Need 2nd Opinion, Orthodontics, removal of teeth on top to close bottom gaps?!


Question: Need 2nd Opinion, Orthodontics, removal of teeth on top to close bottom gaps?
My son is 18 months into his orthodontics (braces) and when he started another dentist pulled two teeth on the bottom to fix an overbite assuming that they could pull his molars forward using a herbist (Sp?) approach, we had the braces work done by another dentist that has used forces to pull those lower molars forward and now he is conceding that they are not moving forward enough to continue with this approach, so he is suggesting that he pull two teeth from the top (above the gaps) that will help close the gap below. To me this doesn't sound logical, but he assures me that this is a common procedure. Is he right? I think the teeth pulled are the premolars or next to them if that makes a difference.

Answers:

Your orthodontist is correct in telling you that bicuspid extraction treatment is a common procedure; however it is also outdated, archaic and potentially detrimental to the welfare of the patient because such treatment has been shown to cause TMJ problems. Other disadvantages of extracting bicuspids are:
1) makes the mouth smaller than normal;
2)causes a dished-in profile where the nose and chin will be more prominent and the mouth area mushed in;
3) make the upper and lower teeth not line up correctly;
4) force the mandible (lower jaw) to bite too far back and thereby increasing the probability of anterior displacement of the articular disk.

Traditional orthodontists are trained to make teeth straight with disregard to the effects of what such treatment will do to the facial profile. In other words, teeth are made straight at the expense of facial esthetics or beauty. You are absolutely correct and using excellent common sense when you say that the treatment recommended does not sound logical. Traditional orthodontists do not know how to correct Class II jaws skeletally. When they treat Class IIs (retruded chins) they do so dentally and that is not good orthodontics. When a patient has a retruded chin the mandible needs to be advanced (using functional appliances) so that the lower jaw aligns properly skeletally with the upper jaw or maxillae. But since traditional orthodontists do not know how to do this, they shift the teeth around to make it look like the patient will have a Class I (normal) relationship when done. The lower jaw is still too far back and only the teeth have been shifted around to make it look like the upper and lower jaws are aligned properly. So although the teeth look like the patient has a Class I (normal) bite, the lower jaw will still be retruded and the profile will still suffer. Good orthodontics should be about making the structures of the jaws line up correctly as well as the teeth and not camouflaging an existing skeletal problem so that it APPEARS correct. As you can see from the treatment that your son received, the orthodontist was trying to move the lower molars forward or anteriorly to attempt to establish a Class I dental relationship (with the mandible still in the same place) when the mandible should have been translated forward to establish a skeletal Class I relationship.

functional orthodontist; treated TMJ since 1984



Yes this is a common procedure and I would go through with it. It also depends on how old they are as well. If this was not neccasery then it would have been suggested. You have to trust the dentist. The person above was a rare case and doesn't happen alot. Hope this helps

I am a dentist



Hi... the best thing to do is to get a second opinion by a professional. If you can't speak to a dentist, then you can try and go online to get some information. Try these:

http://search.webmd.boots.com/search/sea…

http://www.patient.co.uk/showdoc/9/

http://www.justanswer.com/dental/

http://www.nhsdirect.nhs.uk/

http://www.dentalfearcentral.org/helplin…

Hope these help!!



When correcting an overbite with extractions, it's exceedingly rare to pull lower teeth and NOT pull upper teeth as well, so your dentist's suggestion makes sense. It is normally the premolars that are taken out. Herbst appliances and Forsus springs work basically the same way, so one wouldn't have succeeded where the other failed. Your orthodontist/dentist isn't really pulling upper teeth to help the lower spaces to close. What he's trying to do is make certain that your son's top and bottom teeth fit together well at the end of treatment. In order to close the remaining space in the bottom, your son's bottom front teeth are going to move back a bit. If your doctor doesn't create space in the top and also move the top front teeth back, your son will end up with a LARGER overbite.

If you're uncomfortable with the treatment, get a second opinion from another orthodontist before you commit to the extractions (you can always take the teeth out, you can't put them back once they're gone), but from what you've described it sounds like your current doctor's recommendation is logical.

As for the first answer above, a well-treated and maintained orthodontic case will generally not finish with any spaces between the teeth...whether teeth were extracted as a part of treatment or not. By his own admission that person didn't follow his/her doctor's instructions, which is most likely the reason his/her case didn't have a satisfactory result.

I'm an orthodontist. D.M.D., M.S.



DO NOT DO IT!!!! I had the same thing done...I am now 38 with little gaps between all my teeth because they removed all my eye teeth before my braces. AND I STILL HAVE AN OVER BITE!! They will try to get him to wear headgear and a retainer for the rest of his life (and he won't wear it like I didn't) because it's fricking annoying. But now I get stuff stuck in those small gaps all the time and it just caused more problems. IF and only IF he's got his wisdom teeth in, would I ever consider doing this to my children...and that's only because I would think the pressure from those would close the gaps. BUT all 4 of my wisdom teeth were also removed so there was nothing to put pressure. I really have to ask you, why is his over bite so important to get rid of? Will it cause him pain? Will it ruin his life? Will it make him a shut-in? If you answered no to any of those questions then just move on. Having straight teeth is one thing but I find that my over bite gives my smile personality.




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