Disappointment with Braces - What should i do now?

Question

I had crowded teeth and crossbite, i went on treatment at this corporate orthodontics clinic for 17months since june 09, which have more than 3 different orthodontist doing the treatment.  I thought i can get out with extraction of my 4 1st bi-cuspid, but i can't. I stopped going there and seeking for another dentist told me the same thing, so i did get extracted. So disappointed, my family and friends said my face is too skinny now, not like before rounded. What should i do now?

Brad Lockhart, DDS · Answer

Is your face skinnier because of the extractions done in conjunction with orthodontic treatment? This is a hotly debated topic within the orthodontic community. Does extraction of bicuspids cause change in facial appearance? There is very compelling evidence that indeed it does. There are several cases involving identical twins that were treated one with non-extraction orthodontics and the other with bicuspid extraction orthodontics. At the conclusion of treatment they no longer look like identical twins and the twin that received bicuspid extraction treatment has a narrower face and narrower smile.

	For a look at one of these cases: Google Dr. Hans Eirew, Manchester, England.

	Your dissatisfied results can be "fixed" but obviously at great cost and inconvenience to you and MUST be done by someone who understands orthodontics AND restorative dentistry. It's obviosly best to do the job right the first time. I ALWAYS suggest that my orthodontic patients seek a second or third opinion regarding proposed treatment, ESPECIALLY when extractions are a part of the proposed treatment.

	Good luck and I'm so sorry that you aren't completely satisfied with your results.

Jacqueline Demko, DDS, MSD · Answer

This is a hotly debated discussion in orthodontics. I fully believe what you and your family see can and does happen. That said your teeth are gone and now what?

	There are some options

	1) spaces can be reopened and replaced with implants=approximately $3500/implant after braces again.

	2) expansion can be done to fake that the teeth we not pulled but will not help restore much of any "lip thinning" you may or may not be experiencing.

	In my 11 yrs of private practice I find very few reasons to ever pull teeth, but they do exist and making someones smile less visible and narrower is one of them.

	If you'd like more info on adult expansion, another hotly debated topic feel free to contact me.

Brian Povolny, DDS, PhD · Answer

I'm sorry to hear about your experience.  Since very case is different it isn't possible to address your specific concerns without seeing you personally and evaluating your initial records.  However, I'm certain that regardless of your initial situation, a highly experienced and trained orthodontist would be able get a good esthetic and functional result.  Sometimes this might require extracting teeth other than the first bicuspids (ie the second bicuspids) to prevent the front teeth from being pulled back too far, or it might involve using special temporary anchorage devices to move teeth into the best esthetic or functional position. 

	One other factor you might wish to consider is that your perceptions of the changes in your face may not be due to to the orthodontic treatment.  Orthodontics rarely makes someone's face look noticably different in terms of how "round" or "skinny" it is. Carfully evaluating the changes with before and after photos and x rays may surprise you.  Were your teeth were so crowded that you were embarrased to smile?  How do you feel about smiling now?  Sometimes we have trouble adjusting to changes in how we look, even if they are on balance positive.

Gary Kloberdanz, DDS, MS · Answer

Many people are drawn to the "corporate: clinics because of their advertising and "lower" fees.

	The "corporate" orthodontic clinics tend to hire new graduates who have just completed their orthodontic residencies. They are all very intelligent and well educated but lack experience.

	Unfortunately when more than one orthodontist is involved in treatment unless there is a excellent communication treatment may not be as efficient.  

	Sorry to hear that you had a poor result!

Robert Waxler, DMD, MS · Answer

Sometimes extractions are necessary, and often, for symmetry you need one tooth out in each quadrant.

	Many orthodontists (and "orthodentists" will tell people that extractions cause constricted arches but the studies do not show this to be true if the diagnosis and treatment was done correctly.

	.  It is almost always possible to treat without extractions, BUT the final result can be very unstable and unesthetic.
	Having said this, I have no idea if your treatment was done correctly, and extractions might not have been necessary.

	At this time it would be best to find a Trustworthy ortho who has no strong "nonextraction at any cost" view and see what he/she says

Disappointment with Braces - What should i do now?

Answers (5)