Extreme lower crowding can mean a tooth needs removal in order to achieve the best result and or minimise the treatment time.
This lady had been a thumb sucker as a child. As her teeth and jaw were developing the forces of the thumb sucking caused the upper teeth and jaw to protrude and the lower teeth and jaw to be compressed inwards.
She wanted orthodontic treatment without fixed braces.
We advised that the lower incisor was extremely crowded with very little bone in front of it.
To keep this tooth would mean extracting a side premolar and the great movement may cause the tooth to loosen and fall out. Also, she would have had a large triangular space between the incisors. We recommended that the tooth should be removed instead.
Her upper teeth stuck out more than 10mm and this would mean her upper treatment would take a long time. She had fractured the incisors because they stuck out, which is common in this type of bite.
Luckily we avoided taking any upper teeth out to improve her appearance.
We agreed Invisalign with 1 lower incisor removed and the patient agreed.
When the aligners arrived, we removed the incisor and the aligners were fitted.
Patient attended every 6-8 weeks.
She needed 42 upper aligners, changed every 10 days and lower 21 aligners.
Patient was very happy and went to see her own dentist to have the upper incisor edges rebuilt.