To pull or not to pull two upper bicuspids?

I have an 11 year old with a Class II molar situation. The back teeth are a full tooth position forward of where someone with an ideal bite is. She has a moderately severe overbite. She also has overcrowding in her upper teeth. The overbite is masked by the crowding. There is a canine on left upper that cannot come down. Her upper front teeth are shifted to the left and the upper front teeth are cantilevered back(tipped inwards). There may be more here but that is what have. The first orthodontists said the options were to pull the two bicuspids on the upper mouth (one behind each canine), then apply braces to shift the teeth or to apply head gear to try to shift the teeth into position. He does not usually use head gear because kids don't like it. The second orthodontist said, Yes she needs her upper two bicuspids pulled, but wait for braces until her 12 year molars are in as you risk jaw health if you put braces on before this. (he though this would be about 1 to 2 years, however in the two months I have been sitting on this decision, all but one is in / the fourth is trying to come in now. The third orthodontist did not even mention pulling the teeth. When I asked him about it, he said, no. He said, He does not believe in head gear, he uses (some method of putting an anchor point into the gum), if needed. He would use bands to shift the lower jaw and teeth forward, he uses a special brace with a slide bar system that puts much less force on the teeth to move them. He would use some type of a spring mechanism to push two teeth apart on her upper left to let the canine come down. He said the goal is not only to line the teeth appropriately, but to have a beautiful smile . He said by pulling the upper teeth, you affect her facial structure negatively. Of course, I wanted to hear that you don't have to pull the teeth, however when I went to the fourth orthodontist (I know it seems over the top to ask four opinions.. won't go into details as to why I did this), Anyway, the fourth orthodontist, looked at her bite for sometime. At first he said, we might not have to pull the teeth. We can try braces for 6 months and see. Then he said, after consideration, he felt we would probably have to pull them. The problem was that when I told him about orthodontist number 3's opinion. He said, You can't really pull the jaw forward much. He is pulling the teeth forward and you need to consider ?root exposure by doing so, that might present problems 40 or 50 years down road. So, 3 of 4 dentists say pull. The other says that is the easiest solution, but not the best. I went back to him and asked about the root exposure issue. He said, he is pulling the upper teeth forward and not the roots, and that ? bone is building up as he pulls rather than roots being exposed. (I am not sure I got this right), He does not feel there would not be a problem with root exposure. However, he kept saying he is evidence based in his practice and I wonder what evidence there is as it has seemed that the standard has been headgear or pulling teeth, and no long term studies for root exposure with with technique have been done , I am guessing. So, I am stuck. Logic says if 3 out of 4 are saying pull the teeth, or most probably pull them, that would be correct. However, I don't want to pull them if not necessary. However, I don't want her to have problems down the road, because I opted not to pull the teeth. Thanks for any help you can give me. It appears all 4 orthodontists have very good credentials. Jennifer

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