Need advice - Invisalign and IPR vs Braces and Extraction?

I saw 2 orthos who provided 2 different treatments & having hard time deciding. I am 37. Teeth are in order (had braces when young) but have an overbite/jet (3.5mm). Based on 3D xray and teeth exam, 1st ortho said extractions not needed & my results could be achieved in <1yr using invisalign & IPR. 2nd ortho, same diagnostics, but recommended 4 teeth xtractions & did not think IPR would help. Not sure whether IPR will get the results I need; but I'm scared of taking out 4 healthy teeth! Thanks.

Doctor Answers 2

Invisalign and IPR vs Braces and Extraction

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I guarantee you will not be happy if you decide to do extractions. Your smile will become narrow, your airway could become compromised, your TMJ could become compromised, lip support compromised, etc., etc.

I agree with Dr. Waxman, there are three different ways to treat your case and each has its pros and cons but some have much more significant cons (extracting teeth being the absolute worst option).

If you were my patient, I would rank treatment in this order: 1) expansion of upper arch then bringing lower arch forward (both done with simple removable appliances. You might need braces to close a potential posterior open bite (only con), 2) Invisalign with IPR, 3) teeth extractions.

If you were to choose teeth extractions I would not even treat you in my office because I know the treatment is vastly inferior and will lead to consequences you will abhor. The amount of IPR (interpromixal reduction or elimination of enamel where the teeth touch) would be extensive and upper teeth would have to be retracted. Both of these cons carry significant consequences that should be well-explained and well-understood before you decide to do this type of treatment.

Good luck!

Extractions or IPR

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Like a lot of orthodontic patients you have crowding. There are three ways that crowding can be resolved:

1. Expand the arches

2. Extract teeth

3. IPR or enamel reduction

Each of these methods have pros and cons...too numerous to go into now and for borderline problems (like yours) you have to pick one or the other for the most part. And for reasons of symmetry if you take out one tooth you need to take out four (usually). Thus even if both doctors see the same problem with crowding they can come up with what appears to be very different treatment plan depending on which set of pros and cons they think is the best

Robert Waxler, DMD, MS
Saint Louis Orthodontist

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.