Hi,42yo Asian man,Moderate bimaxillary Class 2 protrusive, ,lip incompetence.Confused w/various consults 2 fix CL2 toCL1 #1Ortho said he would extract 4 teeth+ braces to fix profile but that10 yrs from now, my face would like much older bc of retrucline(sp)? #2Ortho says 4 extracts+braces to fix prob 100%,says Dish in look WON'T OCCUR. #2Gen Dentist said 4 extracts would age my face 15 yrs w/dish in look,instead says appliance 2 expand my arches+ braces will retrude lips What r my best options?
Extraction or Nonextraction to Fix Moderate Class 2 Protrusion W/o Dished in Look?
Doctor Answers 5
Orthodontics is the Key
If you have actually been diagnosed with a Bimax. Class II Occlusion, then your orthodontist is correct. This a skeletal problem and the only other issue is whether you will need Jaw Surgery. If your orthodontist is experienced with orthognathic surgery procedures, then he should refer you to a board certified oral and maxillofacial surgeon. If he doesn't, I would find one experienced in jaw surgery to go to for another opinion PRIOR to starting the braces. This surgeon is the one who should extract the teeth and then do the surgery if needed.
Orthognathic Surgery to Correct Class 2 Protrusion
Before you go through any extractions I would seek out the advice of a board certified oral and maxillofacial surgeon to evaluate your case. Without any photos it is difficult to answer your question. Extracting teeth can cause a significant problem in the future if you plan on having orthognathic surgery. If it is a skeletal growth issue rather than a dental issue, than jaw surgery may be the correct answer as opposed to "masking" the real problem with extractions and orthodontics, This extraction and ortho treatment can give you a "dished in" look if not carefully done.
Smilemaker and Extractions
There are very few cases that should be treated with bicuspid extractions. In most cases expansion should be used. It can and has been done even on adults. Another consideration is your airway, with the type of bite you mentioned, I suspect that you have some airway issues. Be sure to work with someone who is experienced in this area.
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Extracting teeth in order to create space in the jaw
Extracting teeth in order to create space in the jaw, is not always the best thing to do. If you already have a profile that is not pleasant to you, extracting 4 teeth will just collapse the arch and makes your profile more collapsed in vertical dimension .( if that is what you meant by dished in look) .
Now if you have headache and TMJ issues, ever more reasons not to extract. consult with a reconstructive dentist, and look into upper jaw expansion as well.
Extraction vs non-extraction
Based on what you have said and without any pictures, the real question here is why are you getting braces? Is it for you appearance? Is it to help headaches? Is it so you can clean your teeth better? I'm not sure but if you have teeth removed it will create space and the way that space is closed is to bring the teeth in toward your tongue and back. That will change your appearance and if that is what you want, great. I prefer a fuller face and I also like to make sure the tongue has enough room, so I usually vote for expanding and keeping all of the teeth. I think this leads to better muscle function and isn't pushing the tongue back into your airway. Keep those things in mind when you make your decision. Hope this helped some. Enjoy!