When you’ve been told you need teeth removed to fix a crowded smile, it can feel discouraging, especially as an adult. Many patients worry that extractions may change the appearance of their smile or negatively impact facial balance over time. 

That’s exactly where Shawn found herself before coming to Hatcher & Frey Orthodontics for a second opinion.

Shawn’s Concerns: Crowding and A Blocked-Out Tooth

When Shawn came to Hatcher & Frey, she had severe lower crowding, including a blocked-out lower canine that had been pushed completely outside the dental arch. She had already started experiencing gum recession around the area and wanted to improve both the health and appearance of her smile without sacrificing its natural fullness.

At the same time, Shawn liked many aspects of her smile, including her facial support and positive /include on her upper front teeth, and overall appearance. Her goal was not to make her smile smaller. She wanted a broader, fuller smile that looked natural and healthy.

In short, Shawn wanted an orthodontic plan that would:

1. Preserve the positive/inclined look of her upper front teeth
2. Include braces
3. Not involve extractions

After a thorough exam and listening to Shawn’s goals, Dr. Frey determined that she did not need extractions. In fact, Dr. Frey recognized that removing teeth would be counterintuitive to Shawn’s goals and a healthy bite, as it would cause her bottom teeth to be too narrow to match the upper teeth, both alignment-wise and aesthetically.  

Shawn’s case would involve addressing the following: 

• Severe lower crowding
• A blocked-out lower canine
• Existing gum recession
• A deep bite
• Narrow smile width

Unique Challenges

The position of the lower canine (blocked-out tooth) was especially concerning because it had been pushed outside the natural arch form, where it was more vulnerable to gum recession and tissue wear. 

For adults, this can become more complicated because the bone and soft tissue are no longer actively growing or adapting like they do in younger patients.

Over time, severe crowding can contribute to:

• Gum recession
• Bone loss
• Difficulty cleaning teeth properly
• Bite imbalance
• Long-term instability

Why Extractions Were Avoided

Shawn had previously been told that teeth may need to be removed to create space. However, Dr. Frey knew there was another option.

Instead of narrowing the smile through extractions, the treatment plan focused on:

• Broadening the arches
• Creating space naturally
• Preserving facial support
• Improving long-term gum health

By widening the arches, Dr. Frey was able to create enough room to bring the blocked-out tooth back into alignment while maintaining the fullness Shawn wanted in her smile.

The Treatment Plan

After reviewing her options, Shawn chose braces for treatment.

Using Hatcher & Frey’s advanced braces system and high-technology wires, Dr. Frey carefully expanded the arches with gentle, controlled forces designed specifically for adult tissue.

One Key Part of the Orthodontic Treatment Plan:

The blocked-out canine was NOT moved immediately.

Instead, the team first created space gradually using specialized springs and arch expansion techniques before attaching the tooth into active treatment.

This approach helped:

• Reduce stress on the gums and bone
• Improve comfort during treatment
• Protect existing tissue health
• Create a more stable final result

Shawn’s Smile Transformation

As treatment progressed, Shawn’s smile became:

• Wider
• More balanced
• More harmonious with her facial structure

Her smile arc was customized to follow the contour of her lower lip, while the arches were broadened to reduce dark spaces at the corners of the smile.

Most importantly, the blocked-out canine was successfully brought into alignment without worsening the existing recession. 

Final Results

By the end of treatment, Shawn achieved:

• A wider, fuller smile
• Improved tooth alignment
• Better long-term gum support
• Preserved facial balance
• Healthier bite function
• No extractions

Her final result improved both aesthetics and long-term oral health while preserving the natural appearance she loved about her smile.

Why Second Opinions Matter

Shawn’s case highlights something important: Just because extractions are recommended does not always mean they are your only option.

Modern orthodontic technology and advanced treatment planning allow many complex cases to be treated more conservatively than ever before.

At Hatcher & Frey Orthodontics, every treatment plan is customized around:

• Facial structure
• Smile goals
• Long-term function
• Gum and bone health

We believe orthodontic treatment should improve both aesthetics and overall oral health without compromising one for the other.  

If you’ve been told you need extractions or extensive orthodontic treatment, it may be worth getting a second opinion.

Schedule Your Free Consultation

Looking for an orthodontist in Virginia Beach, Norfolk, or Chesapeake? Hatcher & Frey Orthodontics is the only Invisalign expert in Hampton Roads and specializes in advanced customized treatment plans designed to create healthy, confident smiles.

Schedule your FREE consultation or second opinion today and discover what’s possible for your smile.