Advice on private orthodontic treatment - your thoughts?

[andyf92]

Hey guys,

I am looking for some thoughts and opinions. Recently i decided to have my teeth straightened privately in the uk. I'm almost 22 years old and have a few cosmetic dental problems; slight crowding of my top arch, particularly the front four teeth or so, as well as about 7mm of horizontal overlap (overjet).

I recently saw an orthodontist about my options and was given essentially 2 options:

1. Have a white/ceramic fixed brace fitted across the top front six teeth or so, for around 6 months to address the crowding issue. The benefit being the short treatment time and less intrusive nature of the work, but hopefully with a fairly significant improvement in the look of my teeth. The disadvantage of this is that it will not really address my horizontal overlap at all, which would remain about 6/7mm afterwards but at least the top teeth would be "perfectly straight". Cost is approx £1500

2. Have ceramic/white braces fitted top and bottom to address both the top crowding and the horizontal overlap. This treatment is comprehensive and would basically fix all the issues with my bite but would involved the extraction of two teeth from the top arch, as well as 12-18 months of top and bottom braces with elastics. So, far more discomfort, longer treatment time and higher cost (£3500 or so)



so i suppose i am wondering what you guys think would be my best option. would my teeth look okay if they were straight but with the horizontal overlap intact? Or would it be worth going all out and getting option 2? The orth did say that i can do one then the other if i decide i want toption 2 after option 1, the cost wouldn't be more than going straight to 2, but would take six months longer... so i have considered doing that and seeing how happy i am with them after option 1. The problem as well, is my age and career - it's difficult for me to commit to longer treatment times.


Anyway, your thoughts would be appreciated!


-A



PS: i should say, my dentist uses "3M clarity" braces, normally with stainless steel wire as he feels the "Teflon" coated one isn't very good, and the coating rubs off seemingly.

I sent my orth an email asking if there s any way to do option 2 without extractions (IPR or similar) i'm waiting on his response.

[Mightymildred]

Hi,
I think you should go for a second opinion.
My ortho is very much against extractions- unless absolutely necessary!
You can do so much expanding arches and shaving bits of tooth here and there...
Once you've lost a healthy tooth, you'll never get it back. I lost my upper 6,7,8 the 7 was iatrogenic! Ie the dentist at a dental hospital took out the wrong tooth... So please think carefully about letting any heathly teeth being extracted.
I'm 33 years old, in month 19 out of ?month sentence.
I've paid £4500 for Damon system- ceramic uppers and metal lowers plus have a miniscrew because I have no back teeth on upper Right.
Make sure you seek a second opinion. Also research the ortho.
Mine has written several texts on adult orthodontics.
Where are you in the UK?
Good luck
MM

[andyf92]

Hi,

Yeah, i am very wary of having teeth extracted, so if he doesn't offer me an alternative i will probably get a second opinion. i'd be happy to try the shaving (IPR etc) my front teeth are quite large, so i thought this may be a sensible option.

I think my teeth would obviously look better if i could have the overjet reduced as well as the crowding f the upper arch fixed, but the extractions are really what is deterring me from going all out.

I like in glasgow, scotland.

[Mightymildred]

I'm seeing my ortho on the 30th. I'll ask if he can recommend anyone in Glasgow.
I'm so frightened of extractions now, I've been told I need a general anaesthetic because I fought against them so much even with IV sedation. Hence why I'm uber keen for everyone to explore every option...
I must say that it's been the best thing I've done. This time last week I was really down and depressed... But I've picked myself up and dusted myself down...
Will let you know what I can find out. :-)
MM

[sean89]

I'm in a similar position to you Andy.

I have an overjet that I would like to correct that isn't as bad as yours, and didn't use to bother me until I saw a video of me speaking.

Now, I am very conscious of it and on that basis, I would definitely address the overjet.

I was told that I would get most movement from the lower teeth being pushed forward. The teeth in the upper arch can only really tip back (or so I'm told) if you expand the arch unless you extract teeth which would allow a lot more movement.

At your age, I wouldn't be too bothered about a couple of extractions if it brings about the right result.

Alternatively, if your jaw is recessed, you can have orthodontics in conjunction with orthognathic surgery.

[mmkay]

My opinion is that an overjet looks nasty and given you are seeking treatment, going with option 1 will bug you.

