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Dr. Peel
Dr. Peel, Dentist
Category: Dental
Satisfied Customers: 981
Experience:  General dentist with 20+ years of experience.
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In 1990 (when I was 10) I was fitted with a traditional

Customer Question

In 1990 (when I was 10) I was fitted with a traditional bracket, and all 4 of my 1st premolars were extracted to make room. After I completed 2 years of treatment, I wore a retainer for 1 year. As a result, my teeth moved forward a little bit. Recently
my upper left 2nd molar was extracted due to it being cracked, and to fill the gap left by the missing tooth (and because I have an overbite), my dentist suggested I do another orthodontic treatment. I am now 35 years old. Fact 1: I got into an accident when
I was small, causing my 2 upper middle incisors to be chipped, and I then had crowns put on them. The current crowns were of inferior quality and bulky, thus making the overbite even worse by about 1mm. At the moment, my overjet is 6-6.5, and 1 mm of that
is (probably) caused by the crown like I mentioned earlier. As far as I can tell, I don't feel any pain at all from the crowned teeth, but I fear the suggested procedure will kill my 2 crowned teeth (since their size are already small), causing them to need
root canals. Fact 2: I went to 3 different orthodontists about my current problem, and here are their take on the procedure: 1st: my upper right 2nd molar must be extracted, then she'll use traditional bracket with mini implants as anchors. It will take about
2-2.5 years. 2nd: the same tooth must be extracted, but she'll use self-ligating bracket and a bow-shaped wire anchored on my wisdom teeth. It's exactly like the wire in this picture here: http://www.martinezortho.com/Portals/0/pic_anchorage2.jpg (NOT the
part with the arrow (the TAD), but the bow-shaped wire below the TAD). Treatment also took about the same time. 3rd: I can use any brackets I want (including lingua/incognito) and Forsus. There is a chance that the aforementioned tooth doesn't need to be extracted.
Treatment will take about 3 years. My current crowns will be replaced by a temporary crowns -herself- to see the condition of the teeth, then set the bracket and Forsus, then wait. If it turns out an extraction is really needed, the tooth that will be extracted
is the upper right wisdom tooth. So my questions are: 1. If I were to do the procedure, will it kill the crowned teeth? I want to avoid root canals. 2. Will my upper right 2nd molar need to be extracted for the procedure? 3. I -feel- that with my upper left
2nd molar gone, the chewing surface on my molars is no longer level. I mean, my 1st molar is bulky and tall, while my wisdom tooth is quite a bit smaller and shorter. The extracted 2nd molar usually acts as the bridge between the two, forming a level surface
for chewing. If I were to undergo the procedure, my wisdom tooth and 1st molar would be next to each other right? Would it cause any problem whatsoever? Or is it just in my mind? 4. I don't see anything wrong with my lower teeth. The front ones are not slanted
at all. There is ONE tooth that's a little bit misaligned (right lower middle incisor), and I don't see it as a problem, but other than that one tooth everything else is normal. Do my lower teeth really need braces as well?
Submitted: 1 year ago.
Category: Dental
Customer: replied 1 year ago.
Whoa. What happened to my paragraphs? Everything's jumbled into one paragraph. Bad programming, justanswer... Anyway, one question I forgot to ask.
5. What are your thoughts on the three treatment plans offered?Thanks.
Customer: replied 1 year ago.
the link to the image's busted. I'll just post the picture here. The wire I was talking about is the part circled in yellow, not the TAD/pin.
Expert:  Dr. Peel replied 1 year ago.

I am Dr. Peel and I will be happy to answer your question. Can you please send me a picture or two that shows your upper teeth and your bite on profile? That would help a lot. Thanks.

Expert:  Dr. Peel replied 1 year ago.

Is that latest picture during braces in the 90"s?

Expert:  Dr. Peel replied 1 year ago.
Hello,
I have waited for awhile now with no response. I may have to be away from my desk for awhile so you may submit the information I requested and wait for me to return or re-submit to another doctor. Thanks.
Customer: replied 1 year ago.
Hi Dr. Peel. I was waiting for a response from the justanswer team for some time and then fell asleep, hence the no response.Anyway, regarding your request, I only have the latest x-ray taken about 2 weeks before my upper left 2nd molar was extracted (it was extracted a month ago). Could you please look at them first and let me know if they suffice?And for your question, the answer is no, that's not a picture of my teeth. It's only a sample image I found on the Internet of the supporting wire the 2nd orthodontist was planning on using in addition to the self-limiting braces. I was told the name of the wire when I was there, but I forgot, so I just show you the image instead.Thanks.
Customer: replied 1 year ago.
Err... I meant self-LIGATING braces. Phone autocorrect strikes again.
Expert:  Dr. Peel replied 1 year ago.

Hello,

I am sorry it has taken so long to get back to you.

Thank you for the x-rays. It helps to know that you do have most of your teeth and they look in good shape with few fillings, etc.

Of course when you seek help from an orthodontist they assume that is the way you want to go and they present an orthodontic plan. It is one way to go but your concerns are legitimate regarding possible damage to other teeth. Moving adult teeth takes longer as bone is more dense and mature.

1.The possibility of trauma exists when treatment is aggressive (fast) but over a few years not likely a problem.

2. You do not have to extract the opposite molar for treatment.

3.See below- implant/bridge option

4. If you get upper braces, you need to get lower ones as well. During movement your bite will change and the lower needs to be adjusted in tandem. In addition, sometimes the lower brackets are used to place bands that also attach to the upper to provide movement options such as pulling a tooth forward or backward in an arch.

