These three cases represent malocclusions where the lower-front teeth were very crowded, and/or too forward, almost outside of the upper teeth (crossbite), and the upper teeth only mildly crowded. In such cases, alignment of the severely crowded lower teeth would be difficult, and result in the lower teeth coming too far forward, either leading to, or worsening, a crossbite.

Therefore, the best way to create the space needed to align the crowded lower teeth, without flaring them beyond the upper teeth, is to remove one lower front tooth. A temporary tooth colored filling is placed to cover part of the space that is created, and as the lower teeth unravel, the tooth is trimmed away. Notice in the final result that everything looks symetrical, with the only drawback that the upper "midline" will not align with the lower. This is never an esthetic problem. (If the upper midline is off, then it is certainly a problem) These cases are treated with lower braces in six to nine months, and Invisalign in twelve to eightteen months.

Please note that in cases where the lower teeth are crowded but too far back of the upper teeth, (an overbite), it might be beneficial for the lower teeth to come forward as they straighten, as the overbite would lessen. In such situation, removal of a lower incisor is not the treatment of choice.

Dr. Goodman is a Certified Invisalign® Provider