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Confused by my son's orthodontic treatment...Advice greatly appreciated!

Greetings - new member here.

I need to provide a bit of a back history here that leads up to this point of confusion. So please bear with me.

My son who is now 17 has had braces now for 3 years, with the same orthodontist. He goes to a local school that has a pre-K, elementary, secondary, and university as part of the institution. The university itself has a dental school and a department of orthodontics.

When my son was around 12-13 years old, when his baby teeth were being replaced by permanent teeth. Our dentist showed us an X-ray that showed that three of his baby teeth will NOT be followed by permanent teeth, and we needed to do something about it. So basically he will end up losing one tooth on top, and two at the bottom.

We went to the dental school's department of orthodontics. It is right next to his middle school building and convenient. Asked around and the opinions of others were good. Only negative comment was that sometimes the dental school students who work on the braces are inexperienced but the teacher supervises the work and it should be OK.

We consulted with the resident orthodontist of the dental school, the one who supervises all the work. He suggested that we have braces on the lower side since there are two missing permanent teeth one on each side. The upper baby teeth hasn't come loose yet. The orthodontist said let's wait for the baby tooth on the upper side to come loose then decide. We started the treatment on the lower side.

After some time we went in for a consultation on the upper teeth where only one side was missing a permanent teeth. However the baby tooth never came loose. The orthodontist recommendation at the time was to have the baby tooth (upper "C" right) extracted, then "shift" one or two teeth in the back one at a time to fill the gap, and put in an implant further back. My question at the time was why not just put in an implant at the gap instead of shifting teeth one at a time? His answer was by doing this the implant would be much less visible...OKAY that makes sense.

The next step was to get an opinion from another dental school doctor who specialized on implants. When that doctor came to look at the X-ray and examined my son, he dismissed it immediately and said my son cannot do an implant simply he is too young and his teeth are still growing and an implant would not be practical until say he is 21. We also didn't like the implant idea because it would be something he would be dealing with the rest of his life, and I am not too excited about having to shift his back permanent teeth to the front one at a time. What was more surprising to me was the chief orthodontist at this dental school didn't know my son who was 15 at the time was "too young to do an implant".

So the orthodontist recommended to extract the baby teeth, then put braces on top to close the gap vacated by the baby teeth. The next 20 months he wore braces on top and bottom and the gap in the front closed gradually.

Recently we went in for another check and the orthodontist said that the gap is closing however his upper and lower teeth are not aligned for the bite AND his upper teeth are not symmetrical...His front teeth instead of being in the middle is shifted to the right. So he recommended that my son have one of his permanent teeth removed (upper left #12) to create a new gap, and use new braces to close off the gap to bring the teeth back into symmetry.

Here is where I am confused.

When he initially recommend to have his left baby tooth extracted and put on braces to close the right gap, he already knows the braces would introduce a mis-alignment two years later right? It seems logical now that I think back, when you are missing one tooth on the upper right, the braces when closing the gap would shift everything and end up moving the left side out of alignment. Now he is saying this is an issue and he needs to extract the upper left side and do more braces to close the new gap?

This is going on for three years.  The lower teeth had two gaps and were braced at the same time.  Why does the upper teeth need to do it one at a time, and why wasn't the current situation not predictable before this whole thing started?  This is a lot for my son to go through.

I need some advice...is this normal - standard procedure or are we dealing with someone inexperienced or incompetent? Thanks in advance for any comment.
asked in Orthodontics Forum by miamibite (4 points)  

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