To Brace of Not to Brace?

Discussion in 'Orthodontics' started by AndyPandy, May 25, 2018.

  1. AndyPandy

    AndyPandy

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    My daughter has been wearing removable braces for a while and is now moving up to fixed ("train line") braces. This'll means having 4 teeth (molars) removed. When the teeth are removed will that space remain blank for forever, or do other teeth move into the empty space?
     
    AndyPandy, May 25, 2018
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  2. AndyPandy

    Raj Kumar Bhushan

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    Molar is NEVER extracted in any situation in Orthodontic treatment. It is 1st PREMOLAR of all quadrants. It ensures a 'space' for each jaw line (upper & lower). It is a normal case to create space for 'crowding' tooth. And this space is used to correct malignment of tooth, which fit in gap for a natural smile. Just maintain brushing technique and rinse properly with antiseptic solution (mixed with water-logged 3 times a day). Avoid sticky food, chocolates, sweets, junk foods etc. Follow dentist's instructions.
     
    Raj Kumar Bhushan, May 27, 2018
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  3. AndyPandy

    AndyPandy

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    Great, thanks.

    How does the gap left by the 1st premolar get "used". I thought the hole left would need to be filled in with say an implant or something. Is it the case that the gap heals and eventually fills up on its own, is there a name for the process?
     
    AndyPandy, May 28, 2018
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  4. AndyPandy

    Raj Kumar Bhushan

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    Well, can you send me a snap of patient's mouth to know the exact situation?
    Orthodontic treatment included surgery (implant etc., If it is then only done after completion of Ortho treatment. Because implant is the final way of filling the not possible created gap. I.e. extracted tooth due to several decay, loosening of gums which can't hold tooth any more, trauma etc. But implant can be done at any part of life. As old people gets full mouth fixed denture based on implant abutment) periodontal treatment (gums- flap surgery), Endodontic (filling, RCT etc.).
    Also apart from braces, a dentist uses external or internal appliances to correct malposition, either skeletal (bone) or dental.
    It is a basic rule of Ortho to either create or fill gap. And 1st pre molar is a natural choice. The applied physical forces due to braces (which dentist tighten time to time, and it causes strain Everytime patient visit to dentist but disappear soon) and/or appliances causes tooth to be aligned with desired shape.
    Ortho treatment needs several x-rays. Panaromic, lateral, individual (choice of dentist if any defect), CT scan (if any doubt or study) etc. Then dentist study on it. On a transparent paper diagram is drawn. Then strategy is made. And it takes time. From 6 months to few years, depends upon what is goal. Follow instructions of brushing, eating habit (abstain from chocolate, sticky junk food), gargle 3 times at least with antiseptic solution diluted with water, take vitamins, eat raw food etc. Ask dentist about it.
     
    Last edited: May 29, 2018
    Raj Kumar Bhushan, May 29, 2018
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  5. AndyPandy

    AndyPandy

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    Thanks, snap attached.

    The problem are the incisors at the front and they seem to have more room than they need. Is it possible to just stick with the removal braces (for a longer time) to straighten them rather than take out teeth to make an even bigger gap.
     

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    AndyPandy, May 29, 2018
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  6. AndyPandy

    Raj Kumar Bhushan

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    This is ugly duckling condition of Orthodontic. It happens between 7-12 yrs of age. Canine eruption is interfered by lateral incisors. Don't worry. It is a normal phenomenon.
    But NO orthodontic Treatment is required now. NO BRACES. External appliance what I see in picture, is given by dentist to modify proper growth of tooth. It's ok.Wait for some time. Space maintainers i.e. Nance appliance can be given. Let tooth grows. NO EXTRACTION NOW.
    Lots of time is there to do correction, DON'T HURRY NOW. You may change dentist, if he/she insist on extraction.
    What is her age ?
     
    Last edited: May 29, 2018
    Raj Kumar Bhushan, May 29, 2018
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  7. AndyPandy

    MattKW Verified Dentist

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    Since her canines are clearly visible, she is at least 12 years old. A dentist would know that fact. This is past the "ugly duckling" stage of growth. The ugly duckling stage resolves when the canines erupt and the midline diastema closes in some people. This young girl also has lateral incisors in crossbite, so no hope that this will sort out naturally.
     
    MattKW, May 29, 2018
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  8. AndyPandy

    AndyPandy

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    She is 13 and a half, although she got the removal braces quite late, only about 2 years ago. So is extraction her only option? She's not overly keen on extraction but understands that if there is a medical need she'll have to have them taken out. However, if there is an alternative, even if it means the treatment goes on for longer, than she'd prefer to do that instead of having teeth taken out.

    Personally I can't see how the extractions would help or do, but then I'm no orthodontist so I'm trying to learn what is going on and how best it can be fixed.
     
    AndyPandy, May 29, 2018
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  9. AndyPandy

    Raj Kumar Bhushan

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    Let tooth erupt properly. 7-12 is age for this. Canine and incisors growth age is over (till 8-9, 11-12). But Second Molar grows by 13, till 14 too in some cases. So wait for some time.
    Let all tooth erupt in socket. Also, appliance is doing well. Now Orthodontist has to give frontal appliance too, to take tooth in position. Is there any Orthodontist nearby?
    I don't think it is right time for extraction. Still palatal expansion need to happen, for which appliance can be given later on.
    Appliance is enough for now. NO need for extraction and braces. You would have seen many aged adults with braces. Think for that. So NO hurry. Give some time and go for only appliance. Check for any Orthodontist and let me know his/her opinion.
    And as the anterior crowding is there, extraction is a must to make space (1st premolars, all quadrants). But this thing can be done any time. But in this case give at least 6 more months and off course, check the difference of having this appliance. Is there any visible changes with it? Because appliance does take some time to do correction.
     
