Metal Mouth Message Board

these are my pictures from today.

my overbite today 3/27/08



My Profile 3/27/08



My smile 3/27/08



Gennel

Did any of you have to wear a headgear or any other orthodontic equipment besides just the regular braces?

no headgear for me .Headgear has never been mentioned in 1.5 yrs since I've had braces on...

Gennel

Rest assured that lower incisor extraction can be very effective, but like any treatment modality, case selection is very important. Someone used the term "Bolton discrepancy" in an earlier post, and a Bolton analysis is critical before extracting a lower incisor. Why? Because overjet can result if a lower incisor is extracted in the wrong patient.

In orthodontics, a "Class I" canine is usually our goal - the upper canine should interdigitate right behind the lower in a front-to-back direction. When that's the case, and assuming normal tooth sizes, the upper incisors should then rest just outside the lower incisors when biting (ideal overjet). If a lower incisor is extracted, however, and a Class I canine is maintained, the lower arch length is reduced from canine to canine and the lower incisors collapse back from the upper incisors. This creates overjet.

Accordingly, tooth size is the critical issue. If the maxillary incisors are small - particularly the lateral incisors - then the upper arch length (canine to canine) can be too small for the lower. In this situation, a lower incisor extraction can be effective because then both the upper AND lower arch lengths are smaller than normal. A Bolton analysis examines the ratio of upper to lower arch length.

When I do a lower incisor extraction, I usually ask my lab to do a set-up; they "extract" the lower incisor on copies of the patients models and close the space by moving the other incisors. This lets me see a simulated treatment and assess overjet.

I've seen lower incisor extractions work out with ideal overbite/overjet, but it's not uncommon to have a small amount of overjet remain after treatment and I always make sure the patient is aware of this before extraction. Depending on the tooth shape, slenderizing the upper incisors and retracting them slightly can help a bit.

A little "trick" to see if lower incisor extraction will give a reasonable result is to position your jaw so that your upper and lower lateral incisors are right on top of each other. If the upper is wider, overjet may be a problem. If they are the same size or the lower is larger, a tooth size discrepancy likely exists and lower incisor extraction may be an option. Keep in mind this is just a "ballpark estimate"!

DrBill: Thanks for the detailed info In my case there was no other choice since I was going to lose #24 . As soon as the archwire was connected that tooth went all the way forward and was coming out
It was due to boneloss in that tooth only. If I had minor crowding my ortho would have told me it might not be worth it because I would lose that tooth. But in my case I had soooo muh crowding that I would have serious dental problems later on so I chose to lose that one tooth and fix my bite and have straight teeth
At first I worried over this but now I am ok with it .I am very happy with the progress I've had in 1.5 yr of treatment so far.I feel like a different person,in a very positive way
If I didn't need the braces , I was going to have a bonegraft done to save that tooth but my chances of losing it anyway with braces were too high and I didnt want to spend so much money just to hope it would work.

Gennel

Unfortunately medicine, including orthodontics, doesn't always lead to textbook solutions. That doesn't mean they're not good solutions. I've had patients where I've HAD to extract lower incisors because there was so much gingival stripping the tooth couldn't have survived ortho without extraction. It's not uncommon for young patients who are congenitally missing a lower incisor to have their parents elect NOT to open for an implant and leave a bit of overjet, saving them the hassles of implant surgery.

I'm glad things are going well your treatment! My response wasn't directed specifically towards you; it was to give people considering lower incisor extraction some things to consider from an orthodontists perspective. The original poster was unhappy - others said their extraction results were good. The results shouldn't be random; case selection and knowing what to expect if a tooth size discrepancy doesn't exist are important.

WOW! Thanks for the professional insight to lower incisor extraction, DrBill! I am still relatively new to being braced...only had mine in for a little more than a month...so alot of your terminology is new to me.

