As an adult I recently had braces. I had crowding in my lower teeth so prior to braces I had one my lower incisors removed. Now, post braces, my teeth are perfect on the top. On the bottom the incisors go straight across instead of rounding the same way the the top row does (because I only have three incisors). This has left me with a 4mm overjet. Can this overjet be fixed for a person who is missing a lower incisor?
Lower Incisor Extraction Followed by Braces Left Me with an Overjet. Can This Be Fixed?
Doctor Answers (6)
Sometimes there is a compromise to achieve a better result. We can't in all cases achieve an ideal result because it may take 2 or 3 times longer than the more practical route and the patient gets worn out. Would you be willing to wear braces for 5 or more years. You might be able to correct the overjet by reproximating some of the upper teeth and pulling them back. But then your face may look sunken in and not as attractive. You need to consider aesthetics primarily and then see if you can get a proper bite as well. Sometimes you have to compromise
Removing a Lower Incisor
For the upper and lower teeth to fit together in an ideal relationship, the number (size) of the upper teeth must be matched by the number (size) of the lower teeth. An orthodontist named Dr. Bolton described this relationship decades ago. If the upper teeth are relatively smaller in size or number than the lowers, there will be spaces between them, an underbite, or crowding in the lower. If the lower teeth are relatively smaller in size or number, an overbite, spaces in the lower, or crowding in the upper will exist. Fixing an overbite due to a missing lower incisor can be done by making the upper teeth slightly smaller (reshaping the teeth), making the lower teeth slightly wider (veneers or crowns), or by adding back the removed tooth (bridge or implant). Good luck!
Missing lower incisor and residual overjet
I wonder if there was a plan in place to reduce the overjet when the decision was made to extract the lower incisor. A single lower incisor extraction works best when there is a natural compensating REDUCED tooth width on the upper incisors, especially the laterals, or when there is an underbite "tendency" present. Absent either both of these conditions, overjet will result from a lower incisor extraction. To compensate for this you can wear elastic to CREATE a slight underbite tendency and reduce the width of the upper insisors slightly with "IPR". Of course to accomplish this you'd need to get braces again.
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Get an Orthodontic Opinion
Without photo's it is very hard to envision what is going on in your case. Anything that you try to do will be a compromise. If you flare the lowers to close the overjet, spaces will open between your teeth. Once bonded (or veneered), those teeth will appear larger in size which may bring attention to them or bother you. You have also now lost your midline as one lower tooth sits between your upper two front teeth. My best recommendation would be to seek the opinon of a board certified orthodontist to discuss your options. If your upper teeth are aligned well and the midline issue doesnt bother you, you may be able to do some minor IPR (reduction) and retract the uppers to close the overjet or even better, retreat the orthodontics on the lower, open up the space where the extracted tooth was, and place an implant. If space is really an issue, minor IPR could be done on the lower canines or first bicuspids to give you enough room for a natural looking lower central incisor.
Overjet should be able to be corrected
I would think that this overjet problem could be corrected at least partially. I wonder what your overjet was before you began treatment? This can sometimes be a problem with extractions to gain space for orthodontic tooth movement. To close the space the teeth must be retracted. This can cause that problem.
The teeth can probably be moved outward to reduce the overjet but know that if you do this you will probably open gaps between your lower incisors. These gaps can then be closed with restorative dental procedures such as porcelain veneers or dental bonding.
Overjet after lower incisors extraction with braces
As you noted in your question, you have overjet due to what we call a tooth size discrepancy (TSD) due to the fact that you have one less tooth on the lower. The only way to really address this would be to negate the TSD by either opening space on the lower to address the missing tooth (bridge or implant), or by reducing tooth structure on the top by (in this case I'm assuming since you are saying there is no crowdin) tooth reduction between teeth (IPR) to gently shaving away increments of enamel spread out between the upper teeth to equal the mass of the tooth you are missing on the lower, thus reducing your overjet. There are other factors involved in this decision obviously (ie angulation of your upper teeth, your facial esthetics, etc), but the aforementioned may serve as a couple of options.