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Extracting baby teeth before ALF, then placing implants?

New Member

Hi everyone, I'm new to this forum - hoping to get some feedback on whether my dentist's proposed treatment plan makes sense!

I'm planning to get an ALF with the goal of improving my nasal breathing, being able to have a more comfortable lip seal, and improving aesthetics eg. gummy smile. I have the typical narrow palate, overbite and recessed chin. 

The dentist I am leaning towards working with (let's call her Dentist #1) says I need both upper and lower expanders... but for the lower one to work, she needs to extract these 2 baby teeth I still have hanging around.

The teeth are in the 1st premolar spot, right beside the canines, one on each side. Apparently they have grown so big (I guess at the roots?) that she thinks they would prevent the ALF from doing its job properly (i.e. swinging the lower jaw upwards). Her plan is to extract them, since I'd eventually need to get implants anyway, and then replace them with implants after the ALF treatment is done.

Meanwhile, the other dentist I am considering (Dentist #2) doesn't want to remove teeth and just wants to fit me with an upper expander. She says the lower jaw will naturally follow the upper. 

Needless to say I am confused and not sure which is the right treatment! Based on my research and meetings, I have more confidence in Dentist #1, but the idea of extractions is giving me pause. 

Hopefully some of the experts here can weigh in on this! I have x-rays I can also upload if that helps. THANK YOU!

Topic starter Posted : 24/06/2020 2:19 pm
Estimable Member

How old are you and how do you still have baby teeth? I would be very skeptical of a dentist advising to extract teeth, dentist #2 sounds like the better option.

Posted : 25/06/2020 1:36 am
New Member

@sinned I'm 40. I think it's pretty common to still have some baby teeth, it's genetic. They don't fall out if there's no permanent tooth to push them out. I had 4 of them but had to replace one with an implant.

Here's my x-ray. You can see the 2 teeth I'm referring to at the bottom, the roots are not as long as the others but they're definitely wider. I've had to get them filled a bunch of times as they are more prone to decay.

I guess it's the width of the roots that might prevent the ALF from moving the teeth properly? I don't really want to remove them but then again I don't want to spend all this time/money on ALF treatment and not have it work as well as it should.


Topic starter Posted : 25/06/2020 4:41 pm
Estimable Member


Do you still have baby teeth on the upper? If it negatively affects occlusion you might want to get it removed, otherwise you should keep them, I don't see how they would affect ALF, the two bottom teeth are the only ones I can see with shorter roots than the rest of your teeth, so I think you're fine. I agree with dentist #2, ALF doesn't expand that quickly so the lower should be able to follow the upper, you're 40 years old though which could be a consideration. I've seen cases around your age and older so I think it's still possible to get some change in the lower arch/mandible.

Posted : 25/06/2020 7:47 pm
New Member

@sinned I think I figured this out. I did a search on retained baby teeth and found this:

Retained baby teeth

When baby teeth have been retained into adulthood, they can become ankylosed (fused to the bone) and are resistant to movement. The evidence suggests that healthy baby teeth presenting at age 20 should last until approximately 40 but at that age a solution will need to be found for the missing tooth. An alternative to replacing the failed baby tooth, orthodontics can intervene and close the space, negating the need for any further dentistry in later adulthood.

Also, at least one if not both are submerged, sinking lower than the other teeth beside it. (Hard to tell on one because it has bonding.) Apparently this is a problem according to this article

Timing and Assessment of Ankylosed Deciduous Molar Teeth – A Case Report

Ankylosed or submerged deciduous teeth are teeth that do not keep up with other teeth in the quadrant in their vertical development. As a result, this may cause significant problems in eruption, often with severe bone loss and migration of deciduous and permanent teeth. .... If there is evidence that significant submergence is taking place extraction and space maintenance is indicated. If the deciduous teeth cease to submerge and significant damage has not occurred then the deciduous teeth may be retained.

So now it does make more sense that she wants to remove them, if they're going to resist movement... and if keeping them as they continue to submerge puts me at risk of bone loss! 

I think I have one baby tooth left on the upper (opposite to the implant) but she didn't say it was an issue.

Topic starter Posted : 26/06/2020 6:34 pm