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My son is three years into orthodontic treatment and now the orthodontist asked for an extraction!

My son who is now 17 has had braces now for 3 years, with the same orthodontist.

When my son was around 12-13 years old and his baby teeth were being replaced by permanent teeth. Our dentist advised us by showing us an X-ray indicating 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 in the bottom.

We consulted with an orthodontist and 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 on that one side is still in place and not yet loosened. The orthodontist said let's wait for the baby tooth on the upper side to come out 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. 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 but shift teeth one at a time? His answer was by doing this the implant would be much less visible...OKAY.

The next step was to get an opinion from another 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 orthodontist 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...One of his front tooth is now shifted more to the middle. 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 totally confused.

When he initially recommend to have his left baby tooth extracted and put on braces to close the left 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 left, the braces when closing the gap would shift everything and end up moving the right side out of alignment. Now he is saying this is an issue and he needs to extract the upper right side and do more braces to close the new gap?  From my reasoning it seems like two years ago when his baby tooth on one side was extracted, he should have already know the braces would close that baby tooth gap and misalignment would occur, and a discussion should have happened two years ago!  NO?

I find this troubling and I told the orthodontist that he is missing THREE permanent teeth.  The idea of the braces is to resolve that.  I am not going to extract a perfectly healthy tooth on the other side to make it missing FOUR permanent teeth!

He considered this for a moment then he measured the amount of misalignment of my son's upper teeth in the middle.  He said is is out of alignment by about 3mm.  He suggested that instead of extracting his left upper #12, he could use a procedure called IPR, which amounts to shaving the teeth.  He could create three 1mm gaps, totaling 3mm, by shaving 0.5mm from the edge of each tooth on each side of the gap.  Hence a total of four teeth would be shaved down.  Then he would use a brace and a "coil" to "shift" realign the upper front teeth back to the middle.  This may take another year or more!

Any thoughts or advice?  Should we go with this IPR procedure?
asked in Orthodontics Forum by miamibite (4 points)  

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