Undoing extraction orthodontics?

[kazw]

I am a 34 year old female from England. I too had 4 premolars extracted and braces as a child, and am becoming increasingly aware of my sunken in mouth and lines / creases above the top lip near the corners due to lack of lip support due to front teeth being retracted in order to close the extraction spaces. I have been looking in to this for a while, and was surprised at how many of us there are out there. If you google tooth 975 - he is an American orthodontist who is an expert on reversing premolar extractions. He uses functional appliances to bring everything forward and out, and then implants to replace extracted teeth. Also there is an American woman CCarrieb on Youtube who is in the process of getting this procedure reversed - and sharing it with the world. I hope you all manage to find the right treatment. I am currently looking for an orthodontist who can do this for me. If anyone from England can recommend anyone to me that would be great.

[menomomma]

I was so happy to find this thread. I am 51 years old. I have been dealing with the problems caused by four bicuspid extractions, braces and headgear which I was treated with as a child. I now have serious neck and tmj problems, my cross bite and overjet have returned, my condyles started melting away and now my back teeth won't come together. I just completed 7 years of diagnostics and treatment to find my proper bite. My migraines are mostly gone thankfully (I had disabling migraines for over 20 years). Now to start phase II. My treatment plan will use Invisalign to move my teeth forward and widen my arches, restoring spaces where those four teeth once were. Then, I will likely have implants to fill in the spaces, and a redo of the crowns on my back teeth to support my bite. What a mess (physically and financially) this has all been. If my parents only knew! At any rate, I am very excited to be starting my Invisalign. I really hope this will help restore some of my facial profile as my chin has receded and my smile is now crooked from all of the bone damage. I will try to share my experiences with the use of Invisalign to reverse prior orthodontics.

[Mylovedtheeth]

There some profits of replacing extracted teeth and risks such as gum problems, periodontitis, relapse of crowding because
[guote]our jaws are too small; it's why we needed extractions.[/guote]
e.g. my second premolar extracted itself by growing at palate. So in the arch is one teeth less. this is my left profile and it looks good. at right side every teeth manage grow in one line, unfortunately protrusion occur, gums suffer witch chewing and looks like monkey mouth.

[stillnight000000]

[quote="maxhammer"]The best thing you can do is understand your face. Look at old photos, and your pretreatment photos. Try to see if you lost a lot of bone due to extractions. Try to understand how far the front went back vs the back molars coming forward. Inform yourself. Then you can figure out where it went wrong.

My guess is that you all had the front retracted and the arch constricted with little movement of the back molars forward. I went down this path (had extractions 1 year ago, freaked out at the results, and took charge in my case). I informed myself and went to my ortho with the complaints. We pushed the front 6 teeth forward 3mm using coils. Found out that TADS could be placed in that newly created space to pull the back molars forward (why wasn't this done to begin with? Oh, because orthos are lazy and want the quickest treatment rather than the best treatment). Okay, a generalization, but I think true. Anyway, we put a wider wire on my arch, which helped with the small, caved in mouth, then we pulled the back molars forward using TADS (reveres head gear is a cheaper option). I'm a few months into this modification, and it's way better than the pure retraction method, though I am struggling to close the remaining 4mm of space in an aesthetic manner. I might have to concede and retract a mm.

One thing to remember: our jaws are too small; it's why we needed extractions. So to me extractions weren't the problem, but (a) were the right teeth extracted (e.g. second bicuspids are smaller) and (b) was the space closure handled correctly? I had about 6mm of crowding, but by pulling two front bicuspids we created 16mm of space. The difference is 10mm. Now, I had an overjet, so 4mm of that was closed by pulling the overjet back and constricting a little. That was fine. It was the remaining 6mm that was the problem. I'm down to about 4mm now. I might just leave a 1 or 2mm gap behind the bicuspids. That might be better than pulling the back molars forward or retracting. The latter is horrible, and the former runs the risk of the cheeks caving in (though my ortho swears this won't happen). Also, pulling the back molars forward tends to open the bite.

Something to understand about implants: the smallest ones require 6mm of space. If you needed extractions, that will be difficult to find. You'd have to have the ortho torque and expand the teeth to the outer limits of the jaw bone. This will result in a "monkey face" for many people in that you'll be too far out. Consult with a periodontist about getting bone grafted. They call it ridge augmentation. This will provide support. You can also get bone grafted in the cheek area. This might help some peoples' problems. It really depends on your bone structure, something orthos don't consider enough.

