Jaw surgery vs tooth extraction. Which is the best option for me?

Question

I'm a young adult that needs braces. I've been told by 2 orthodontists that I have an underbite. One tells me jaw surgery, the other says teeth extracted. I've had surgery in the past and trying to avoid surgery of any kind, if possible. I'm kinda curious as to why I'm getting different opinions. Is having teeth extracted that bad? Will it affect my jaw that bad in the future. The emphasis the first orthodontist is placing on jaw surgery is kinda making me second guess the 2nd orthodontist's opinion.

Robert Waxler, DMD, MS · Answer

first doctor who responded said he didn't like either option...I agree....I don't like to have teeth extracted or ask for surgery.  Unfortunately though sometimes these are required.  His answer that some type of  orthodontic treatment called "functional orthodontics" or "epigenetic orthodontics can correct your problems is magical thinking that is not really supported by the scientific literature or by the vast majority of trained orthodontists.The reason you are getting different opinions is that your problem (like many other people) is caused mostly by a skeletal disharmony.  Now if orthodontists wanted to ideally fix every patient with skeletal problems we would be treating a very large percentage of our patients with surgery...obviously we don't.  The reason is that most of the time, when the skeletal problem are not too severe, we can move the teeth to compensate for the skeletal disharmony.  The problem is that the more severe the disharmony the more compensation is needed...eventually requiring tooth extractions in some cases.  At some point (depending on the doctor and the patient's wishes), the compensation becomes too severe to get an acceptable result...at this point surgery is brought up.It sounds like you are at this borderline position...You need to have your doctors explain the pros and cons of their plans...then you need to decide which way to go!

Brad Lockhart, DDS · Answer

Personally, I don't prefer either option. There are compromises and adverse consequences for both of these options and rare indeed is the case where one of these two options is the only option. Search for a provider who understands "Functional Jaw Orthopedics" or "Epigenetic Orthodontics". More than likely, your problem can be resolved with simple removable appliances that are comfortable and easy to wear and eliminate the need for extracting teeth or doing costly and traumatic surgery.Good luck!

Doug Depew, DMD, MS - Account Suspended · Answer

Bravo to Dr. Waxler for a very thorough and scientifically based response, and his effort to correct erroneous information.  I totally agree with everything he said. He laid out some of the pros/cons and thinking that goes in to these important decisions.  I want to add, that frankly, it is often the doctor's education, experience and comfort level with either procedure that leads to their primary decision.  Probably the "best" result would come from combined surgical and orthodontic treatment.  The question is can you get an "acceptable" result doing it with extractions.For example, if your lower teeth are really crowded and your uppers are not...it might work out fine with extractions.  One thing I would be looking at is on your cephalometric x-ray (side view of the head), are the lower incisors already leaning backwards?  If they are, there may not even be enough bone support to move the lower teeth backwards further to correct the underbite. This is certainly a situation where even a third opinion might be worth it..."to break the tie".   I'd be happy to see you, but I'm on the other side of Atlanta.  If you choose to do so, ask them to send me your "diagnostic records" in a digital format ahead of time.  It would be really helpful.

Jaw surgery vs tooth extraction. Which is the best option for me?

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Jaw surgery vs tooth extraction. Which is the best option for me?

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