Do you think its necessary for me to have upper teeth extractions in order to have braces? (photos)

Hi i'm 35 and considering to wear braces to fix overcrowding on the top row of my teeth. I've seen 3 orthodontists and all 3 said i need to have both first bicuspids extracted. Is this really necessary? My 2 front teeth are slightly caving in from the overcrowding and the alignment is off to the left side. The left side is where most of the overcrowding is. I'm concerned that removing 2 teeth (healthy ones too) would create more gaps and alter the shape of my face.

Doctor Answers 2

Do I need teeth extracted?

Ways to deal with crowding:
1. extract teeth...usually done bilaterally to maintain symmetry....done correctly there will be no spaces left at the end
2. expand by pushing front teeth you really want you front teeth sticking out further?
3. slenderize...narrow each tooth slightly...only good for minor crowding
4. push all of the back teeth backward until you have enough room to correct the crowding in the front....very, very difficult if not impossible to gain a lot of room this way with adults

So, there you have it! have to do one of the above....I vote for the extractions

Saint Louis Orthodontist

Do you think its necessary for me to have upper teeth extractions in order to have braces?

There is a fifth option to the four options previously mentioned by another doctor and that is palatal development. The reason your teeth are overly crowded is because your upper arch is underdeveloped. The reason your left side is more crowded than your right is most likely due to your left arch being less developed than your right. I would be willing to bet that you have some kind of nasal obstruction on your left side that inhibited nasal air flow on that side. Your face is most likely asymetric and your left nostril more constricted. These are obviously all things that should be evaluated before ANYTHING is done. 

If you extract only upper teeth, your upper arch will become even more constricted than it already is. What is the plan for making the lower arch fit into the upper arch if you extract teeth from the upper arch only? 

Palatal development can be done quite nicely with a simple removable appliance. The reason it was left off of the previous doctor's list is that many American trained orthodontists believe that arch development in adults is either not possible or not stable. There are volumes of cases proving this simply isn't true. Some of the most unstable orthodontic cases I have ever seen are cases involving bicuspid extractions. Palatal development works in adults and if done correctly is extremely stable. I have personally treated patients using arch development from four years old to one patient in his late 80's and all ages in between. 

Your upper arch was not supposed to develop asymetrically. Your teeth were not supposed to be crooked. Something happened during your growth and development that altered the course of your genetic potential. There are appliances that can be worn that will actually pick up where nature left off and allow your dental arches to properly develop, thus allowing sufficient space for all of your teeth to fit. 

Proper development of your dental arches will not only result in sufficient space to properly align all of your teeth but will also enhance facial aesthetics and improve airway and TMJ health. 

Good luck!

Brad Lockhart, DDS
Tustin Dentist
5.0 out of 5 stars 11 reviews

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