Post extractions - Dished in mouth!

[Angel21]

They definitely should explain the side effects that could arise and give you all your options. A lot of orthos go for the easiest option and only care about how the teeth will look, not the face. Have you heard of Orthotropics? (something I read about in the past), which helps the jaws grow correctly in young children so to avoid the need for extractions and braces later on. Sounds very positive and should really be made more well known to people. I think dentists, orthodontists, surgeons are making way too much money off of our crooked teeth and probably don't want things to change!

Of course if you analise someone's teeth you'll be able to notice they've had extractions. My teeth very slightly curve inwards so that the bite fits, but I don't think it's in a negative way. My overjet was really bad and even though I researched all the options, extractions seemed the best option.

When people say, "oh no don't have extractions!" I then think, "what, would you like having that overjet and badly crowded teeth?" "would you rather have major surgery to bring your jaw forward, even though you have a nice profile as it is?" There really was no other way for me.

https://imagizer.imageshack.us/v2/420x5 ... 1/6o7l.jpg
http://imageshack.com/a/img839/3748/dnym.jpg

overjet-
https://imagizer.imageshack.us/v2/574x5 ... erjet2.jpg

Sorry to hear about what it's done to your daughter, if it really bothers her then I would suggest getting opinions from other orthodontists and then go from there. I know on the internet it seems everyone's against extractions, but the vast majority of people have them as I mentioned before.

[jenim]

Thanks for posting your pics Angel.
I wish more extracted folks on this forum would come forward to post pics of their profile before and after, so it will give me a chance to see not all were affected by extractions, as they grew up.

I hadn't heard of Orthotropics until I saw your post, so I went to that site and was able to read about it and see those pics. There's a girl's picture posted there (her Age 12 and Age 15 pics). In the Age 15 profile pic, the girl's flat cheek and receding chin looks just like my daughter's and this is what has been worrying me. Today, I spoke to the mom of a friend of my daughter's and got their Ortho info. I heard from her that their ortho (who follows the traditional method) had actually suggested Palate expander to some other kids she knows and not extractions. I guess it's just our bad luck in who we chose to take our daughter to, 2 years ago. I'm planning to get a 2nd opinion from this ortho as well. I'll post our experience here, so parents of children and other similar extraction cases, can share their experience too.

[Angel21]

It's a shame that even nowadays dentists and orthodontists don't give everyone all the options. They always seem quiet until you mention a problem. Like everything, it takes time for everyone to know about all the bad effects. Removing teeth and pushing everything back in children will result in changes some way or another. It's probably worse with children because they're still growing. I think a palette expander is great for those with a narrow upper arch, if that's the reason for the crowding.

Good luck with the other orthodontist!

[jenim]

Just back from our Ortho visit and here's the update:

Since we asked to see him in his office instead of the area where they do adjustments (aka assembly line env), the ortho seemed disturbed/nervous from the start. The front desk said they had already advised him of our request, so not sure why he was fidgety. In a consult that lasted under 10 minutes, he kept reminding us how busy he was and yet he was taking the time to talk to us. I mean we have paid for this in full, seriously, to whom else can we talk to about our concerns if not for the one providing the services?

I very politely brought up just a few things that I've been observing in the last few months in my daughter (mouth getting smaller, narrow smile, retracted lower teeth and jaw). He said he has been practicing for so many years and no one had questioned him such! He seemed very nervous through out and repeatedly said no one could have done a better job than him. I wanted him to be at ease and I immediately acknowledged that her teeth alighment was fine for now, but it was the facial structure that I was concerned with. In short, he said no one could've done it better (and he seem to be implying, couldn't have done without extractions).
BTW, the orthos whom we went to for 2nd opinion yesterday said, their practice surely thought this was a no-extraction case since first evaluation was done when she was only 9, but since the teeth were already gone and we were at the end of the treatment they could'nt do anything more at this point

When asked about the rest of her treatment, our ortho said her LOWER "12 year" molars aren't in yet (she's 12 now) and so in the next month or so if they don't come in, I have to take her to a dental surgeon to remove the tissue covering the molars, so he can put braces on them. I'm sure these molars don't come in for everyone when they are exactly 12 and for some it may be delayed right? It seems like he's in a haste to finish up with her treatment and I don't want to anything surgical unless it's totaaly warranted.
My question to anyone familiar with the 12-year molars is, is this (surgically-removing-tissue procedure) really necessary when she's only 12?

I was a little hopeful that something good might come out of this consult, but not sure anymore. I have pics of the profile of her skull from September last year when I first talked to him about her lisp (there's a name for this x-ray but I forgot what he called it - It's not the Panorex). This has measurements on the side with "variable" such as "Nasolabial angle, Palatal Mad. Angle - but I don't know what these values mean or what their difference between the clinical norm indicate. Is there someone on this forum who can shed some light, if I were to share these measurements and her x-rays?

