, or abnormally large teeth, it seems perfectly reasonable to have both surgery and extractions or surgery and tooth slimming. I would guess that in some cases the amount of movement needed to completely surgically fix a jaw might be unstable, and in a case like that I could imagine surgery and extraction being necessary -though that's only speculation.

I should also mention that it does seem like there are very good reasons for just extractions, without surgery. And I'll reiterate that some people are super happy with having extractions/braces. In my case, none of the orthodontists I talked to (before my current ortho) could give me a reason for wanting to do extractions that I found acceptable. They claimed my jaws were normal (they are definitely not) and my teeth are of normal size (that's true as far as I can tell). I don't have any extra teeth... in fact I've had all of my wisdom teeth removed before all of this because I was told it would help with my headaches (unfortunately it didn't). I don't regret losing my wisdom teeth as they were only partially erupted and were causing plaque traps. But I think I would regret having any other teeth removed.

Again, not trying to be pushy. Just wanted to throw that alternative view out there.