Braces with extractions have ruined my smile. How do I undo this? (Photos)

Question

4 premolars were extracted, two up and two down on each side. Also both my lower wisdom teeth were extracted. My smile is smaller, lips don’t have support, teeth are too pushed back in and the worst is that my face looks uneven and lopsided. I heard that braces or invisalign could help recreate the gaps and teeth implants could fill those gaps. What should I do?

Brad Lockhart, DDS · Answer

Moving teeth ALWAYS affects the face. Extracting teeth in order to straighten the remaining teeth will have an even bigger effect on the face. Unfortunately, when bicuspids are extracted there is often an adverse effect on the TMJ and the airway as well. Your concerns are extremely common for patients who have undergone bicuspid extraction orthodontics. The only way to improve your facial aesthetics and TMJ/airway health is to reverse the bicuspid extraction procedure. It is unrealistic to think you can regain enough space to replace the missing teeth but you can certainly regain a significant amount of lost space. I love the DNA appliance to do this; there are others that work also.Good luck!

Ira Shapira, DDS · Answer

It is unfortunate that Contraction Orthodontics with extraction (amputations) of healthy teeth continues.  Ideally, early expansion is done prior to 8 years oof age.  Sooner is better.  If early expansion  is not done there is insufficient arch length to fit the teeth.  There are various methods too expand the maxilla including SARPE procedure.I find that the DNA Appliance is thee best device to provide orthopedic growth.This can provide a full wide healthy smile with good tissue support and eliiminate dark buccal corridors.  More impoortantly it also increases the size of thee naso-pharyngeal airway which can improve headaches, Migraines, TMJ disorders and head posture.Having already extracted teeeth you will likely create spaces where extracted  teeth need to be replaced.Ira L Shapira DDS, D,ABDSM, D,AAPM, FICCMOPast Chair, Alliance of TMD OrganizationsDiplomat,  Academy of Integrative Pain ManagementDiplomate, American Board of Dental Sleep MedicineDiplomate, American Board Sleep and BreathingRegent, Master & Fellow, International College of CranioMandibular OrthopedicsBoard Eligible, American Academy of CranioFacial PainDental Section Editor, Sleep & Health JournalMember Cranio Editorial Board, Journal of Craniomandibular and Sleep PracticeMember, American Equilibration SocietyMember, Academy of Applied Myofunctional SciencesMember, Academy of Cosmetic DentistryLife Member, American Dental Association

Rob van den Berg, DDS, MS · Answer

Opening up space for 4 missing teeth is a big deal. You're talking about creating about 15 mm of new space in each arch. In terms of complexity in a way this would be similar to treating a patient with 15 mm of crowding per arch. In orthodontic diagnosis mild crowding is 1-3 mm, moderate crowding is 4-6 mm and severe crowding is 7 mm or more. Putting in 15 mm of new space in each arch, that's in the super severe category!Now there are things that can be done to lessen the complexity. One is to open up the space farther back in the arch, for example at the second bicuspid positions, even if first bicuspids were originally removed.Another consideration could be to open space, but to open up less space than the full 15 mm for 2 implants. Perhaps a few mm of space can be opened at strategic locations in the dental arches, and those spaces could be restored to fill them in.All in all there is a lot to consider. What is the condition of the roots? Since you've had 4 bi's out, will your teeth withstand several years more of orthodontics? What is the condition of the gums? Is there a risk of gum recession as the teeth are expanded out to this extent? Also, what are the airway considerations, could you benefit from having wider dental arches from that perspective?Lastly in terms of facial symmetry, that may or may not change with dental expansion treatment. Ortho moves the teeth, some bone, but the effect on the soft tissues in particular facial contours with the lips closed is not very predictable.It sounds like you could benefit from a second opinion. Many offices will provide one complimentary.

Braces with extractions have ruined my smile. How do I undo this? (Photos)

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Braces with extractions have ruined my smile. How do I undo this? (Photos)

Answers (3)

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Everything you need to know about Braces

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