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Orthodontics/extractions of 1 molar and 3 premolars

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Question
I need help and my time is running out. I am getting braces, for my bimaxillary protrusion, crowding, overbite and overjet. the orthodontist I have chosen recommends i extract my 1st molar in my left upperquad and 3 1st premolars in the other quads.his rational is because I have had 2 root canals on my molar which has a potential cracked root that should be removed however he wants the premolars removed due to it being a shorter area to close.I have 2 conerns with that.1. the alignment of my teeth after and 2. 1 of my other 1st molars have a big filling and there may be a cavity on my 1st lower molar, my premolars have no fillings or cavities. this orthodontist has high ratings on rate my doctor but now im having second thoughts. please help.

Answer
Hi Brianna,

Pardon the delay in replying. We have experienced power failures and internet access interruptions due to the snow and ice of late.


What I write here are only my opinions based on very limited information. My comments should not be viewed as any form of diagnosis, definitive or otherwise,  or any form of  treatment recommendation.  Indeed, in the ultimate analysis all final decisions, particularly clinical ones, should  only be made by qualified doctors who have had a chance to see you in person and who have had an opportunity to take and analyze proper diagnostic records.

Okay… having said  that…  your  questions focused on orthodontic treatment " for my bimaxillary protrusion, crowding, overbite and overjet. ".  You  wrote:

==snip== the orthodontist I have chosen recommends i extract my 1st molar in my left upperquad and 3 1st premolars in the other quads.his rational is because I have had 2 root canals on my molar which has a potential cracked root that should be removed ==snip==

I think you have an extremely sophisticated  orthodontist and he/she is putting a lot of thought into this. I must state that without the benefit of seeing you, or any of the radiographs including the lateral cepahlometric X-ray which gives an idea of your hard (skeletal) and soft tissue (skin) lateral profiles, it is difficult for me to say much.

In my experience, the notion of removing a tooth which has a potential cracked root, especially one with a history of root canal treatment which is therefore already somewhat compromised, reflects sound and wise clinical diagnosis.

Extracting the premolars is quite commonly done, and I have nigh zero reservations about that provided that extractions have indeed been deemed necessary for your treatment. A good orthodontist will generally be quite capable of achieving sound, esthetic alignment of the teeth. In your case this is to also help address the not so small horizontal gap which you explain you have.

The other molars, despite having fillings are not being extracted because they likely serve as index teeth to help define the meshing of your upper vs lower teeth. Given the choice for profile purposes and for the reduction of crowding, premolars are generally far more commonly extracted vs molars. I suspect the potential cracked root and past root canal history of the one molar is prompting the orthodontist to consider extracting it vs a premolar.

I have great confidence, based on the limited information that you have presented, that you are in good hands.

Paul Supan, DDS, MA, MPH
Board Certified Orthodontist

Specialist in Orthodontics
Specialist in Dental Public Health
http://www.braces.com
http://www.leesburgbraces.com  

Orthodontics

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Paul Supan, DDS, MA, MPH

Expertise

First may I say please set your questions to Public so other readers can benefit from the response. Also, if you look at my comprehensive answers, they are not short 1 or 2 paragraph quickie replies that anyone can type out in < 5 minutes. Instead I often will ask other colleagues in other specialties for their advice in order to provide you the questioner with a more interdisciplinary perspective. This all takes time. I ask for readers to therefore allow 5-7 days. You will be rewarded with a very detailed response.

Because of the nature of Orthodontic questions, any pictures of the teeth and X-ray images would be very helpful. If you write to me and explain that you have crooked overlapping front teeth can be interpreted in many many ways, and my goal is to provide a specific response that meets your needs.

I hold double specialty credentials. I am Board Certified in Orthodontics and Board Eligible in Dental Public Health. I welcome questions regarding Braces, Invisible Braces, & Invisalign, as well as issues involving combination Cosmetic Dentistry and Orthodontic treatment. Orthodontics alone sometimes is not enough to achieve that perfect smile. Gingival (gum) re-contouring, tooth reshaping, bonding and other services are sometimes needed. I also have substantial experience in the areas of Infection Control and Sterilization in the Dental Environment. My personal websites braces.com and Leesburgbraces.com are non-commercial for information purposes only and may provide you with some background to more precisely frame your question for allexperts.com.

Please allow a week for a reply. I am in full time Private Practice, lecture on occasion, and am involved in many volunteer activities. I am therefore not always able to respond to questions straight away. Your understanding is appreciated.

Experience

Board Certified Orthodontist (ABO Diplomate) with over 25 years of Private Practice experience. Second Specialty Certificate in Dental Public Health with research experience at NIH, and Epidemiology Training & Research at Harvard, NIH, and the Centers for Disease Control (CDC) in Atlanta. Postgraduate Masters degree from the Harvard School of Public Health, as well as a Master of Arts Degree in Education.

Organizations
American Dental Association, American Association of Orthodontists, Academy of General Dentistry, College of Diplomates of the ABO, OSAP - Office Sterilization & Asepsis Procedures Organization, Others

Publications
Available upon Request.

Education/Credentials
BS College of William & Mary, DDS Medical College of Virginia, Masters of Public Health (MPH) Degree Harvard School of Public Health. Dental Public Health Specialty Certificate from NIH. Orthodontic Specialty Certificate from University of Rochester Eastman Dental Center. USPHS clinical research experience at NIH, and Epidemiology Training & Research at Harvard, NIH, and the Centers for Disease Control. Fellow of the Academy of General Dentistry (FAGD), and Fully Board Certified Diplomate of the American Board of Orthodontics. Board Eligible in Dental Public Health. Visiting Adjunct Associate Professor at the Meharry Medical College School of Dentistry, Nashville, Tennessee.

Awards and Honors
Available upon Request Please see my personal websites braces.com and Leesburgbraces.com for further personal background.

Past/Present Clients
Available upon Request

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