Orthodontics - are extractions always necessary?

fiona-f

Hi,

I'm in the very early stages of researching braces for overcrowding on my bottom front teeth. So far, I've only been to one consultation, where the orthodontist said that I would require two extractions on the lower teeth (fair enough, that's where the obvious overcrowding is) but also two extractions on the upper teeth - where I didn't even realise there was slight overcrowding! I pressed him on whether there was any possibility of doing something on the upper teeth without extractions (or indeed doing nothing at all) but he was quite certain that the both sets of extractions would be necessary.

I'm somewhat concerned about this; I've had problems with decay in my teeth when in my teens and the four teeth that he proposes to remove are the only four back/middle teeth without fillings that I have. So where possible I would obviously hang on to my few completely healthy problem-free teeth! I'm going to go for one or two more consultations elsewhere but would be interested to hear from the experts on this forum about extractions for orthodontic work. Are there any long-term problems in having fewer than the full set of teeth? Is there any logic in preferring to opt for filled teeth to be extracted, rather than one that has never been filled? Or is it just a choice that I'll have to make and get used to?

On another note - how open are orthodontists to negotiation on cost? The one I visited recently offered a 5% discount (€200) if I paid upfront but that would be difficult for me to manage.

Many thanks for any advice.

vishal

show a case to several orthodontists and they will all have different treatment plans (non-extraction/extraction). you should go for a couple of different consultations and find somebody you trust and go with what he/she says.

there is nothing wrong with extracting teeth if needed imho.

it is usually more advantageous to extract premolars as these are smaller teeth and most the extraction space is used to align the teeth and there is less space to close and less treatment time.

i prefer to extract 2nd premolars over 1st premolars as these are smaller and less aesthetic teeth than first premolars. they are also easier extractions and further back in the mouth so the patient does not mind as much.

it is very rare to just extract in the lower arch 2 premolars and not compensate in the upper arch with 2 more extractions unless there is an underbite and then even then not that normal.
also sometimes if there is going to be surgical correction of an overbite.

extractions are needed in the upper arch to make sure your teeth fit together properly.
also sometimes extraction of one lower incisor is possible if you have small upper teeth, you should ask your orthodontist this.

digzy

It's very difficult to say whats the best way to create space.To be fair your orthodontist is in a better position to decide than a dentist-especially without seeing you chairside.I wouldn't waste your money going for multiple consultations.Different ways to arive at one solution.I think your best option is to discuss your concerns with the orthodontist regards extracting previously restored teeth instead.Enamel can be trimmed to create a little space too. Post removal of the braces most dentists couldn't tell which premolar was extracted so I wouldn't worry about aesthetics.I got mine when i was 25 and the result is well worth it!

pikachucheeks

If you're not sure, have a second opinion.

The first orthodontist I went to told me I'd need four teeth out before I had my work started.

I sought a second opinion and the orthodontist said it wasn't necessary and he'd try to sort out my teeth, without extracting anything.

I was happier to seek treatment without extraction and although I've been seeing my orthodontist (the second one I mentioned) for a good few years to try and perfect my teeth, I'm very happy I chose that option.

Extractions can be risky, imo. While they might be the "easy" option in some cases, they're not always the best option. Removing teeth can cause problems with your bite etc. Unless there's no other solution, I wouldn't immediately agree to having teeth pulled.

digzy

pikachucheeks wrote: »

If you're not sure, have a second opinion.

Removing teeth can cause problems with your bite etc.

One of the goals of orthodontics is to improve your bite!

pikachucheeks

digzy wrote: »

One of the goals of orthodontics is to improve your bite!

True, but if you have teeth out, it can cause the whole shape of your mouth and bite to change, making it very difficult and lengthy for braces to fix.

Obviously, there might be some cases where teeth do need to be taken out, but if there was an option not to, I'd opt not to.

digzy

pikachucheeks wrote: »

True, but if you have teeth out, it can cause the whole shape of your mouth and bite to change, making it very difficult and lengthy for braces to fix.

Obviously, there might be some cases where teeth do need to be taken out, but if there was an option not to, I'd opt not to.

having 2 premolars will not cause these problems. Remember the idea of the braces is to close the space post extraction.another is to reduce treatment time.

It goes without saying that patient/clinician would like to avoid extractions. Sometimes It's the most efficient way to create the space required to achieve the most successful outcome.

ballsymchugh

in the strictest sense, the answer is no, but then you need to start your treatment very early, maybe about 8 or 9 years old in a mixed dentition to make the most of the growth spurt.
if you're starting treatment aged 15 or later, and you need to make about 7-10mm of space, then it's pretty certain that extractions are your only option.
the trick is not to suck your thumb and keep your mouth closed when you're a kid. brats.

fiona-f

Thanks everyone. No, I'm a couple of decades older than 8 or 9 so it seems that the extractions are the only way to go if I do choose to go ahead with it!


That's very interesting what you said Vishal about the top teeth needing to be extracted to match the bottom ones - I hadn't thought of that and had been considering maybel just getting treatment on my lower teeth only, but what you said makes a lot of sense. I'm booked in for one more consultation and will have a bit of a think over it all then.

On a similar note, how do people choose which orthodontist to go with? Recommendation, location of the office, price? How much research should I do - I presume they are all qualified to a high standard so I presumably can't go too far wrong?

day dreamer

Hi there fiona

Extractions are commonly used in orthodontics and when done appropriately there is no problem. some patients are clear cut extraction cases and some are clear cut non-extraction. The grey area or the border-line cases can be treated either way and it is up to the orthodontist and the patient to discuss the best option.

If you have a lot of lower crowding then extractions may be the only option. If lower extractions are necessary then the vast majority will need upper extractions in order to get a good outcome. Think of it like a jig-saw and to get things to fit together you need the same number of pieces upper and lower.

If possible the orthodontist will extract teeth that have fillings but this is not always possible. I often find that the teeth that are filled are not the ones that I would need to extract and if I do extract them the result of the treament may not be as good or the treatment take longer.

About the fees, I am sure than in the current climate fees are more negotiable than in the past. There is a recent thread on orthodontic fees! Best of luck