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Question:
Two daughters with crowded teeth: My two daughters have the same problem.
Their lower teeth are too crowded for their jaw. The teeth in the front are overlapping slightly and are turned.
The orthodontist said the teeth are crowded, and to make room by removing a front tooth and then straightening them out with braces.
When the dentist received the request from the orthodontist, she was reluctant to remove the tooth saying she never heard of doing this (she is a relatively new dentist).
My question is this: is removing a bottom front tooth and then using braces a reasonable and good solution to an overcrowding problem, or are there other better ways? ...Visitor from PA
Answer:
There are a few situation where removing a lower front tooth is a good treatment plan, but this is rare.
In 17 years of practice I have removed a lower front tooth only once.
We as orthodontists refer to upper and lower jaws containing teeth as arches, because that is their geometrical shape.
I want you to think of the upper and lower arches as circles rather than arches. This will help you to understand the next couple of sentences. In order to finish with a proper bite on each side, a normal overbite relationship between the upper and lower front teeth and the upper teeth lying on the outside of the lower teeth, the lower circle needs to be slightly smaller than the upper.
I hope you can understand this, because this will help you to see why taking out one lower tooth is not such a good idea. If you remove a lower incisor you are going to disrupt the ratio between the upper and lower front teeth.
This will make your lower circle smaller than it needs to be the fit properly with the upper circle, which will leave you with an excessive amount of overbite between the upper and lower front teeth.
Establishing a good coupling between these teeth is imperative to the stability of our cases once the braces are removed.
If there is excessive crowding in both arches and expanding the teeth is going to cause overflaring, excessively full lips may result and possibly may compromise the bone and gum tissue surrounding the front teeth. In these situations, the best treatment plan is going to be removing two upper and lower teeth behind the eye teeth.
This will give you an acceptable result and will help you maintain the proper overbite relationship. Today about 10-15% of patients will require tooth removal, most can be expanded.
My suggestion is to get a second opinion in your area.
James J. Awbrey, D.M.D.
4895 Windward Parkway, Suite 200
Alpharetta, Georgia GA 30004
(770) 751-1688
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