Dr. Bowmn is clearly a brilliant and innovative orthodontist. He is very skilled and has pioneered the use of many of the appliances that he uses, including mini-screws, which he utilized on me, rather painfully. I was motivated to get braces due to a sever overbite, which led to physical discomfort and cosmetic flaws. Pros: Trust that Dr. Bowman knows what he is doing Effective, multiple options, and (relatively) quick Butterfly brackets Mini-screws an option few have Cons: Mini-screws hurt horribly and are easily infected Pain is not exactly taken into consideration by Dr. Bowman Various technicians - some good and some bad The outcome was very positive, with what I would describe as a perfect alignment and overbite correction. I would recommend finding a good technician and sticking with him/her; that way you know who you'll have and be confident in them. Also, find a sympathetic oral surgeon, such as Dr. Kanar, to give you pain medication if you are having mini-screws, as they are extraordinarily painful, require significant maintenance (cleaning, in particular), and Dr. Bowman will not prescribe painkillers.
It is truly unfortunate when misinformation is disseminated to the unsuspecting and trusting public. Certainly, matters of professional opinion can differ but are best resolved by professionals and one of those methods is through the use of research and peer-reviewed publication. Making brash, bold, and unsubstantiated claims and generalizations not based in reality, especially in this type of forum where patients may use the information to make treatment decisions is at best, simply unbecoming of a learned profession. Statements such as "creates excess," "often cause," "are the result," "primary reason" attended without in fact are a disservice by the uniformed to the layperson. The prospective patient is searching for information to make an informed consent and would be best served first suggesting that they personally return to a licensed orthodontic specialist or two to gather this information; not propagating myths. First, "Damon" is a name brand of braces and there are hundreds of brands. It has nothing to do with preventing extractions or reducing TMD. There is no evidence. It is marketing. In regards to your question, there is a plethora of data on the question at hand. Doing a simple PubMed search using keywords is a good place to start. Also contacting the NIH for their position white paper (i.e., paraphrasing "orthodontics is not a cause or cure of TMD (including the extraction of premolars") might be useful. To give you a start, below is the abstract from a peer-reviewed paper (one of numerous others) that provide with the answer: Extracting premolars (a procedure that provides substantial improvements for patients that need them) is not a risk factor for TMJ (PERIOD). Orthodontic risk factors for temporomandibular disorders (TMD). I: Premolar extractions by Kremenak, Kinser, Harman, Menard, Jakobsen, American Journal of Orthodontics and Dentofacial Orthopedics, Vol. 101, Issue 1, Pages 13-20, January 1992. "Concern about claims that premolar extractions may put patients at risk for temporomandibular disorders (TMD) led to this study. We report first findings from a longitudinal study of orthodontic patients begun in 1983. By using the methods of Helkimo, we collected TMD data before initiation of orthodontic treatment, between 0 and 12 months after debanding, and 12 to 24 months after debanding. Analyses related Helkimo scores with premolar extractions in 65 patients for whom orthodontic treatment had been completed. Twenty-six patients were treated without premolar extractions, 25 had four premolars extracted, and 14 had two upper premolars extracted. Tests for significance of differences between mean Helkimo scores were conducted for the nonextraction group compared with the extraction groups, and between pretreatment and posttreatment Helkimo scores for each group. Results included: (1) no significant intergroup differences between mean pretreatment or posttreatment scores, and (2) small but statistically significant (P < 0.05) differences (in the direction of improvement) between mean pretreatment and posttreatment scores for both the nonextraction group and for the four premolar extraction group."
Before the teeth have the chance to move further, make sure to visit with your orthodontist to ask his or her opinion. Don't wait for additional changes as small discrepancies may be resolved with a simple retainer adjustment. Good communication with your doc is key.
It is important that there is clear communication with your orthodontist about what can and cannot be achieved. Looking at the pictures, it seems that some mild improvements might yet be possible by wearing your custom tooth positioner 24/7 for a minimum of one week; "chewing it" regularly during the day. Since you've moved on to Hawley retainers, returning to the positioner should be under the supervision of your orthodontist. If the retainers are being worn 24/7 and no improvement noted, then it may be time to bite the bullet and opt for some minor re-treatment with braces if suggested by your doc.
You have received a number of excellent answers from other practitioners. Final lip position is not strictly a function of whether extractions are performed. In fact, more protrusive lips can be produced even with extractions depending upon the biomechanics employed and the goals determined for treatment. If retraction of the teeth to reduce protrusion is desired, then some degree of lip retraction is likely to accompany the teeth. There have been a number of studies attempting to determine the predictability of the amount of this lip change that have demonstrated varying success. In 2005, workers from Brazil and U.S. published a study of upper first premolar extraction patients and again found only mild predictability, but on average there was about 0.7 mm of lip retraction for each 1.0 mm of front tooth retraction. Interestingly, enough, these changes are most often determined to be esthetically pleasing in these types of situations where patients desire reducing the protrusiveness of their front teeth.
Dr. Waxler's answer is correct; however, the most important message is clear communication. You need to insure that you get your questions answered at your appointment. If you are confused, then get clarification from an orthodontic assistant or even the receptionist. If they don't have the answers, they will get them from the orthodontist. Don't leave without your question answered.
