Severe crowding – confused about the different treatments

[lilymouth]

Hi,

I have moderate to severe crowding, and my front teeth are very crooked. I can’t upload a pic as I am a new member, but both top and bottom are overcrowded by about the width of a tooth.

For my top front teeth, I have a tooth that sticks right out (lateral incisor). There is only a 2mm gap for it. I also have a small amount of crowding on the other side as my other top lateral incisor slightly overlaps my central incisor. For my bottom teeth, all front 6 teeth are crooked, and 1 is rotated by almost 90 degrees. At the moment I have all my teeth, including my wisdom teeth, although the bottom two are only partially out (they are covered by a bit of gum).

I’ve seen a couple of orthodontists, who both recommend premolar extraction. However, after researching online, there seems to be a lot of negativity about doing this. People talk about thin lips, breathing problems, less defined chins etc. Also people have linked it to TMJ, and I already have a clicking jaw. The rational part of me knows this does not apply to everyone, and that some people (especially adults) will still need extraction, but it is still worrying!

I’ve looked into IPR, but my Orthodontist says he would have to shave a lot off the majority of my teeth to try and get the space needed, and he thinks that is more destructive than extraction (because of the amount he would have to do). I have also read about expansion, but I am 32 and it does seem to be controversial in adults. Also I have receding gums (from vigorous brushing!), so I don’t think it would be a good idea. I am not willing to go through jaw surgery.

I have actually paid a large deposit, and approved my final plan, and my extractions are scheduled for next week! So there is still time to run away, but I am also worried that if I just leave my teeth as crowded as they are, it will have a negative impact in the future.

At the moment the plan is to extract the 2nd premolars, straighten my front teeth, and then move my back teeth forward to close the remaining space. I tried to do some research on how the back teeth are moved forward and what the consequences of this are, but I couldn’t find out much. I am also a little confused about whether you should have wisdom teeth out instead of premolars.

Any advice would be appreciated. I have spent the last few weeks doing nothing but Googling this, and I am still confused! I am in the UK, and I’ve read that Orthodontists in the UK are still really keen on extracting teeth. So I don’t know if it is just extraction to easily fix the problem, or extraction because I really do need it!

Thank you (and sorry for the really long post!)

[BracesGuy]

I visited so many orthos who insisted I had to have 4 extractions. A lot of wasted time and appointment fees. However, after many years I finally found some who said they could/would do it without extractions. It's possible to make some space by tilting the teeth outwards and IPR.

My teeth are now in line without any extractions. At the end it will require permanent retainers to keep the result stable but that suits me better than 4 extractions.

I recommend you visit more orthos. Once the teeth are out you can't have them put back in!

[lilymouth]

Thank you for the advice. I've delayed my extractions and am looking for a third opinion. Although I don't think I would want too much flaring (also I doubt my gums would cope if the teeth were pushed out too much), but lets see. It may be less damaging to take out 4 teeth (I have all my teeth, including wisdom teeth, so maybe losing 4 is not so bad!). But no extractions sound much nicer, so fingers crossed!

[sirwired]

There are certainly a lot of horror stories online about extractions (the Internet is a big place) but the truth of the matter is that most extractions go just fine, and an ideal result may be difficult or impossible without them. Every case is different, and just because one person had a potential extraction case done without them doesn't mean that will work for you.

IPR, expansion, etc. can only create so much room...

There is a thread on this board with pictures of celebrities who have had pre-molar extractions, and I think you'll agree that they ended up with a fine smile. Speaking personally, my wife had four extractions when she was a child (she was rather buck toothed) and her smile is gorgeous.

Edit: ok, you've found that thread already...

[lilymouth]

Thanks for the reassurance. I've just found out that both my sisters have had extractions (not sure how I didn't know that!), although they had 2 premolars and 2 wisdom teeth out, rather than 4 premolars. But they both look good (and their smiles are certainly better than mine!). I'm now feeling that extraction is better than doing excessive teeth shaving, with the risk that it will not create enough room and I end up having to extract anyway (that would be a lot worse).

It's a shame that so much negative information comes up straight away on the Internet when you research it. There seems to be a certain group of people who post a lot of negative extraction comments, stating that extraction will guarantee a ruined face and jaw problems, even though that is clearly not true and surely depends on the situation! It is worrying that they are advising people not to get extractions no matter what.

[Langers00]

I can speak from experience as i had 4 teeth extracted before having my braces on.

It was absolutely fine. I too had severe crowding and honestly couldnt see how they could even consider straigtening them without removing some teeth - there just wasnt enough room!!

Im now 13 months into my estimated treatment of 18-24 months and have been told i will only have two more appointments and ill be done. More than happy with that!

[Featheryy1221]

Yeah, like sirwired said and as you saw in the extractions positives posts, there are plenty of good extraction cases. IPR has limitations, there's only so much room to be made without destroying the tooth. And jaw surgery and expanders are really only used for extreme bite issues (underbite, overbite) or narrow v-shaped palates. So I wouldn't even consider them since your ortho didn't mention them.

I think most people get their wisdom teeth out. Mainly because they're more prone to decay and are harder to reach. Everyone I know has had theirs taken out.

My sister had four premolars extracted when she was 13 as well as all wisdom teeth removed at age 16/17, and her smile is wide and pretty. No issues with her face looking sunken in.
It really depends on the case.

As I noticed from your other posts, I'm interested to see how extractions and invisalign would work. I didn't even know they did extractions with Invisalign.

[lilymouth]

That's great Langers00, not long to go at all Thanks for the reassuring words, its really good to hear from people who have had extractions (and from the UK!). How much gap is left to close? The video of my treatment shows that once the teeth are straightened there will still be small gaps, so they will be moving my back molars forward to close them. I have no idea how easy that is (sounds like it could go wrong!).