[smiley1011]

Jenim Have you found any success with your daughter? I would pm you but for some reason I am not able to

[Confusious]

The reason why I got involved as a general Dentist in Orthodontics was the so called dish face phenomena. (concave lower face). Many of my patients I had sent to orthodontists came back with straight teeth and ideal bite, but their faces looked the worse for it - 1st they have a dished look , small mouths with almost no lips, large looking noses, fallen in cheeks and I could already see that they were going to age must faster, lower jaw retrusive. The smile is also much narrower and when they smile the teeth almost disappear out of the smile from behind the canines. Since then I had refused to take teeth out if I was at all unhappy about the patients facial profile, when orthodontist sent patients for extractions. (On very select cases extractions are indicated) I did a lot of research etc., did many courses and studied alternatives to the 4 on the floor attitude of many orthodontists (4 on the floor refers to extraction of 4 pre-molar teeth). The results I got was far more pleasing than the results as mentioned earlier. I've been SPAM SPAM SPAMMING for 28 years. If a child especially a girl's top lip is not at the same angle as the nose, beware of extractions and avoid it as far as possible. In your daughter's case it can be reversed to a certain extend, by expanding both dental (upper ans lower) arches, move the upper incisors and canines forward to restore the lip move lower jaw forward with a functional appliance or surgically.
Your daughter's orthodontic classification was most probably a Class II division 1 or 2 before commencement of treatment. If I can get a side on picture of her I can help to give you better advice - most all orthodontists can do the treatment unless they do the BEGG technique , but parents must be adamant they do not want their child's face to deteriorate. I will advice all parents to beg the orthodontist to please start non-extraction for the first four months before any final decisions are made.
I hope this helps a bit - They can take a hand X ray or of the cervical vertebrae to see if there is any skeletal growth to rely on when they fix her face.
I am so sorry to hear about your dilemma, which could most probably been avoided.

Warm regards

[Lovespain5]

The reason why I got involved as a general Dentist in Orthodontics was the so called dish face phenomena. (concave lower face). Many of my patients I had sent to orthodontists came back with straight teeth and ideal bite, but their faces looked the worse for it - 1st they have a dished look , small mouths with almost no lips, large looking noses, fallen in cheeks and I could already see that they were going to age must faster, lower jaw retrusive. The smile is also much narrower and when they smile the teeth almost disappear out of the smile from behind the canines. Since then I had refused to take teeth out if I was at all unhappy about the patients facial profile, when orthodontist sent patients for extractions. (On very select cases extractions are indicated) I did a lot of research etc., did many courses and studied alternatives to the 4 on the floor attitude of many orthodontists (4 on the floor refers to extraction of 4 pre-molar teeth). The results I got was far more pleasing than the results as mentioned earlier. I've been SPAM SPAM SPAMMING for 28 years. If a child especially a girl's top lip is not at the same angle as the nose, beware of extractions and avoid it as far as possible. In your daughter's case it can be reversed to a certain extend, by expanding both dental (upper ans lower) arches, move the upper incisors and canines forward to restore the lip move lower jaw forward with a functional appliance or surgically.
Your daughter's orthodontic classification was most probably a Class II division 1 or 2 before commencement of treatment. If I can get a side on picture of her I can help to give you better advice - most all orthodontists can do the treatment unless they do the BEGG technique , but parents must be adamant they do not want their child's face to deteriorate. I will advice all parents to beg the orthodontist to please start non-extraction for the first four months before any final decisions are made.
I hope this helps a bit - They can take a hand X ray or of the cervical vertebrae to see if there is any skeletal growth to rely on when they fix her face.
I am so sorry to hear about your dilemma, which could most probably been avoided.

Warm regards

I totally agree with you : Class II malocclusions don't have to receive a treatment with extractions.
Probably it was the case of this teenager and it causes some bad consequences in the profile.
Have you tried the Herst appliance to resolve those bad consequences?
I myself received a treatment with my 4 first premolars extracted, but because of bimax protrusion (so Class I malocclusion) and lip incompetence.
On the contrary of the Class II malocclusion, I've finished with a straight profile and more chin projection.
I think bimax protrusion is the only case when a 4 extractions treatment is recommanded.

[smiley1011]

Confusious, can you please tell me how far forward incisors and canines can be moved forward to provide better lip support? My sons face was ruined. He did not have extractions, but he had spaces between his teeth that needed to be closed. His teeth were retracted. It pushed his entire lower face backward and his lower jaw is down and back. I believe his whole maxilla was tilted downward along with his teeth. I believe there was bone remodeling done to his maxilla due to the retractive forces. The top of his cheeks grew very wide and his face is flattened. Please help with suggestions for a fix, or is this permanent? I have seen some research about bone remodeling after growth cessation with oral appliances for underdeveloped maxilla. Also, what are your thoughts on the fixed anterior growth guidance appliance also similar to the CD advancer? Do these appliances really grow the maxilla forward or do they distalize the molars? Thanks for any help