Collapsed Teeth, Narrow Smile? I was wondering what I should do.

Question

Hello Doctor(s) , I recently had my braces taken off. My Orthodontist at the time , extracted 4 of my premolars (2 top , 2 bottom) before applying braces.After 4 years my gaps have closed up , however my smile is rather narrow.When I smile only 4-6 of my teeth are showing , I've heard this can be due to a "Collapsed Arch."I also find it rather difficult to breath when sleeping because my tongue doesn't seem to fit comfortable.I was wondering what I should do , who should I see? Thanks!

Brad Lockhart, DDS · Answer

First of all, extracting bicuspids to resolve dental crowding is RARELY the best option and if it took four years to close the spaces created by the extractions then it definitely was NOT the best way to treat your case. Extracting bicuspids to create space to straighten teeth will perpetuate and quite possibly exacerbate narrow dental arches. It will create a narrower smile, decreased lip support, create a long narrow face, decrease airway space and volume and possibly adversely effect your TMJ.Doctors who advocate extracting bicuspid teeth prior to orthodontic treatment will never admit that this type of treatment has a negative effect on facial appearance, much less all the other adverse effects discussed above but the reality is that I see patients in my practice every single day who have had the bicuspid extraction orthodontics who are completely unsatisfied with the same things you are dissatisfied with. What's worse, over time this treatment is generally extremely unstable and results in teeth going crooked again.ANYONE who is thinking about having braces and the doctor is recommending bicuspid extractions should seek at least two additional opinions. I am not saying that bicuspid extraction orthodontics should never be done, I'm suggesting that it should RARELY be done. What can you do now? Unfortunately, the only thing you can do at this point is to undo what was done. The good news is that there are some very effective dental appliances that will redevelop your collapsed dental arches which will expand your smile, open up your airway, give you added lip support and develop your mid-face. Talk to a doctor who advocates arch development instead of bicuspid extraction. Talk with a doctor who understands the relationship between orthodontics and dental facial orthopedics. Talk to a doctor who understands that orthodontic movements affect TMJ, patient's airway, smile width, lip support and facial development. Ask lots of questions and make sure you feel comfortable with the answers.Good luck!

Ira Shapira, DDS · Answer

Amputating 4 bicuspids did not correct your underdeveloped maxilla and 4 years of squeezig together also did not correct narrow maxilla.  Ideally the concept of "FOUR ON THE FLOOR" orthodontics would disappear completely.Ideally expansion can correct underdeveloped axilla and create a full wide healthy smile and airway.  I like utilizing the DNA Appliance and Epigenetic orthopedics / orthodontics to 3 dimensionally grow maxillas and airway.  The mRNA version of DNA Appliance is an FDA approved sleep apnea appliance and case reports have shown instances of curing sleep apnea.  In addition to the DNA Appliance you can also do a SARPE procedure, Crozat Appliance, Alf ApplianceIra L Shapira DDS, D,ABDSM, D,AAPM, FICCMOPast Chair, Alliance of TMD OrganizationsDiplomat,  Academy of Integrative Pain ManagementDiplomat, American Board of Dental Sleep MedicineRegent & Fellow, International College of CranioMandibular OrthopedicsBoard Eligible, American Academy of CranioFacial PainDental Section Editor, Sleep & Health Journal
Member, American Equilibration SocietyMember, Academy of Applied Myofunctional SciencesMember, Academy of Cosmetic Dentistry

Robert Waxler, DMD, MS · Answer

First let me say that, done correctly for the right reasons, extractions for orthodontic treatment is a good thing!This is not to say that it should have been done in your case (4 years to close spaces seems like a very long time!)I would seek at least 2 or 3 opinions and try to avoid doctors who have very strong opinions one way or another about extractions

Collapsed Teeth, Narrow Smile? I was wondering what I should do.

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Collapsed Teeth, Narrow Smile? I was wondering what I should do.

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