Bicuspid Extractions Changed Face Negatively

had extractions & its changed my face. I have an appointment with my original ortho and i am unsure how to approach this situation and ask him to change it. I had a consult w/ a diff ortho who said she'd open my spaces and give me an expander. I dont feel as though i should have to pay someone else to fix this problem, as it would b my 3rd time in braces if i do and im only 23. i paid 7k myself for results that are truly depressing. Id like a professionals advice how to approach this with him

Doctor Answers 3

Bicuspid Extractions Changed My Face Negatively

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I'm so sorry to hear your sad story; unfortunately, it is a common story with patients who choose to have bicuspid extractions with orthodontic treatment. I wish more patients were aware of the possible negative ramifications of bicuspid extraction therapy. There are many of us trying to spread the word but our words often fall on deaf ears within the orthodontic community and as a result, patients suffer the consequences. 

When bicuspids are extracted for orthodontic treatment it means that a person's teeth are so crowded that they can not be lined up straight and still fit within the dental arch. In order to make the teeth fit you have to make room by either making the dental arch wider or taking teeth out. 

Unfortunately, when you take teeth out you then have the same size dental arch (which is obviously too small since the teeth didn't fit in the first place) and you now have too much space because taking out teeth almost always creates more space than is needed. To fill in the extra space the front teeth have to be retracted (pulled back). When you retract teeth the face overlaying the teeth is retracted too. The nose will stay the same but the lips become less prominent and the lower face becomes flatter and even concave in appearance. The patient ends up with small lips, a narrow smile and a flat or even concave lower face.

In many of these cases the lower jaw is also too far back because of the underdeveloped upper jaw which results in a weak chin and potentially compromised TMJ.

Bicuspid extractions before orthodontic treatment is antiquated orthodontics and NOT indicated in fully 90%+ of cases with excessive crowding. Bicuspid extraction orthodontics is focused solely on straightening teeth and does NOT consider the negative effects on a patient's face and TMJ, nor does it consider the negative long-term effects on a patient's airway. Straightening teeth should come AFTER muscular concerns are addressed and both upper and lower arches are developed to their genetic potential and the relationship of the upper to the lower jaw is optimized. MOST orthodontic cases require extremely important treatment steps BEFORE any teeth are straightened and these steps rarely require the extraction of bicuspid teeth.

What can be done now to resolve your concerns? You must find a doctor who understands that the end-game for orthodontic treatment is NOT solely straight teeth but also involves the other steps discussed above. This doctor will have to, in large part, undo what was done with bicuspid extraction therapy and go through the required steps to achieve not only straight teeth but also a beautiful smile, enhanced face and healthy TMJ and airway.

Good luck! 


Premolar extractions

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The extraction of premolars, although common in orthodontic treatment, will have a tendency to flatten ones profile and create a shorter smile.  The space can be recaptured again by have expansion of the arch, however once the space is obtained you will need to have an implant along with a crown to replace the tooth that you once had. You should talk to the orthodontist that originally did the treatment to see if he or she would redo the case at no charge. However, despite the fact that you may right in trying to regain the arch length lost by the extractions, you will need to have implants placed. This is more treatment and more of an expense. Something to think about.

Bicuspid Extractions

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I am very sorry about your current issue. Seeing a change in your facial structure after this  procedure is a very common result. Personally that is not a route that i see many orthodontist take very often anymore. There are so many different options such as palatal expansion that are looked into before  choosing to remove teeth. Although you are upset with your current doctor, i would recommend seeing someone else to finish and correct the issue at hand.

Svetlana Novak, DMD
Natick Dentist

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These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.