Braces/orthodontics to close UL6 first molar extraction gap?

JamesH2888

I’m 42 and currently have all my adult teeth. I have a few composite fillings but have had no dental work other than that, so the prospect of losing a tooth, and an important one at that, is pretty daunting.

A CBCT scan has revealed a cracked root in my UL6 (first molar), with extensive external root resorption, which apparently means the tooth is unrestorable. The tooth isn’t causing me any pain but I’ve been told that it needs to be extracted.

The obvious treatment option is to have an implant (a bone graft would be needed at the extraction site for this due to the bone loss).

But coincidentally, shortly before discovering the UL6 issue I had an orthodontist consultation with a view to correcting moderate crowding and an upper midline shift to the right-hand side.

After hearing that I was considering orthodontic treatment, the specialist who diagnosed the UL6 problem (who actually offers implants) recommended closing the gap left by the UL6 extraction with braces, and felt this was a better solution than an implant.

I’ve seen two orthodontists to get their opinion about closing the post-extraction UL6 gap, and have had two very different opinions/recommendations:

Orthodontist 1:

Told me the space could be closed by moving UL7 (the second molar) forward into roughly half the space that will be left by the UL6 extraction, with the other half space filled by correcting the midline shift, which means moving my front teeth, canine, premolars, etc, over to the left.

I asked about moving my UL8 (wisdom tooth) forward as well – as otherwise there would be a new space created between UL7 and UL8 – and was told it might be possible but that it would be more difficult to move this tooth than it would UL7.

I was told the treatment time would be approx. 2 to 2.5 years.

Orthodontist 2:

Told me the above (treatment recommendation outlined by orthodontist 1) was possible but that at the end of treatment my front teeth "wouldn’t look right" (I think maybe due to creating another midline shift) unless they also extracted a healthy tooth on the upper right, which obviously I want to avoid.

Instead, their recommendation was to leave the gap left by the UL6 extraction and correct the crowding/midline shift by moving the teeth forward without further extractions and using only about 1mm of space left by the UL6 extraction. (Estimated treatment time for this would be 1 to 1.5 years).

In their view, after treatment, it would be fine for me to leave the gap caused by the UL6 extraction or, if I wanted, to have an implant in the space. But they said there were no issues with just leaving a gap.

However, orthodontist 1 has advised against leaving a gap after the UL6 extraction because of "unstable occlusion and bone loss to the area" and because it is "unnecessary when UL7 could provide good occlusion for the mandibular antagonists".

Confusion

I'm really confused by the two differing opinions and not sure who to believe. Both orthodontists have orthodontic masters degrees and plenty of experience.

Has anyone on here, as an adult, tried closing a gap left by a molar extraction via braces? If so, did it work? Were there any problems?

Would also be great to hear the views/thoughts of any orthodontists or dentists if poss.

My teeth and gums (apart from the UL6 tooth) are generally in pretty good health/condition and my original enquiry about getting braces was for cosmetic reasons to improve the appearance of the front teeth.

Many thanks