“I only want braces on top teeth. No one sees my bottom teeth anyway.” This is a common request, especially with all the recent buzz about Six Month Smiles and "direct-to-consumer" aligners. Is single arch treatment good treatment?

Although possible, straightening the upper teeth only may produce undesirable results
One-arch treatment is possible and gives excellent results in some patients. The success of one-arch treatment is determined by the starting position of the teeth in both arches and the way they are related to each other (the bite). Any time you align teeth that are crowded, they tend to move forward. This is a wonderful thing if the upper teeth are behind the lower ones (crossbite). If the bite is good in the back but the lower teeth are crowded, aligning only the upper teeth will create an “overbite” that wasn’t there before. This might be a compromise that you are willing to accept to avoid bottom braces; you just need to be aware of how it will turn out before you get started. If you have a little overbite at the beginning of treatment, you should plan on it getting bigger if you only treat the top arch.

Interproximal reduction can be used to reduce flaring
In some cases, it is possible to reduce the amount of upper arch flaring by reducing the size of the upper teeth during treatment. Known as InterProximal Reduction (IPR), Air Rotor Stripping (ARS), or slenderizing, this is an option that you should discuss with your orthodontist. IPR can be a useful procedure in the right cases, but it is not advisable in everyone.

Sometimes straightening the upper teeth only looks just fine
Braces in the upper arch only can be an excellent treatment in cases where there is space between the upper teeth at the start of treatment, especially if there is an overbite. Closing spaces between the front teeth tends to move the teeth backwards reducing the amount of overbite. In this case, single arch treatment is able to address both conditions at the same time. As long as you are happy with your bottom teeth exactly as they are, single arch treatment in this case is the treatment of choice.

Closing spaces between the upper teeth requires some "overbite"
In smiles where the lower teeth look good, there is no overbite, and there are spaces between the upper teeth, the problem may be with the size of the teeth themselves. In these cases, there are a couple of options. Since closing all the space will move the front teeth backwards, doing so is not an option if the bite is good. Instead, we could use the braces to move the front teeth that people see together and move the spaces where they are more hidden. The other option is to have your dentist close the extra space by adding “enamel” (bonding) between the teeth either where they are now or after we line them up. Building up narrow teeth not only makes them look nicer, it will also give you a more stable result.

NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist who is in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the Westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa in the United States. Dr. Jorgensen’s 25 years of specialty practice and nearly 10,000 finished cases qualify him an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog is for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in the state of New Mexico. He cannot diagnose cases described in comments nor can he select treatment plans for readers. Please understand that because he has tens of thousands of readers each month, IT IS IMPOSSIBLE FOR HIM TO RESPOND TO EVERY QUESTION. Please read all of the comments associated with each article as most of the questions he receives each week have been asked and answered previously. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.