Wildly different treatment plans - what do you think?

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#1 Post by **Slickster** » Fri Mar 23, 2007 3:37 pm

OK, so I have basically crowded upper and lower (lower is worse). My bite is actually OK, but I'd like my teeth straight.

Now, I have visited four orthos. Every one except one has said they would pull 4 teeth (the usual 4) and slap braces on for 12+ mths. Except ONE! He said he will use an expander on the top, then fixed braces for 6 months (the upper only has one front tooth crowded out of line). On the lower he proposes braces for 8-12 mths, will tilt them out a little and slenderize them. Now this sounds like my ideal solution (I actually wondered if this could be done before I found him after having kept hearing "you need 4 teeth out"). Of course, i could go on paying for consults with more orthos, but as they all tend to say "4 out", it seems a waste of money.

The three "pullers" were all UK trained guys, but the expander guy has worked in the US (maybe different philosophy/techniques...?).

However, given this one ortho is the only one to propose it and the others were so adamant I had to have 4 out, I can't help wondering if this is a realistic treatment plan. He told me "I wouldn't do it if it wouldn't produce a good result". One other slight concern I had was that he offered to just straighten the top, but that it wouldn't lead to a good occlusion and only be cosmetic (isn't that a bit unprofessional?). Also he wants to pull two lower impacted wisdoms, where all the others say no way due to the risk of nerve damage. Others (including an oral surgeon) have said these won't cause crowding in the other teeth, but he says there's a high risk of it doing so.

Any thoughts? I am somewhat nervous about this whole thing ending up in a mess. Thanks in advance.

#2 Post by **Slickster** » Fri Mar 23, 2007 6:30 pm

How bad is your occlusion now? Does it affect the way you chew or position your jaw? Will it cause problems such as TMD in the future? Does it need to be fixed??

Perhaps your case can be considered purely cosmetic. If your occlusion is not bad enough to affect your mouth, straightening the teeth may be all you need to improve your occlusion without focusing on it specifically.

Which procedure do you feel the most comfortable with? Is cost or length of time a factor?

I would call back the first three and tell them what you heard from the 4th guy. Ask them what they think and whether they could do that approach with you.

I think you have a few more questions to ask. If you're well-informed on the opinions of all the orthos and exactly what the results will be, then you can make a decision about what is best for you.
It's your mouth. What's important to you?

Hey thanks for your reply. Of the other orthos, I asked one of them about the non-extraction ortho's plan and he basically was an old school always extract 4 guy, so I don't think he even had the skills/techniques not to do that. Another ortho, he said the result wouldn't be good, the teeth would be too proclined (bucked I guess) - but this guy, his attitude was poor/inflexible and he didn't seem to like questions.

In terms of occlusion, there's basically no problem with it, but if I get the upper expanded it won't fit the lower arch anymore and then I assume once we start moving the lowers everything will be out of whack, so I just hope it can all be fit back together again.

Kinda scares me.

#3 Post by **iBorg** » Sat Mar 24, 2007 12:11 am

I had the four on the floor technique 25 years ago. For me, I was left with a result that was not good. Guess that's why I'm back with wires? I'd ask a lot more questions before I went this route. One curious question for repeaters on this list would be how many had this type of extraction.

In my case, the ortho ( a kind name), pulled the teeth and then pulled the remaining ones back in a way that my remaining teeth were hid in my mouth. If it was me, I'd rather do an expnader, headgear and or surgery to keep the four teeth. Maybe you truly need these teeth removed for space but I'd be darned sure.

Good luck on making a hard decision.

Mike

#4 Post by **bracey** » Sat Mar 24, 2007 4:58 am

I also had too different consultations

the first ortho; option 1; align upper teeth with braces, possible slenderising,retainer for 1 year it wont perfect my bite(I have a half molar bite over where it should be)but I have no real problems with my bite
option 2(compromised result); pull two molars and use mini screws to pull teeth into postion

ortho2; option 1; surgery on both jaws if I want perfection
option 2(comprised result); expander on upper, braces, slenderising, retainer forever. and possibly might still have to pull teeth!

so I decided to go with ortho 1 option 1

it is a less invasive treatment and I am ok with having a comprimised result in the end,

so really you just have to ask yourself what do you want from the end result maybe you can be happy with a cosmetic result? and which ortho do you trust and get the best feeling from.

#5 Post by **Boolajoojoo** » Sat Mar 24, 2007 10:13 am

In my personal opinion, I'm all about the no-extraction route for myself. I feel your pain though, this is such a tough decision, is it not? The first consult I had, I was recommended to have two extractions. I saw a TMJ specialist after that, and he insisted that pulling upper pre-molars would cause my jaw to be set further back, and make the TMJ problem worse. I know everyone is different and not everyone has messed TMJs, but the way it was explained to me, it would be bad for my jaw to pull teeth.. his cost projection was really out of my budget though. I chose my 3rd consult because he's an orthodontist who tries to go without extractions whenever possible (95% of the time). #3 is who I went with. I was told by my dentist that typically the orthodontists he's encountered around here will just make people's teeth "look pretty" without much regard for function... and often ask for teeth to be extracted needlessly. This made me very wary when I went to consults.

I know going to more consultations would probably cost you more moneys. Maybe you could try cold calling a couple more orthodontists, ask about their extraction preferences, and try to find one more that prefers non-extraction solutions for a final consult? It really can be luck of the draw who you get for these initial consults. Three of them wanting to pull teeth could just be coincidence.

Well, like others have said, it's 100% your decision. If you feel comfortable with one of these four, you should definately go with your gut.

#6 Post by **chillin-in-grilz** » Sat Mar 24, 2007 8:45 pm

I just went with the one ortho, cuz we only have 1 available and practically my whole school goes to him, he's a great guy, always asking how I am, and explains things, not pushy or anything, and his assistants are so nice.