Orthos should reject patients. That is the bottom line. If a patient has a configuration where the space can't be closed in an aesthetic manner, they should be told to keep their current smiles and be happy. They never do this, though. People have a lot of trust in orthos and think "since they're professionals they know best." No, a patient knows their face best, and they know what they want to look like. Don't trust an ortho with that. They're all about mechanics and function. If the teeth are straight, they say they've achieved a desired result. As you can probably tell, I am very much against orthos (and I consulted with 4, all are the same) after my experience. It's not a total disaster like some, but it's definitely not what I was picturing when I went in to fix my bite.[/quote]


Have the effects from your previous orthodontics been completely reversed as a result of your new treatment?

[Stargirlxx]

Is there a Facebook group for people with this problem? I am dealing with it too and would like to start a group if there isn't one already.

[isthistaken]

Some cases are obviously necessary where the teeth are just piled on top of one another but it sounds as if from this discussion extractions should be avoided virtually at all costs.

[carlarae]

I'm so glad I joined this forum you guys... thanks for all your input... I DO NOT want extractions anymore! I thought it was the only way to correct an overbite or something... but so many people are mentioning a "weak chin", and I already feel like I have a weak one! I don't want it to look worse. I want my lower jaw to come forward a bit to help that problem! Hopefully that can be accomplished just with rubberbands. I just hope I have enough room in my mouth to make the crowding better. How can they fix crowding without pulling teeth to make more room?

[isthistaken]

How can they fix crowding without pulling teeth to make more room?

Interproximal reduction can be done in lieu of extraction. A tiny bit is shaved off the sides of the crowded teeth. I had this done and I was really worried about it. I was afraid it would hurt, and I was afraid it would compromise multiple teeth instead of removing probably one. I read that it supposedly does not harm the teeth, although you do have to take a fluoride rinse every day afterward to build up the fluoride on those teeth. It did not hurt, in my case. I had a hard time weighing the pros and cons even though extraction wasn't even presented as an option. I still have all the roots of those teeth is the one big benefit besides being far less traumatic procedure than extraction.

[sirwired]

I'm so glad I joined this forum you guys... thanks for all your input... I DO NOT want extractions anymore! I thought it was the only way to correct an overbite or something... but so many people are mentioning a "weak chin", and I already feel like I have a weak one! I don't want it to look worse. I want my lower jaw to come forward a bit to help that problem! Hopefully that can be accomplished just with rubberbands. I just hope I have enough room in my mouth to make the crowding better. How can they fix crowding without pulling teeth to make more room?

That is a question for a qualified orthodontist to answer. There are ways of making room that do not involve extractions that are appropriate for some case, not appropriate for others. You may even end up being one of those patients that simply needs to have extractions to have a long-term stable result. Most extractions do NOT have negative long-term effects.

As a side note; if the overcrowding is on the upper, pulling teeth from that arch isn't going to mess up your chin.

[Stargirlxx]

Yes, pulling from the upper can make the chin appear weaker. If the top teeth are retracted, your lower jaw will be postured back farther as well. This is what happened to me. My ortho had told me it wouldn't, since I had an overjet, but he did not account for the fact that in order to speak/breathe/chew properly I actually postured my lower jaw forward. Can't do that anymore since the top has been retracted.

[JumpTheDitch]

As a side note; if the overcrowding is on the upper, pulling teeth from that arch isn't going to mess up your chin

This depends, it may. If the extractions are done to treat crowding, and the molars are not retracted any, I suspect the chin would not be affected. I suspect also that the TMJs would be equally unaffected. If the overcrowding is not severe enough to warrant extractions (two teeth is a lot of space to create), or the extractions are to treat overjet instead/as well, my uneducated opinion is that if the biting surface is moved backwards at all, your chin/TMJs could be negatively affected.

Pushing the upper teeth that bite together to form occlusion further back will require the lower jaw to then come even further back in order to get the corresponding molars to meet. This can result in a retracted mandible (extremely unpleasant, squashes the TMJ discs out of the joint and causes all kinds of distressing TMJD symptoms).

In my case extraction of the upper bicuspids caused this to happen. Where upper bicuspid extraction (and ensuing retraction) is used, it is often to treat an overjet. From my experience, I think the danger lies in the correct diagnosis of overjet. Since the TMJD problems manifested, and were eventually diagnosed, I have had three drs diagnose my upper palate as being narrow. My recent models of both arches shows clear tipping of the lower molars, apparently common where a narrow upper palate 'traps' the lower jaw and prevents it from coming forward into it's natural postition (like trying to push your foot into the end of a pointy-toed shoe). (The lower molars tip inwards in order to contact the narrowed upper teeth to occlude).

Upper molars : | |
Lower molars : / \

If your lower jaw is 'trapped', and sitting further back that it should be, it can make the upper front teeth appear as though they are too far forward (ie: overjet).

Profile diagram
Upper front teeth : |
Lower front teeth : |

The upper teeth appear to be further in front of the lower teeth. There is a larger than cosmetically desireable space between the uppers and lowers, but is it the uppers that are too far forward, or the lowers that are too far back?
This could depict an underdeveloped lower jaw, OR an overjet. I think the key is correctly diagnosing which.

