Palatal Expander vs. Extraction Of Upper Bicuspids In A 19 Year Old Female? (Photos)

Question

I have seen 4 orthodontists (first ortho I have ruled out, 3 left now) who each gave me different opinions: - 3/4 mostly said 2 upper pre-molars to make room for the high canines - Most didn't really recommend lower teeth extractions - Wisdom teeth are my choice but I will get them out - 1 said an upper expander - 2/4 said elastics A lot of my decision is financial and how comfortable I am. 1. Will an expander work? 2. Do I need elastics? 3. Do I need teeth removed? 4. What would you recommend?

Brad Lockhart, DDS · Answer

The easiest (and probably cheapest) way to straighten your teeth is extracting upper bicuspid teeth and then braces. HOWEVER, this is DEFINITELY NOT the best way.There is FAR more to straightening teeth that must be considered than simply moving teeth. You should ask all the doctors you are considering the following questions: 1) what effect will moving my teeth have on my facial aesthetics? 2) what effect will moving my teeth have on TMJ health? 3) what effect will moving my teeth have on airway health? If the doctor can't answer these three CRITICAL questions with confidence and inspire you with the answers then you need to RUN from their office.You have a grossly underdeveloped upper arch that must be developed to allow room for all of your teeth. You do NOT need to extract bicuspid teeth. If you straighten your teeth without widening your palate you will have to remove healthy teeth to create the needed room and you will always have an underdeveloped palate. The ramifications of an underdeveloped palate are: compromised facial aesthetics, potentially compromised TMJ and potentially compromised airway. Compromised facial aesthetics alone should dictate that you never seek this type of orthodontic treatment but couple that with potential TMJ and breathing issues and you should run from any doctor willing to extract bicuspid teeth from your mouth.Good luck!

Robert Waxler, DMD, MS · Answer

Photos alone are not enough to know for sure but I do disagree with Dr. Lockhart's analysis of your case and his blanket rejection of extractions:1. Palatal expansion is not possible at your age (without surgery)...the expansion will be almost totally arch widening...not skeletal...no good scientific study shows otherwise!  It will be very unstable.2. Done correctly, extractions do not cause negative facial effects3. The scientific consensus does not support his conjecture that extractions cause TMJ problems or airway problems.4. Even if expansion was possible, your bite is completely off and expansion would not be the way to correct the biteAs I have said many times before...be very afraid of any doctor who is so dogmatic in his beliefs...Good orthodontists (and he is just a general dentist) let the patient's problem dictate the treatment ...and then use any and All available treatment options to arrive at the best possible treatment plan...sometimes expansion, sometimes extractions, sometimes surgery

Palatal Expander vs. Extraction Of Upper Bicuspids In A 19 Year Old Female? (Photos)

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Palatal Expander vs. Extraction Of Upper Bicuspids In A 19 Year Old Female? (Photos)

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