Orthodontist wants to pull one of my daughter's front incisors based on "Bolton Analysis"? Is that common?

Question

We are worried that her mouth will look unbalanced and asymmetrical. He says the only other option is to pull as many as four teeth. I've never heard of having one front incisor pulled. Is this really a common thing? Will the other teeth move together so her mouth looks normal? What is "Bolton Analysis"?

Answer 1

The Bolton analysis is an indicator for evaluating the degree of intermaxillary (upper) tooth-size and how they look together in the arch. It depends on which incisor he is talking about. Is he talking about a lateral incisor? (The second from the front?) If that is the case, this doesn't sound as drastic. Removing a CENTRAL incisor (the front one) raises different questions for me. I am assuming he may be suggesting crowns or veneers after the ortho is complete to make the teeth asymmetrical. The question about extracting 4 teeth doesn't concern me as much because I am assuming he is talking about premolar extractios which is pretty common in ortho. If you are in doubt, have a second opinion or return to the doctor for more explanation. Did he show you a study model of your daughter's mouth? Some orthodontists can do computer generated or even mock-ups in wax so you can see what she would look like after treatment. Your questions are logical and any doctor would be happy to address your concerns.