I have my wisdom teeth because I never had orthodontics as a child and avoided the dentist until I turned 32. Not sure how I still have my teeth! I was feeling worried about losing 4 premolars and then potentially losing 4 wisdom teeth. It's good to hear that doesn't mean a deformed face!

Featheryy1221, I noticed that you are using an expander so checked out your story (I was a little unsure about the whole expanders with adults thing), but your results with it are amazing, your teeth look awesome I noticed that a lot of people on this forum used expanders, which is part of the reason why I wondered if I was doing the right thing or not. I was worried that my Ortho might not have mentioned it because it is not as common in the UK (that's just my assumption!). But I don't have problems with my bite and although my arch is a little narrow I don't think it is too severe (I am petite with a small face anyway).

I am going to find out if my Ortho has done Invisalign with extractions before (I initially hadn't realised it was rare). He has done a lot of Invisalign cases so hopefully he knows what he is doing! I think it helps that I don't have other issues with my bite, but I am a little sceptical. I wouldn't be surprised if it doesn't work out as predicted and they have to stick braces on in the end! I just hope he is not being over confident.

[twentyseven]

Hello Lilymouth,

Firstly, congratulations on doing the right thing (deciding to get braces).
Secondly, unfortunately none of us can tell you what to do 100%. But here are some pieces of information that can help you take the right decision about extractions:

1) From what I know, expanders can't be used in every case. If your upper teeth fit your lower teeth well (ingore crowding for now:) ), i.e. upper molars overlap lower molars, then expander cannot be used, because your upper jaw would be too wide. Expanding lower jaw is quite hard, and results that can be reached, are limited from what I've read. Expanders are generally used in cases where there is no good alignment between upper and lower jaws, e.g. cross bite or gothic palate (abnormally high and narrow palate). Do you know which for of maloclusion you have? I'm not an orthodontist, but I think that expander cannot be used when your occlusion is fine, just to treat overcrowding.

2) I know that some orthos offer some kind of visualisation how you're going to look like when the treatment is finished. Probably not the cheapest option, but maybe it's worth trying?

Good luck and make sure to let us know about your choice:)

[lilymouth]

Hey twentyseven!

Thanks for the info. I didn't know that about expanders, there is so much to learn My teeth are more or less aligned I think, it is mainly crowding. So it sounds like an expander is not something for me to consider.

If I go down the Invisalign route I do get a video of how the teeth will move and end up (I actually already have one for the treatment I am thinking of getting). But from hearing about other peoples experiences I get the impression that the video is more of an idea than guarantee! Otherwise I don't think any of the orthodontists around my area do videos for fixed braces. There aren't many Orthodontists where I live that have lots of experience with adults. I just tried to book a consultation with another one but I would have to wait 2 months

I sent my Ortho an email with a long list of questions and concerns, and luckily he has taken pity on me and agreed to see me before my extractions (and I can still cancel if I am undecided). This time I must make a list of all my questions before going (I never ask the right things when I am there)!

I will keep you posted!

[Featheryy1221]

Featheryy1221, I noticed that you are using an expander so checked out your story (I was a little unsure about the whole expanders with adults thing), but your results with it are amazing, your teeth look awesome

Thanks!

Again, because your ortho didn't mention any issues I wouldn't even worry about the whole expander or surgery thing. (when I went for consultations, one of the very first things the first ortho I went to mentioned was how I was lucky to not need surgery because damons 'would have fixed everything,' and when I saw my ortho, he obviously mentioned expanders and even discussed how other people in my situation need surgery). You'd know if you needed surgery. You're more than likely one of the many lucky ones that don't need it.

Glad your ortho is taking the time to answer your questions and I hope everything works out for you well. Just don't fret too much about the whole extraction thing, there are numerous situations where it has turned out just fine.

Good luck!

[Handsdown]

I've been having the same worries as you! I'm also in the UK and have (at least from my point of view) severe crowding, especially on top, not so much on bottom... My ortho has said I need 4 2nd premolars extracting. I did say I wasn't so keen and feared face changes to which she said that my face won't cave in or anything like that so don't let the internet scare me... She did say I would look different because my teeth would be straight!! In her words 'yes you will look different, you'll look better!' Haha. That made me chuckle.

She told me that if I don't go for the extractions the only other option is expansion and IPR which, in my case at least, would be very unstable, and she said that I would need so much space making that I'd be damaging lots of teeth rather than just removing 4 (that mostly happen to have large fillings anyway). She mentioned flaring too and said I could end up looking odd with a hugely broad smile that looks like my teeth don't fit in my mouth. Although this all makes perfect sense I am still terrified!! I have my extraction appointments booked for in a couple of weeks and still don't know if I'll wimp out or not

It's all about trusting the orthos we see I suppose. I had a consultation with one other ortho but he wasn't very thorough and said he could extract the teeth or keep them, both would work fine, it just depends how different I want my face to look!!!?! So frustrating! I just want this face but with straight teeth!! He didn't mention teeth flaring or instability etc... He didn't even X-ray me or take moulds!! The ortho I've gone with seems to be very 'on it', she didn't tell me anything until I'd had moulds taken and X-rays, and she'd had time to look over it all for a few weeks. She's to the point and confident but I don't feel like she's making any false promises. I asked her about Invisalign but she said that I could do that but it wouldn't work well for me due to the amount of crowding I have, and can be a big pain for me to care for compared to braces (having to take them in and out all the time etc..).

Did you go with the extractions? Good luck with your decision!!

[sheilas]

Hi, I have moderate to severe crowding too (see photo). My initial consult was for extraction but I took time off to think about it (6 months to be exact). Decided to go through with it but ortho decided to try non-extraction first. Is yours similar to mine, cos I think mine are pretty bad! Do you have any photos of yours now?