ohmyjaw - You didn't scare me! When I started getting consults I was not expecting to hear that I needed extractions. I thought that the first ortho I saw was absolutely crazy! I guess I'm still not over the shock even though I've had so many orthos tell me I need extractions.
Lisa65 - Thanks for sharing that. I hope that your treatment goes well.
Dr. Rick - Thanks so much for your input. I didn't know what the different classes meant or how they related to extractions.
2 opinions, different orthos, I have to guess who is right
Moderator: bbsadmin
Hi Joual,
Unfortunately a situation like yours is often challenging in adults due to the lack of growth. I'll try to put the two differing opinions into perspective for you (I've been practicing 9 years).
It sounds like you have a Class II malocclusion and, as you mentioned, significant lower crowding. While Rick explained the bite classifications from a molar perspective, we can also classify the canines. One of our goals as orthodontists is to establish a Class I canine, which means the upper rests behind the lower in a front to back direction. The orthodontists who suggested extracting two upper premolars did this because it allows retraction of the upper canines while the lower canines stay put. If you extract lower premolars as well, the lower canines move backwards (they're already back too far in a Class II malocclusion) and it can be difficult - sometimes impossible - to establish a Class I canine.
However, the orthodontists who suggested extracting 4 bicuspids did so because of the lower crowding. If a patient is too crowded and you don't extract in the lower, the incisors dump forward and can become excessively protrusive. This can be unesthetic and negatively affect your profile.
Hence your dilemma. In a growing patient, it's much easier to extract 4 premolars in a Class II patient because even though the lower canines move back in the jaw, the jaw itself is moving forward and we can still get a Class I canine with headgears and other appliances. Not so in an adult.
So which option is best? There may be no perfect answer, but here are some things to think about.
1) Ask your orthodontists how Class II you are. A "full step" would lean me away from extracting in the lower, a "half step" may make lower extraction more viable.
2) When in doubt, you can always align the lower teeth and then decide about extraction. It roundtrips a little bit but also may give you peace of mind. If the teeth look ok to you and you're committed to lifetime retention you should be ok non-extraction.
3) Sometimes in adult treatment we have to compromise due to the lack of growth. Is it more important to you to reduce the jetting out of your top teeth or avoid protrusive lower teeth even though some overjet may remain? Occasionally, to get a more ideal result, we compensate for the lack of growth with jaw surgery.
4) A third option not mentioned that can occasionally be used in a situation like yours is extracting the upper premolars and one lower incisor. This way the lower canines are not retracted. However, the viability of this option depends on the size of your front teeth. I assume your doctors would have mentioned it if it looked like a good alternative, but it wouldn't hurt to mention it.
While I got a bit technical, hopefully this made some sense and good luck!
Unfortunately a situation like yours is often challenging in adults due to the lack of growth. I'll try to put the two differing opinions into perspective for you (I've been practicing 9 years).
It sounds like you have a Class II malocclusion and, as you mentioned, significant lower crowding. While Rick explained the bite classifications from a molar perspective, we can also classify the canines. One of our goals as orthodontists is to establish a Class I canine, which means the upper rests behind the lower in a front to back direction. The orthodontists who suggested extracting two upper premolars did this because it allows retraction of the upper canines while the lower canines stay put. If you extract lower premolars as well, the lower canines move backwards (they're already back too far in a Class II malocclusion) and it can be difficult - sometimes impossible - to establish a Class I canine.
However, the orthodontists who suggested extracting 4 bicuspids did so because of the lower crowding. If a patient is too crowded and you don't extract in the lower, the incisors dump forward and can become excessively protrusive. This can be unesthetic and negatively affect your profile.
Hence your dilemma. In a growing patient, it's much easier to extract 4 premolars in a Class II patient because even though the lower canines move back in the jaw, the jaw itself is moving forward and we can still get a Class I canine with headgears and other appliances. Not so in an adult.
So which option is best? There may be no perfect answer, but here are some things to think about.
1) Ask your orthodontists how Class II you are. A "full step" would lean me away from extracting in the lower, a "half step" may make lower extraction more viable.
2) When in doubt, you can always align the lower teeth and then decide about extraction. It roundtrips a little bit but also may give you peace of mind. If the teeth look ok to you and you're committed to lifetime retention you should be ok non-extraction.
3) Sometimes in adult treatment we have to compromise due to the lack of growth. Is it more important to you to reduce the jetting out of your top teeth or avoid protrusive lower teeth even though some overjet may remain? Occasionally, to get a more ideal result, we compensate for the lack of growth with jaw surgery.
4) A third option not mentioned that can occasionally be used in a situation like yours is extracting the upper premolars and one lower incisor. This way the lower canines are not retracted. However, the viability of this option depends on the size of your front teeth. I assume your doctors would have mentioned it if it looked like a good alternative, but it wouldn't hurt to mention it.
While I got a bit technical, hopefully this made some sense and good luck!
-
AngelaMiller
- Posts: 4
- Joined: Wed Jan 21, 2009 3:59 pm
Removing teeth
I am not a dentist; however, I was a victim of unsuccessful orthodontic treatment.
I think the biggest guide for whether or not you let them extract teeth should be your face. Understand that after your teeth are extracted, they will close the gaps making your arch often times smaller.
When your arch gets smaller, your lips do not have as much support.
You should ask yourself, can I afford to have my less lips? How big is my arch to start with? If you are someone with that doesn't have much lips to begin with, extractions may be undesirable.
If you are someone with overcrowding that has a big arch anyway it may not be too bad.
I think the biggest guide for whether or not you let them extract teeth should be your face. Understand that after your teeth are extracted, they will close the gaps making your arch often times smaller.
When your arch gets smaller, your lips do not have as much support.
You should ask yourself, can I afford to have my less lips? How big is my arch to start with? If you are someone with that doesn't have much lips to begin with, extractions may be undesirable.
If you are someone with overcrowding that has a big arch anyway it may not be too bad.
im hoping shes made a decision by now hehe