If upper teeth are extracted, and the remaining uppers retracted to treat an overjet that is actually a misdiagnosed underdeveloped lower jaw, I suspect the jaw joint suffers, displacing the TMJ discs, and causing the chin to appear 'weak'.

Stargirlxx me too

Malilou25 I'm reversing the retraction that followed extractions, but will be moving the molars into the reclaimed space, rather than implant false teeth to replace the extracted ones. I have all my wisdom teeth so hopefully that gives me the flexibility to utilise the molars coming forward instead of having to go for implants. Unfortunately, the molars are multirooted (as opposed to the single-rooted front teeth), so all the advice I've had has been consistent in the need to take it slowly. Which is also important to avoid root resorption. Three years of expansion and braces to correct 18 months of quick traditional orthodontics!

maxhammer How did you go bringing the molars forward into the extraction spaces?

[JumpTheDitch]

I see the site has corrected all my carefully spaced out diagrams!

Imagine the upper molars sit straight up and down, but the lowers are slanted inwards on either side.

Similarly, the upper front teeth were supposed to show some spaces in front of the lowers.

I don't know why it cancelled out all the spacing I put in...

[Nate92]

[quote="Lynette"]There was someone on here not that long ago that was looking into a similar thing. Maybe try searching through the archives?

It's not impossible to reverse it. Just costly and time consuming.

The last time I had braces, I had extractions and everything was brought backwards. My current ortho has moved everything a tiny bit forward and I am finding that my chin is so much more defined and my upper lip has more definition.

If you go forward with it you may find that moving everything forward just a tiny bit is enough to give your chin more definition and you may not need any work done on your chin.

:)[/quote]

Hi Lynette,

Would you mind elaborating on your case? Did you just have your teeth moved forward? And did moving your front teeth forward give more definition to your upper lip? I didn't know it would that.

[audax719]

I had the classic 4 on the floor treatment when I was 19. I had a overjet of upper incisors ( due to thumb sucking as a child) and retruded mandible. Also had a considerable posterior open bite.
The correct treatment, in hindsight would have been to use a functional appliance to expand my upper palate. And since the palate is expanding , the upper teeth would have retroinclined to balance the forces and would have evened out at a natural flare providing lip support. A Herbst or bio-bite correct to advance the lower jaw so that my molars have a neutral occlusion would have been ideal.

Of course , all of this would take 2 years easily and considerable planning on the orthodontist's part- which he didn't. He extracted 4 bicuspid and pulled my anterior teeth on both jaws- it pretty much annihilated my maxilla. And over the last 5-6 years my entire profile has sunk in. In response my mandible is forced to move back to an unnatural bite position just so that my molars come into contact.

The best looking and balanced profiles are that of people who have forward growth in faces. Extraction orthodontics will lead to vertical growth with the maxilla collapsing and the mandible retruding This will lead to TMJ-TMD issues and sleep apnea because narrower arch means tongues have no room and they use the airway space. Orthodontists who do not consider facial profiles must never be licensed to practice or atleast not take on the patient's case. I feel they have a very myopic view of just getting straight teeth at the end of the day, even at the expense of disfiguring facial profiles. Our face is not just the teeth. We have jaw muscles, lips and so many other cranio-skeletal things to consider. I feel balance and fullness to face should be paramount and lastly getting straight(er) teeth. The trauma that the patients endure for 2-3 years in treatment is enough, but the after effects of a unsatisfactory treatment is horrible. People start to hate how they look and it really affects self-esteem.

I'm currently in talks with a dentofacial orthopaedic/ orthodontic specialist in the Washington DC area. Consulting a periodontist too to see if I can reopen the extraction spaces and get 4 implants. It's costly and time consuming, but im 27, and hopefully will lead a full life till 65-70. So it's a quality of life issue.

[Lovespain5]

Hello! I just read your post and I want to answer you!
I totally agree with you. Extractions are not recommanded for people who, like you, have a retruded mandible. A treatment like that will end to a retruded profile and less lip support.
I had my 4 first bicuspids extracted because I had a general protrusion on both jaws. So my profile which was initially convex, become straight. I didn't loss lip support, on the contrary, my lips have a better contact between them.
But during the last part of my treatment, my orthodontist worked to change slightly the shape of my upper arch, to make it rounder in order to not lose lip support and avoid the problems you deal with (sleep apnea, place for the tongue...).
Because having 4 bicuspids extracted isn't recommanded for everyone (only for people with protrusion or with very crowded teeth in my opinion), it is compulsory seeing different orthodontists before starting a treatment.
Good luck with your second treatment!