Two Different Specialist Advice, Need Help from an Expert. Which Treatment Plan Is Right For Me? (photo)

I visited two different experts, and I got two different tecniques, I don't know what to choose considering i'm not an expert... This is my two options : 1- Traditionnal braces, invisalign impossible, will extract 4 teeths marked with blue spot. Treatment 18-24 months. 2- Invisalign specialist ready to use this technique. Will extract two teeths red spots. Say that upper canin need to be removed.24 months. Obviously I will prefer Invisalign but scared to remove my canin. Your advice please!

Doctor Answers 7

Measure twice, cut once

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As soon as you extract teeth, there is no going back.  I think you should explore a non extraction plan and see if that fits within your goals.  If you were a member of my family, or if this was my own mouth, I would NOT want extractions.

This may be beyond what Invisalign was designed for, and a more traditional approach should be considered.  I would look into Damon braces.

Non extraction orthodontic treatment

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I know in my practice I would not take out any of your teeth but rather develop the shapes of your jaws which appear narrow and collapsed. Damon braces would be a great choice for your case so getting another opinion from a certified Damon Braces orthodontist would be a good idea. Go to and go to the doctor locator- there you can put in your zip code and find orthodontists that are close to your location. You will be happy you did it!! Good luck!! 

Scott Vincent, DMD, MS
Sandy Orthodontist

The Right Treatment Plan Depends on Your Goals

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Without radiographs and photos showing me how the position of your teeth factor in to your facial appearance, I am afraid it is hard for me to tell you what treatment would be best. The impact of the positions of your teeth on your smile and on your facial appearance can be dramatic, and there has been a greater shift towards facially focused orthodontic treatment in recent recent years instead of simply lining teeth up.

If you are simply wanting to get your teeth straight, both treatment plans will likely accomplish that, but there are many more factors to a gorgeous smile than just straight teeth, and although both plans contain some compromises (with good reasons that your orthodontist can discuss with you) the Invisalign treatment is probably not a good idea for the following reasons:

  • This treatment does nothing to help your upper midline and will likely make it worse. You want the contact area between your two central incisors to align with the middle of your face (about where the cupid's bow on your lip is), and from the photos there are several red flags that tell me it is probably off to your left by a lot.
  • The gumline on your bicuspid is very different from your canine, and without some shaping of the gums removal of your canine will make your smile look odd.
  • You'll likely end up with a black triangle where your lower incisor has been removed, which I am sure you won't like much.
  • There are going to be some minor tooth position issues that can't be fixed by Invisalign alone (and would require some work with braces).

Frankly, I'd want to check behind door number three, but between those two treatments I'd pick the one involving braces.

Scott Frey, DDS
Allentown Orthodontist

Keep that Canine!

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You need so much movement to correct your occlusion.  I would use traditional braces.  Keep the canines  THey are very strong and important teeth.  MAybe clear braces or lingual braces will be more acceptable to you.  Specialists are vulnerable to meeting their patients wants or risk losing the case.  A good specialist will tell you what is the best way and the compromise of the alternatives.

Lawrence Singer, DMD
Washington Dentist
5.0 out of 5 stars 4 reviews

Upper molar distalisation with Invisalign

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Hi Alex,

I would if you haven't already, remove you wisdom teeth and then sequentially distalise your molars with elastic removing the need to extract teeth at the front. Great Class II Invisalign case. 


Dr Luke

Luke Cronin, BDSc
Sydney Dentist

Extractions of canine and incisor or bicuspids may compromise final result

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Your degree of crowding is severe. Let's take a look at some ortho math to see how things could come together without extractions. You have about 10 mm crowding in your upper arch and 5 mm crowding in your lower arch.

For the upper teeth:

  • expand upper 2 mm per side, net about 2 mm space (based on current V- arch shape)
  • procline upper incisors 1.5 mm, net about 2 mm space (again due to arch shape change)
  • push upper left molars back 4 mm to correct bite and create 4 mm space
  • resolve remaining 2 mm of upper crowding with slenderizing of select teeth

For the lower teeth:

  • expand lower arch 2 mm per side also to match upper, creating 2 mm space
  • procline lower incisors 1.5 mm to match upper, creating 2 mm space
  • resolve remaining 1 mm of lower crowding with slenderizing of select teeth

This is just an example, and the numbers should be adjusted by your orthodontist to your specific case. Advanced techniques such as TADs anchorage may be needed to achieve the bite change on the left side. Gum tissue grafting may be needed to address existing gingival recession and allow adequate arch expansion. I have used this "all of the above" technique with Invisalign to align a fully blocked out canine like yours with Invisalign without extractions in an 18 year old.

Extractions may be an easy way out, but have some drawbacks:

  • canine extraction would result in significant asymmetry in the smile
  • bicuspid extraction would result in a narrower smile than what you currently have, and would retract the teeth back from the profile perspective
  • a lower incisor extraction seems unnecessary with either approach

Consider non-extraction first!


Rob van den Berg, DDS, MS
San Ramon Orthodontist

Extractions and braces or Invisalign

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Before extracting any teeth I would get a few more opinions.  Now days very very few cases require extraction and there are lots of future drawbacks (like bite and TMJ problems) to pulling any teeth especially cuspids because certain teeth are designed to fit together best in certain ways..  See if you can find an orthodontist that will give you alternatives without extractions.  This would require traditional orthodontics to move the teeth effectively, and I would definitely use a orthodontic specialist.

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.