Hi...although the photos are not enough information for me to make a final recommendation, I'd highly recommend that you avoid bicuspid extractions altogether! Many orthodontists still recommend this option because it may appear to be easier for them to straighten your teeth by creating more room for the remaining teeth to be straight. The problem, however, is creation of EXCESS space that then must be closed by retracting your remaining teeth. This can often create a less esthetic facial profile and appearance...and the angles of the teeth can result in an uncomfortable bite.I'd highly recommend that you find an orthodontist who can align your teeth without extractions. Some light smoothing of enamel between the teeth may be necessary, but at least you'll be keeping your teeth. And, a "big pretty smile" is much better than a "retracted, straight smile"!
Hi Nick, Believe it or not, you can actually have space created where your teeth used to be, and have dental implants (or bridges) placed to replace those teeth. However, the process is involved and takes time...and without an exam it's not possible to know if you're a candidate for this type of treatment. I personally don't provide the treatment, but you can go to FaceFocused dot com and learn more. It's a controversial topic in orthodontics. I won't go so far as to say that 'no one' should have 4 premolars removed for the sake of aligning their teeth. Nor will I even say you shouldn't have had yours removed...I haven't seen any photos to know for sure...and even then I don't know what your situation was like 15 years ago...BUT... In my opinion there are VERY FEW people who would benefit more from extraction of premolars than being treated without extractions. OK I'll say it...almost zero! There are two primary factors involved: how much space is needed for the existing teeth; and how much space is available in the jaws? The problem for many people is...not enough attention is paid to the second question between the ages of 7 and 12, when favorable jaw growth can be encouraged. Think of it this way, using a metaphor. If you imagine the teeth to be like "cars", and the upper and lower jaws to be like "parking decks", you want to make sure the upper and lower decks are built big enough so that all the cars can park straight, right? Well, if more growth is needed, it's best to occur at ages 7-12, with functional dento-orthopedic appliances (expanders, active retainers, etc). Then, when the permanent teeth come in, there is more room to "park the cars" in good alignment, making the orthodontist's job much easier. In many cases, however, there is less attention paid to the growth of the jaws (perhaps by parents as well as dentists/orthodontists), and a more traditional approach was to wait for the permanent teeth to erupt into the mouth, then just straighten them with braces. Problem is, by the age of 12 it's much more difficult to stimulate needed jaw growth...so, out with the premolars! The resulting problem is often that MUCH more space is created than needed to straighten the teeth (few people have enough crowding to equal the width of two permanent premolars)...so the only way to close the spaces is (you guessed it) to SHRINK the arch by bringing the teeth together. This creates a less esthetic (my opinion) facial profile, a smaller intraoral volume, less room for the tongue, altered biting angles on the lingually tipped teeth, etc. The trend to remove premolars has definitely decreased over the years, but some doctors still subscribe to it. And there are always exceptions when extracting premolars may be a good option, albeit very few in my opinion. I hope this helps...again, it's a bit controversial among dentists and orthodontists, so you will get varied opinions ranging from "you're just fine!" to "that should never have happened". I can't tell you my opinion of your situation, but Dr. Hang at the above referenced site can give you his expert (biased against extractions) opinion on how fesible it is to replace your teeth.
You've gotten great answers so far. Usually they cost about the same, and even though veneers require less removal of tooth structure, they are often more difficult and exacting...because a well-trained cosmetic dentist needs to know WHICH tooth structure to not remove! Crowns cover the whole tooth, while veneers cover the front and wrap around the sides and biting edge. Since veneers are thinner they are often more delicate than crowns, but also more conservative and a great choice if the teeth are healthy and just need cosmetic improvement.
Hi, Are you looking for a cosmetic solution, or trying to fix decayed and broken down teeth? The first question should be, "should you get Lava crowns for your front teeth?" Lava is a very strong porcelain material, but perhaps not the most esthetic choice for front teeth. There are other choices of porcelain that well-versed cosmetic dentists can help you with. As far as when...in the world of dentistry you are an "adult" at about age 16, when most growth has slowed down significantly. The front teeth are mature enough to receive crowns (ONLY when necessary) as early as then, but each patient is different.
Hi Sasie, If you can feel the junction between the crown and tooth with your fingers, then it certainly does not fit properly. Any crown not fitting the tooth should be replaced asap with a new, excellent fitting crown. The dental lab is responsible for making crowns that fit great...but the dentist is responsible for choosing the best labs and monitoring their work. Ultimately any crown placed should fit excellently before being bonded on. The odor could be from the crown, or other issues related to your gum health, or both. A complete periodontal exam can rule out other issues besides the ill-fitting crown. For crown edges that are below the gumline, a laser is the best and most precise way to gently trim excess gum tissue so the dentist can get a great impression. Really deep areas may require more significant reduction by a periodontist, but most cases can be handled easily with the laser Best wishes with your situation! Dr. Chris Bowman
