Arch Expansion Without Dental Implants?

Hi MillyS,

While you can reopen the space using Invisalign or braces, and replace the missing tooth with an implant, there is another option for widening your smile and improving your facial aesthetics -- No-Prep Veneers.  I do a lot of No-Prep Veneers/Smile Improvements on patients who had 4 premolar removed during prior orthodontic treatment.  With no numbing or shaving-down of your teeth needed, you can have a brilliant smile that will broaden your smile (arch expansion) and improve your profile aesthetics -- instantly.

There are several options to fill spaces left by arch expansion. The ideal procedure is based on how many spaces are present and how large the spaces are.  One option is orthodontics alone. Sometimes orthodontics can be used to close spaces as long as this does not ultimately casue a problem with your bite. Spamm spaces in the anterior can be close with Veneers, this may involve shaving the teeth slightly though.  There are some "No Prep" veneers available, but I have seen mixed results with these. If hte spaces are as large as a missing tooth, the  best treatment is a dental impant.  This will both retain the bone in the area and be functional. 

Using Invisalign we can move the teeth forword in a serial progression so that the teeth move forward in the jaw bone. It would add to your profile a little as well. I guess it all depends on what you want from this type of treatment and the willingness to be in treatment for a while.

Extraction of 4 premolars for braces was very common in previous years. Now a days it is less common and the reason is exacly what your complaint is about. It pushes everything back to close the spaces and your profile changes.

You are correct in your observation that if you expand the arches you will create more space. The question is how much space?  Can you live with small spaces behind the canine teeth?

It is possible to create several small spaces which can be closed with bonding or veneers, but this means doing more stuff to your teeth and additional cost (and will make them slightly bigger). If you have small teeth or if you wish to improve the shape and color of the teeth then it may be a good option. If you are happy with the way the teeth look now, then not a good option.

I recommend a couple of consultations from experienced orthodontists. I am not an orthodontist but you should ask them if it may be possible to expand the arches and move the teeth forward to give you a fuller profile without creating spaces. This would be ideal.

If you wish to create a full space for each extracted premolar and replace with an implant to get back to your original arch size, I'm going to advice against this. This would be quite difficult and would take a long time to do. Not to mention, very expensive.

Hope this helps

Dr. T

It sounds like the removal of the four premolars left you with a narrow constricted arch which means you have a narrow smile.  If this is the case then expansion or moving the teeth outwards towards the cheeks may help in giving you a more proportioned smile.  Pure expansion does not create spaces between your teeth and therefore no implants or replacement of teeth is required.  You need to check with your doctor to make sure the conditions are right to preform this expansion.  Hope this helps.

It sounds like you have a good understanding of your condition and options.  Depending on the amount of room you have an the size of your teeth, to get the best facial esthetics it is good to expand the arch (to reverse the sunken-in look).  If things work out well you will have enough space when you are done to replace the four extraacted teeth with implants.  I strongl suggest you consider periodontally accelerated osteogenic orthodonticcs.  This will give you the best expansion result in terms of size, physiology and stablity.  This technique was originally developed by the Wilcko brothers.  While it was poo-pood at first, it has lately had great acclaim and is changing the baradigm of adult orthodontics. 

You are right, the reopening of space will leave... a SPACE.  Implants are the best solution, but a dental bridge or partial denture are also options.  Discuss all options and possibilities with your restoring dentist and you should be able to make the best decision for yourself.

The case when premolars are extracted prior to orthodontic treatment happens very often. There are multiple limitations with dental arch expansion and arch expansion in some cases require surgical involvement. Implants are used in some cases when posterior teeth are absent. The best way to define future steps are to consult with the specialist.