    Last edited: May 29, 2018
    Raj Kumar Bhushan, May 29, 2018
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  10. AndyPandy

    MattKW Verified Dentist

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    I would've thought all this would have been explained to you by the orthodontist. In some cases, where there is not enough room to fit the teeth, the 1st or 2nd premolars are extracted, and then the braces will rearrange her teeth into the new space provided. The extractions are quite straightforward. I can't tell you if there is an alternative to extractions based on a photo. I'd suggest you talk to the orthodontist again, and with the help of models and x-rays, he should be able to satisfy your concerns.
     
    MattKW, May 29, 2018
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  11. AndyPandy

    MattKW Verified Dentist

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    She just stated she is 13 1/2. Do you have a reason why she should wait for 2nd molars? They will already be in place by now.
     
    MattKW, May 29, 2018
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  12. AndyPandy

    Raj Kumar Bhushan

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    Off course. Second Molar is very important like canine. Canine decides arch position and second molar the back of jaw line. In expansion it holds the braces (band is placed around this tooth mostly) for fixed Orthodontic (braces) treatment. Hence any dentist wait for eruption of Second Molar to begin treatment. If this molar is tilted or maligned then, treatment can't be done. Second molar gives more stability, support and force sharing to 1st molar during fixed treatment. If elastic or Anchorage need to be placed, 2nd molar shares pressure of 1st molar which is tooth for mastication/grinding food and 'very important'. Band can be given to 1st molar too but in my view wait for some time and tell me any changes due to already having appliance in her mouth. Any before & after appliance snaps? (You can see images of braces placed with second molar as a band- Google images).
     
    Last edited: May 29, 2018
    Raj Kumar Bhushan, May 29, 2018
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  13. AndyPandy

    MattKW Verified Dentist

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    Ah, so you definitely aren't a dentist or orthodontist. Expansion usually starts about 8 years old after the 1st molar erupts, and well before the 2nd molar erupts. And bands for braces always need the 1st molar, not the 2nd. An orthodontist isn't waiting for the 2nd molar to erupt, they're waiting for the premolars and canines to erupt.
     
    MattKW, May 29, 2018
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  14. AndyPandy

    AndyPandy

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    She's been to an orthodontist for about two years now, had one set of braces for about a year and then moved to the current ones. They're planning to do the extractions over the summer and then insert the fixed braces. I've asked a couple of times of what is going on in detail but I can't say I've yet had a satisfactory answer. Just want to make sure everything (including the extractions) are being done for a medical reason.

    In your opinions does it look like extractions are going to be unavoidable? Is it worth waiting a bit longer or nothing really to be gained?
     
    AndyPandy, May 29, 2018
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  15. AndyPandy

    Raj Kumar Bhushan

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    Again the same mistake. 1st molar band is placed or not!! Did I support to place 1st molar band or not?
    Depends upon cases a band is placed or a dentist wait for treatment. The best time to place fixed braces is '10-14' yrs. In this case why not there is need to wait till 14? Didn't I say to wait for merely another 6 months?
    Didn't I emphasize on ' canine & 1st molar's importance in my reply? Did I say about any other tooth?
    In this case, definitely a good Orthodontist would start treatment by 14. Don't you see, still she is under treatment (appliance is already given)? Is it ok to drop appliance simply. What is this..
     
    Raj Kumar Bhushan, May 29, 2018
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  16. AndyPandy

    Raj Kumar Bhushan

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    Best time to place braces is '10-14 yrs'. I said to wait for merely another 6 months to attain that age and by then everything will be clear. Appliance change is ok. It means they got desired space. So they changed new appliance. This I wanted to know.
    Anterior crowding needs to create space. So by extracting they shall make space to pull back tooth in jaw line. It is ok.
    Extracting 1st pre molar is ok. There is no as such treatment available to create space simply. Jaw line has limited area (you can check by yourself. Tell her to open mouth. Have disposable gloves and check the upper jaw line. Posterior side you shall not find back space.
    Imagine if any appliance works to pull it further back, what may happen..last tooth come out of jaw line Also what about wisdom tooth space, which comes by 20-23?).
    Which month is your next appointment (when is summer)?
     
    Raj Kumar Bhushan, May 29, 2018
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  17. AndyPandy

    AndyPandy

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    The next appointment is due in mid-June, and they're thinking of doing the extractions in July and then the fixed braces in late July or early August.
     
    AndyPandy, May 29, 2018
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  18. AndyPandy

    Raj Kumar Bhushan

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    You can proceed, no problem. Can you show me some more open mouth snaps of kid? Mouth open upper and lower. Also full mouth.
     
    Raj Kumar Bhushan, May 29, 2018
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  19. AndyPandy

    MattKW Verified Dentist

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    If you're not sure, there's no harm getting a second opinion before you start this next stage.
     
    MattKW, May 29, 2018
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  20. AndyPandy

    Raj Kumar Bhushan

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    Which place do you live? You can search online for any other qualified Orthodontist.
    As I said in previous post, it is up to you to begin Treatment. I need to search online, another Orthodontist for you to confirm this situation. I said in the beginning - NO HURRY NOW.
    Give time. Talk to this dentist and schedule appointment after 4-5 months. As you have at least 6 months in hand (as per text).
    As extraction is inevitable. But another Orthodontist may give you a new clue. Let me know about it.
     
    Last edited by a moderator: May 30, 2018
    Raj Kumar Bhushan, May 29, 2018
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