Second Time w/ Braces. Facial Profile Changes. Options?

2nd time wearing braces,the first one i stopped during 17mths because they suggested to extract my 4 1st bicuspids, but i don't want to and seeking for another orthodontist and suggested the same thing and so i did. The 1st treatment, i had crowded teeth and crossbite, the 2nd treatment i have an open bite because of the 1st treatment,been wearing it for 5mths now. I'm regretted because my facial profile changes from round to skinny. Should i ask the dentist to re-open the space and get implant?

Doctor Answers 5

Extractions can reduce the fullness of the smile and lead to many other problems.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Most traditionally trained orthodontists still use teeth extraction as a way to eliminate the imbalance between the bone structure and the size of teeth (which created crowded teeth to begin with).  Almost all of the time the problem is not that the teeth are too big, but that the bone structure developed too small and has caused the crowding.  Since you already have had the teeth removed, the jaws and arch forms still can be widened to create that full beautiful smile.  Another hint is to use an orthodontist who would not have removed the teeth in the first place.  Otherwise the traditional orthodontist may not understand that you want a much fuller smile and may not know how to achieve it, short of something like surgery.  He may argue that you have had a good result, that is, one acceptable to him.  Also, you may not  in the end  need to replace the missing teeth if an appropriate widening of the jaws take place (a procedure called Dentofacial Orthopedics).  That part of the equation will require a consultation with a dentist/orthodontist trained in these procedures.  It will be worth the search.

Extraction treatment and facial esthetics

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Your question is at the heart of many discussions in orthodontics.  Unfortunately, from the information provided there is no way any othodontist could answer your question because there are so many different factors that must be taken into account.  However, we can discuss several things.

First, if two orthodontists both thought you needed extractions there may have been a compelling reason for the extractions.  While it is always possible to align teeth without extractions, sometimes doing so is a really bad idea.  So in addition to focusing on changes in your facial appearance, ask your orthodontist what would would have happened if you had NOT had extractions.  Perhaps you are better off now over all as a result of the extractions.  If not, your idea of opening space for implants may be the proper approach for you. 

(Parenthetically, not all extractions are equal.  One thing that I often consider if I'm worried about lip retraction is to extract the second bicuspids instead of the first. This may resolve a crowded situation with little or no lip retraction.) 

I'm sorry to hear about your dissatisfaction, but I encourage you to discuss your case with several orthodontists to get a fuller understanding of the best approach going forward.

Brian Povolny, DDS, PhD
Seattle Orthodontist

Opening dental spaces and placing dental implants is possible

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Anything is possible, but the question will be is it worth the money to do it all?  Only you can answer that for yourself.

The opening of spaces is very difficult and many orthodontists don't treat this way, so it may take some homework to find someone that can help.  When done, implants or bridgework will be needed to fill in the spaces, but it should work out fine and very esthetic when complete.

Does Tooth Extraction Before Braces Cause Narrowing of the Face

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

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. Implants to replace extracted bicuspids is probably the best way to reestablish a broad smile and wider facial appearance. Veneers might also be an option if bicuspid spaces don't require complete reopening.

Good luck and I'm so sorry that you aren't completely satisfied with your results.

Reopen extraction sites?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Of course you can reopen the sites, but it would leave you with the need for very expensive prosthetic replacement of the teeth.  If extractions were really required and the treatment was done correctly, then you should not have a negative facial effect.  Those orthodontists who market their practice on their ability to treat EVERBODY nonextraction might tell you that you should not have had teeth extracted but extractions are still a very legitimate form of treatment.  Without seeing all of your records I have no idea what your situation is, but do not do anything until you talk to your ortho and if needed, get a few second opinions! 

Robert Waxler, DMD, MS
Saint Louis 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.