Possible to Go for Invisalign Without Tooth Extraction?

Question

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?

Antoaneta Barba, DDS · Answer

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

Raj Kumar, BDS, LDSRCS · Answer

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

	Dr R Kumar BDSLDSRCS

	I would not advocate

Steve Alper, DMD · Answer

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.

Robert Waxler, DMD, MS · Answer

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

Brian Povolny, DDS, PhD · Answer

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.

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