One thing to make sure is that your overjet is due to the upper arch being too far forward not due to a recessed mandible (as alluded to above). In that case option 2 is not appropriate.

Another question is if your upper teeth do need to be pulled in, whether you have enough space at the back to move the entire upper arch backwards (e.g. after removal of wisdom teeth). My orthodontist indicated this was possible using the miniplates that have been screwed into my jaw primarily for other reasons (closure of open bite).

[andyf92]

Thanks for the reply guys, here is an extract from my clinical report which may answer some of the questions:

"present with a Class II/1 type malocclusion with good oral hygiene. I note that you are concerned about the crowding of your upper front teeth as well as the horizontal projection of the upper teeth. Clinically today the lower teeth were well aligned, the upper teeth were moderately crowded and the posterior occlusion was Class II with a crossbite associated with the upper right first molar tooth. The upper teeth projected at approximately 7mm."


I think ideally, i would rather just have them totally fixed once and for all and then be totally happy with them. My two front teeth sit further out than the rest of the top arch so i think the 7mm OJ would drop down slightly if i had that fixed alone? Although the orth said it wouldn't reduce it by much.

I just don't like the idea of pulling out healthy teeth for cosmetic purposes and risking other issues if it can be avoided. i'd even pay more to have it done a different way, and i'd be happy with a less than perfect result - i.e a reduction of say 3mm rather than the final 2mm "ideal" spacing he has predicted if i go with option 2.

[andyf92]

also, slightly off topic: does anyone know much about these white arch wires? he claims they are not very good, but it seems a shame to have white braces and a metal/silver wire!

[sean89]

Your ortho said your overjet would only reduce by 2mm even if you had extractions?

[mmkay]

Thanks for the reply guys, here is an extract from my clinical report which may answer some of the questions

I don't think it answers the question about whether your lower jaw is where is should be. If you post a pic of your profile it may be clear.

[jem]

If I were you, I would go with option 2. If you are going to get braces you might as well do the job properly. And if you have a class 2 overjet it is perfectly normal to have 2 premolars extracted.

I had the same treatment as your option 1, but I had no bite issue and I am happy with the outcome. It nevertheless still took 18 months, so it may be the case that option 1 would not be that much quicker for you either.

As to white coated wires, my early ones were white coated and they helped me feel less self-conscious. But the coating did wear off after about 4 weeks. By the time I moved onto silver coloured wires, I was less self-conscious about being braced.

Good luck with your treatment

Jem

[andyf92]

Thanks for the replies so far.

I am worried about the possible negative consequences of extraction, such as; change sin my profile, potential for infection, sinus issues etc. My orth replied today to see he'd be wary of using tooth shaving techniques as a lot would be required which could cause structural issues to my teeth. He said another option would be to bring the bottom arch forward with elastics etc, which would result in about a 5mm overjet at the end of treatment (acceptable?) but the risk here is a slightly more unstable position for my lower teeth and he emphasises that i'd need to wear the retainer perfectly to stop them moving back.

So i'm not sure whether to have the option 1 stuff done and then ask him more about improving three overlap without the extractions or just bite the bullet and go for the extractions. A lot of people and literature seems to advice against extractions for cosmetic issues.

As for the white wire, should i give it a try? OR just go for the steel one?

I will upload pics of my teeth for your assessment


-A

[andyf92]

front View: https://www.dropbox.com/sc/qtlgwuh1cl06 ... f0pzakHuAa
https://www.dropbox.com/sc/tpx9z3vxi0ra ... Pe6hQDdLEa

Side: https://www.dropbox.com/sc/70odnqq5wvco ... jB4nBoa9Aa
https://www.dropbox.com/sc/a4anjjyhhuec ... ocAHj5h8-a

[andyf92]

[quote="sean89"]Your ortho said your overjet would only reduce by 2mm even if you had extractions?[/quote]


no, with extractions he will take it to 3mm. by moving my bottom teeth forward (without extrations) he can get it to 5mm or so, and maybe a bit less with IPR on the top. SO he could feasibly reduce it to 4mm without extractions i think (i've just emailed him asking) but it's obviously more complex and he's a bit concerned about the moving of my bottom arch.


-A

[Mightymildred]

Have you has any extractions previously?