Tooth Alignment and Options for Missing Teeth Correction

I would like to inquire about tooth replacement and orthodontics?

Due to the loss of my upper first molar for an extended period and some misalignment of my front teeth, where my upper front teeth have shifted behind my central incisors, I decided to undergo orthodontic treatment.
After being edentulous for at least eight years, my upper teeth have started to drift downwards.
During my initial consultation, the dentist suggested that we could try to correct this, but after about a year and a half of treatment, while my front teeth have been repositioned, the dentist has been reluctant to help me move the missing tooth area forward, repeatedly stating that it is not possible.

Yesterday, when I visited the dentist, they mentioned that it was not feasible and that I was "stuck." However, I am quite insistent on moving it forward.
The doctor stated that to do so, I would need to extract other teeth; otherwise, my dental midline would become misaligned.
They have been pushing for dental implants.
I have several questions:
1.
Is it not possible to move the descending teeth upwards? (Before starting orthodontics, I consulted with another dentist who said that the front teeth could be moved upwards using bone screws in the midline.
Is it really impossible to move the teeth above the missing upper left molar upwards?)

2.
Is it truly necessary to extract teeth to move the molars forward? The dentist mentioned that because of the missing tooth on the lower left, I would need to extract the lower right tooth; otherwise, the midline would be misaligned.
They also suggested that extractions would be needed on the upper teeth.
If I want to move the teeth forward, it could lead to insufficient space.
The orthodontist currently treating me seems to be focused on recommending implants.
I have proposed alternative solutions, such as reducing the size of the teeth (crown preparation) to create space for the teeth to be pushed forward, but the dentist still insists on implants.

I do not doubt the dentist's professional capabilities, as they are a specialist certified by the orthodontic association.
However, after researching numerous cases online, it seems that not all require the extraction of so many teeth.
The current approach from the dentist makes me feel like my only option is to get implants.
Are there other viable solutions? The more I undergo treatment, the more I feel that the dentist may only be interested in making money from implants, which leaves me with a negative impression.
Or am I truly misunderstanding the situation?

Xiang, 30~39 year old female. Ask Date: 2018/06/02

Dr. Cai Shangwu reply Dentistry

Hello,
1.
Currently, you can search for relevant medical information online by entering keywords.
(Our dental department does not provide online information services at this time.)
2.
However, regarding the issues you mentioned, without a visual examination, it may be flawed to make a judgment solely based on the literal meaning of the words.
Therefore, I recommend that you visit the outpatient clinic for an in-person examination and diagnosis to obtain a clearer and more accurate response.

Reply Date: 2018/06/02

More Info

When it comes to tooth alignment and addressing missing teeth, it’s essential to understand the complexities involved in orthodontic treatment and restorative dentistry. Your situation, which involves a combination of misaligned teeth and a missing first molar, presents several challenges that require careful consideration.

1. Can Dropped Teeth Be Pulled Up?
The concern about your upper front teeth being misaligned and the possibility of pulling them up is valid. Orthodontic treatment can sometimes involve techniques like using bone screws (temporary anchorage devices) to create the necessary force to reposition teeth. However, the feasibility of this approach depends on several factors, including the amount of bone available, the health of the surrounding tissues, and the specific alignment issues at play. If your orthodontist has indicated that this is not possible, it may be due to anatomical constraints or the risk of causing further misalignment.

2. Is Tooth Extraction Necessary for Moving Molars Forward?
The need for tooth extraction in orthodontic treatment is often a contentious topic. Your orthodontist’s recommendation to extract teeth to avoid midline discrepancies is based on the principle of creating enough space to achieve a functional and aesthetic alignment. However, many orthodontists also explore non-extraction options, especially in cases where the patient has sufficient space or where the teeth can be reshaped (as you suggested with crowns) to facilitate movement. It’s crucial to have a thorough discussion with your orthodontist about the rationale behind their recommendations. If you feel uncomfortable with the proposed plan, seeking a second opinion from another orthodontist could provide additional insights and options.

3. Implants vs. Other Solutions
Your orthodontist’s inclination towards dental implants as a solution for your missing tooth is common, especially if the gap has been present for an extended period. Implants can provide a stable and functional replacement for missing teeth. However, they are not the only option. Other solutions, such as bridges or partial dentures, may also be viable depending on your specific circumstances. It’s essential to weigh the pros and cons of each option, considering factors such as cost, longevity, and the impact on your overall dental health.

4. Long-term Consequences of Misalignment and Missing Teeth
Ignoring misalignment and missing teeth can lead to various complications over time, including changes in facial structure, increased wear on remaining teeth, and potential issues with jaw alignment (TMJ disorders). These factors can contribute to discomfort and further dental problems down the line. Therefore, addressing these issues proactively is crucial for maintaining both function and aesthetics.

5. Communication with Your Orthodontist
It’s vital to maintain open communication with your orthodontist. If you feel that your concerns are not being adequately addressed, or if you suspect that financial motivations are influencing treatment recommendations, it’s your right to seek clarification. A good orthodontist will be willing to discuss all available options, including the potential for non-extraction methods and alternative treatments.

In conclusion, while your orthodontic journey may feel frustrating, it’s important to remember that achieving optimal dental alignment and function can take time and may require multiple strategies. Don’t hesitate to advocate for yourself and seek additional opinions if necessary. Your dental health is paramount, and you deserve a treatment plan that aligns with your goals and concerns.

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