I haven't had my extraction done yet but when I went in for my consultation, my ortho did a clay model of my mouth and teeth with the extracted incisor. It looked pretty good! But since I got my braces, I have done some extra research online and came across this thread which worried me a little.

So with all that said, my next appointment is just a check-up before scheduling the extraction. I want to do my due diligence before going forward with the extraction. What questions should I be asking him? I don't even know if I have an overjet or overbite. I would like to be well-informed and I want my ortho to know that I have some knowledge on this subject before going forward so as to be happy with the end result of my treatment.

Here are some pics to illustrate my condition:

Before treatment:


Braces put on:




The incisor he recommends to extract is the right lower incisor...in the photo it is the left one (mirror-image)--the one that is sticking out a bit. Any advice is much appreciated!!

DrBill wrote: I've had patients where I've HAD to extract lower incisors because there was so much gingival stripping the tooth couldn't have survived ortho without extraction.

What is gingival stripping? Is this something particular to the lower incisors?

Suetemi - "gingival stripping" is a term for significant gingival recession. If a lower incisor is blocked out of the arch, there can be so much stress on the tissue that it recedes significantly exposing the root.

Missfashionista - in terms of a dialogue with your orthodontist, I think the main question I'd be asking is that since you've been informed extraction is indicated, why a lower incisor over 4 premolars? While 4 premolars sounds more aggressive, it leaves the anterior tooth relationship canine-to-canine intact so the tooth-size discrepancy issues discussed in this thread don't come into play. It's the reason it's a far more common extraction sequence. With that said, lower incisor extraction can work very well in the right case. Ultimately you should be discussing both approaches on overbite, overjet, profile, and incisor torque. Ask if you have a significant Bolton discrepancy (this would favor incisor extraction). It sounds like your orthodontist did a set-up which is a wise move; don't be bashful about opening a dialogue with him before taking the big step. Good luck!

Thanks for the advice, DrBill. I will definitely open the lines of communication with my ortho. on my next check-up!

This is the link to the thread when I was questioning the extraction of a lower front tooth: viewtopic.php?t=19391&highlight=

I also had a lower central incisor extracted. I'm only braced on my lower teeth because I have an upper bridge on my front teeth to replace teeth that were damaged in an accident when I was a teenager. But functionally, by removing one tooth due to excessive crowding, my teeth will fit together much better and I'll replace my bridge so it will look better. My gap is still about 2 mms so I have quite a way to go but everything looks good to me and I think people really won't notice the missing tooth when everything is done. But it's a huge thing to remove a healthy tooth--I really struggled with it but other options weren't viable for me.

I also had a lower central incisor extracted. I'm only braced on my lower teeth because I have an upper bridge on my front teeth to replace teeth that were damaged in an accident when I was a teenager. But functionally, by removing one tooth due to excessive crowding, my teeth will fit together much better and I'll replace my bridge so it will look better. My gap is still about 2 mms so I have quite a way to go but everything looks good to me and I think people really won't notice the missing tooth when everything is done. But it's a huge thing to remove a healthy tooth--I really struggled with it but other options weren't viable for me.

This was exactly the thread I was looking for -

from the people who have posted in this thread - any updates on your progress?

I have my uppers done, and my ortho has recommended to get my lower incisor extracted to get the best results. I'll post a picture later (updated- picture below - sorry its a little grainy) - but its literally its at 90 degrees to the tooth next to it. In fact, the 3 orthos I consulted with before getting my braces all talk about extracting my lower inciscor.

My current ortho also said that there may be a slight overjet at the end of the treatment.

But the responses on this thread have gotten me concerned. I never bothered to find out how much overject there might be, etc.

Wow - perfect timing for this thread to reappear! I'm looking at getting a lower incisor removed. I was actually pretty excited about it because of the benefits I hope to gain. But I hadn't given any thought to some of the downsides mentioned here. This has definitely helped me develop questions for my ortho before I proceed.

Thanks everyone for sharing, and I hope to hear some updates as well.