Posts tagged “extractions”

Invisalign; when to take a tooth out

Dental crowding is an issue of too many teeth and not enough space.

Why is that?

Are we normally born with too many teeth? The answer is No! What has happened is that the size of our dental arch is either developing into a smaller arc, or our dental arch is being constricted.

The latter is usually the case. As we stress over our studies, partners, work and health, we tend to clench and grind our teeth.

The action of our chewing muscles on the teeth causes movement inwards and constriction, leading to dental crowding.

So with Invisalign I usually expand the dental arch to create space, but not always.

Sometimes it is easier to take out the offending tooth and then straighten the teeth

See below, a severely crowded lower arch, corrected by Forma with Invisalign in just over 10 months. The outer tooth was removed first and Invisalign worn night and day.


Invisalign for international patients

Invisalign is not available in many countries and yet patients want it.
Recently I treated a patient who was in fact English, but worked in Hong Kong.
His dilemma was that he did not like his teeth/smile and yet could not walk around mid 40s wearing metal braces. He wanted an aesthetic/removable solution.
I assessed him to severely crowded with an underbite ( which is technically an overjet where the lower jaw was set back ).
We spent an hour assessing his occlusion and I advised him that to reduce the underbite and correct the severe crowding I would need to remove 2 upper premolar teeth.
As he could not attend every 4-6 weeks, I placed him on a 2 month review programme with a leniency of 2 more weeks.
I was able to do that because of 3 things:
1 Because I am great at what I do lol
2 Extractions creates space that can be accurately measured by Align Tech. and the planning is more predictable
3 I would not need to do any interproximal stripping on a regular basis
So we agreed to start.
I noticed some cavities around the premolars and advised him to have them treated in Hong Kong.
Whilst the clinchecks were being programmed from the impressions I removed the 2 lower teeth under local anaesthetic.
Aligners were fitted initially with no attachments for 8 weeks, as his crowding was so severe and he was going to be away.
During the year treatment the patientt switched from HK to Africa and Libya but this presented no problems to his treatment.
As his extraction spaces closed, his anterior crowding began to correct itself.
I reviewed him every 8 weeks and he had no problems in scheduling his appointments in advance.
A year has passed and he is at the refinement stage. New impressions were taken for minor anterior correction.
See what you think.