I would suggest not doing orthodontics based on your history and the radiographs and instead I would suggest an implant to replace the missing tooth. You have good bone for this and it would be far less invasive, complicated and time consuming. It would be a lot less expensive also. An implant, performed by an oral surgeon costs between $1000 and up to $1700 depending on where you live. A crown on top of that is another $500 to $1200 more. Its is possibly close to the cost of orthodontic treatment but done and over in a few appointments vs. a few years.

Alternatively you could get a bridge that would fill the gap. That is almost the same cost.

Costs for both would require clinical evaluation and may be more or less depending to your particular situation, where you live and the choice of doctor.

Let me know if this answers your question and whether you have any further concerns that we can discuss. I am available for the next hour.

Customer: replied 1 year ago.
Dr. Peel,Bridge is something that I definitely would not do, as it damages both the adjacent teeth when they were made into anchors. And I've been offered an implant before, but I also don't see it as something that I would prefer to do. Besides, my mum has had implants put in before, and there's always problem arising after a few years. Maybe in the US or the UK it may not be the case, but going to the US or UK is not something that I can easily do, even only for several times. The travel time and cost involved for several trips is a bit too much.Anyway, on to questions then:
1. You said "I would suggest not doing orthodontics based on your history...". Why not? Which history? Is it bad if one has had orthodontics done as a child to have it done again as an adult? Are there any negative effects to doing so?
2. IF there are no negative effects, then I guess the question now is just whether to ortho or not to ortho (leave it as it is). Actually, I've had plans to do another orthodontics treatment for quite some years now, especially to fix my upper front incisors that look like something the rain would get stuck on. They look like the roof of a house, and over the years they get more and more slanted. Several years ago my lips can easily close when I sleep, and lately it's getting harder to do so, ergo I drool a bit when I sleep. Looking at that fact, would you still suggest against doing an orthodontist treatment?
3. IF (again, if) there are no negative effects, can you look at the treatment plans offered, and tell me what you think of each of them? The (+)s and (-)s.That's it for now.
Thanks much.
Expert:  Dr. Peel replied 1 year ago.
Hello,
By history I meant your previous extensive orthodontics. Using orthodontics for one extracted tooth after all that you have, not to mention the forces to move the teeth forward to fill that sized gap, is not as efficient as an implant or bridge in my opinion.No, it is not bad to have ortho done a second time. There are no negative effects other than the normal issues regarding moving teeth that your orthodontist will go over. Nothing serious.
This last question is one that I cannot offer a complete definitive answer on because it involves personal preferences of you and your orthodontist. Each doctor may have skills and experience that make them prefer a certain method. Your preferences for hidden brackets and such need to be considered as well. I could not render a complete answer without seeing you clinically I am afraid.They all sound reasonable. Your confidence in your doctor and your wishes as a patient are all important and will help you decide.
Due to what you just told me about your front teeth protruding it does sound like you are a candidate for more orthodontics. Leaving the gap when you get the molar extracted is not a good idea. As you know. Teeth shift and will move into an open space over time. The problem is that the way they move, without ortho, may be slanted or twisted. You will be wise to either get ortho or an implant.
Implants are not teeth and do need special care to keep extra clean so that they remain stable over the years. In a young person they can last a while. Older folks have bone loss and other health issues which may complicate the implants viability.
I hope that answers all and that you can make a knowledgeable decision.
Customer: replied 1 year ago.
Hi again Dr Peel,So according to you, all three are feasible? Even the 3rd? How about the fact that she intends to do all steps of the treatment herself, from removing old crown all the way to setting the braces? Don't get me wrong, I have no personal likes/dislikes to those three at the moment.On the plus side, the 3rd dentist is in town, only a***** so it's VERY convenient for me. Cost is a bit lower than the other two, as well. But on the other side, jack of all trades is usually a master of none. The other 2 dentists are in Singapore, which means for every treatment I have to fly there, which is not as big of a hassle as going to the US or UK, but they at least admit that they can't do everything by themselves, and for specific steps of the treatment they will refer me to someone more specialised in that step.What do you think?
Expert:  Dr. Peel replied 1 year ago.
Well, many general dentists are doing orthodontics these days along with other general dentistry and that is not a bad thing at all. Dentistry is a big field and we are all trained to do it all. There are many new paradigms in orthodontic treatment today that a lot of the general dentists are going into. Those are the fast braces or six month smiles or the invisilign braces. It's quite big in the US and parts of Europe. I am sure there is something like it in your area.
Personally I would prefer a local dentist. If you have any kind of emergency it is best to have someone immediately available. Think broken brackets, loose wires, lost appliance and the like. To couple that with someone who does other procedures can be cost saving too as you say.
So yes, it sounds like all three have sound plans so it is up to you to choose based on convenience, cost, trust and compatibility with the dentist and office personnel. You will be with them for a couple of years and want to feel well taken care of.
Expert:  Dr. Peel replied 1 year ago.

I hope I have helped you make an educated decision and that you get the care that is right for you. Please rate if you are finished. Good luck with all and thank you for using our service.

Customer: replied 1 year ago.
Huh. Alright then. By the way, you mentioned that to do the procedure the other molar on the opposite side does NOT have to be extracted, right? Would that not make the result imbalanced? After all, I have 3 molars on the right upper side and only 2 on the left.
Expert:  Dr. Peel replied 1 year ago.
Balance is created by moving the affected side into alignment, not necessarily by pulling teeth in the other side. That doctor may have another reason for the proposed extraction that I am not aware of without a clinical view. In a strict orthodontic sense, it is not necessary.