Possible to Go for Invisalign Without Tooth Extraction?

Recently, I just had a consultation for Invisalign and the doctor told me that he try not to do extraction for me because my side profile is quite flat, extraction make my upper row to move inward and it will make my upper row of teeth become flatter and look older. But before that I was told by another dentist that I need extraction as my teeth are too crowded and too big (front tooth about 10.5mm), he think arch widening cannot create enough space to move the teeth. Who should I listen to?

Doctor Answers 7

Non extraction Invisalign

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Good question and many answers.

My advice woudl be as follows:

You have a slighty convex upper lip which is being pushed out by the 2 front teeth. The profile is nice and should not be flattened too much. Your chin point is slightly forward as well so again moving the upper teeth into extraction spaces may flatten the upper lip and make your chin look slightly long. The front teeth may also have an open bite as well.

The crowding is quite severe and yes you need lots of space. Your upper canines are in class 1 and that is quite stable. To remove 2 upper and 2 lower premolars would create too much space. The dentist may then spend half the time in closing these spaces by moving the molar teeth forward; not easy with Invisalign.

My advice would be to create space in th eupper arch by expanding the dental arch and even moving the molars back 2-3mm. There might be some fine interdental stripping as well. The front teeth can then be tipped back into the dental arch. I have already done a similar case with a twisted upper arch.

Invisalign can provide attachments and now even power ridges on the front teeth to help the aligners to move the roots of the upper incisors.

The anterior open bite should not be closed by pulling down the upper incisors as you show too much of your teeth already.

The dentist should take impressions and create an Invisalign scan and then see what movements he can make. It is then possible to add extractions if really necessary ( I dont think they are) to the scan and then you will be able to use Invisalign.

Sorry for the long explanation but I only extract teeth in the upper arch when the upper jaw is very far forward from the lower arch.

please see my cases


I would not advocate

Do I need extractions with Invisalign

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Whether to extract or not is NOT an Invisalign question...it is an orthodontic question.  Although it its almost always possible to treat a patient without extractions, this does not mean that nonextracftion treatment is the best way to go...it may mean a less stable, less esthetic result.  Once the decision is made whether to extrac,t then the type of appliance can be chosen...In general, Invisalign is not the best appliance if multiple teeth have to be extracted.. Bottom line...figure out what needs to be done and then pick the right tool to accomplish this task

Robert Waxler, DMD, MS
Saint Louis Orthodontist

Invisalign and extractions

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I notice that you have been told that with Invisalign you would not need extractions.  This is true in the sense that your teeth can be straightened without any extractions with Invisalign.  The question I would ask is, would extractions be indicated for you regardless of the appliance system used?  When you have extractions the appliance system needs to be good at moving tooth roots through the bone and keeping them parallel.  Invisalign is not good at this.  So if you actually NEED extractions, but your doctor is limited to using Invisalign, then you are forced to accept NOT having what you really need.

I suggest getting several opinions from qualified orthodontic specialists, who do both braces AND Invisalign. Don't tell them you want only Invisalign.  Ask them: "without regard to what appliance system is used, would you extract teeth in a case like mine if I were your daughter?"  If they say, 'yes, they would not extract teeth' then you know it's the best choice for you.  

From looking at your models and photos my impression is that you might get a very nice result with no front tooth "flattening" or "retraction" if the second bicuspids were removed instead of the first bicuspids. If no teeth are removed, even with "IPR", your front teeth will end up looking a bit more "protrusive".  Only you can really say which look you'd prefer.  And only you can decide to accept a compromised result because you have decided that Invisalign is the only acceptable appliance.

Invisalign is a great tool but cannot do everything braces can do. An experienced doctor knows how and when to use each tool in the toolbox.

Brian Povolny, DDS, PhD
Seattle Orthodontist

Invisalign without tooth extraction

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I see that you have crowded teeth.

However you should try invisalign treatment. It might work. I have had a case similar to this and it worked really well without any extraction. I am not saying that this might aply to your case as well but you have a good chance to achieve your goal without extracting any tooth 

Antoaneta Barba, DDS
Santa Ana Dentist

Not an Invisalign Question.

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Whether or not to extract is not dependant on whether you choose Invisalign or braces. 

The question is; Can you treat your teeth orthodontically without extractions, and acheive the result you want? If the answer is yes, then I would say don't extract. 

Steve Alper, DMD
New York Dentist

Invisalign Without Extractions?

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This is a GREAT question. It is clear (based on the records you have provided) that you have a LOT of crowding of your teeth. Let me say right from the start that you have made a wise choice to straighten your teeth. Straight teeth not only make a more beautiful smile but also create a healthier mouth. 

Typically, with Invisalign (and with traditional forms of orthodontics as well) it is easier and requires less time to treat a patient using extractions than it would without taking teeth out. Because you have excessive crowding you either have to take teeth out, expand the space your teeth occupy and/or make your teeth more narrow.

I would ALWAYS recommend treating a case without taking teeth out if possible. NOT extracting teeth will give you a broader smile, better lip and face support and be less-potentially damaging to your TMJ. BEFORE removing any teeth you must always consider how extracting teeth will affect the look of your face and the health of your jaw joint. If the dentist tells you there is no possibility of a negative affect...seek another opinion or two. 

Good luck!

Who to trust...

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When you have more than one consultation you will get varying solutions for the same problem. (I generally recommend 3 consultations for my friends that live out of town and can't see me.) The proposed solutions likely will make sense while each doctor is explaining them. You want to trust both doctors, and you should.

Bottom line: Go with the doctor whose result you think you'll like better in the end and you felt you could talk to more easily.

It is my personal experience that some doctors will wrongly say something "can't be done," but what they are really saying is they are "uncomfortable doing it for your case." They doctor who says "it can be done" feels comfortable doing it for you. (Don't be afraid that anything bad will happen. It is pretty hard to do anything irreversible when moving teeth.)

An example: Doctors who are uncomfortable treating with Invisalign will say a patient is "not a candidate, " when another will have no problem treating that same patient with it, will do it, and get an awesome result. The doctor who was uncomfortable utilizing the technology just hasn't embraced it, yet. Again it isn't that one shouldn't be trusted over the other, it's that the treatment is out of ones comfort zone and not the others. If people really want Invisalign they will keep looking until they find a doctor comfortable treating them with it, and they should.

I don't think you need extractions, with Invisalign IPR(which can be explained to you by your doctor) can be preformed to help created addition need space. Invisalign can get some expansion fairly predictably. I think you'll have a wonderful result, no matter your choice and you will wish you had done it sooner. Good luck.

Jacqueline Demko, DDS, MSD
Chesterfield 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.