Severe adult crowding: Extractions? Alternatives? Treatment plan? (Photo)

You have a severely underdeveloped maxilla and a recessive mandible which needs room to come forward.  I would not recommend amputating four bicuspids because you need Expansion Orthodontics/ Orthopedics not Contraction Orthodontics.

Do you have Sleep Apnea, Snoring or chronic headaches and migraines?  Ideally, expansion is done before age 8.  As an adult the process is different after typical growth ceases.  In the past a Rapid Palatal Expansion with a surgical assist was the best approach and it is still the fastest process,
Ideally, I would suggest utilizing the DNA Appliance to Orthopedically grow your maxilla and the mRNA version to open your airway and help expand the mandibular arch.  The DNA appliance needs to be worn 16 hours/ day but the lower only 8-12 hours depending on how treatment progresses. 

Ira L Shapira DDS, D,ABDSM, D,AAPM, FICCMO
Past Chair, Alliance of TMD Organizations
Diplomat,  Academy of Integrative Pain Management
Diplomate, American Board of Dental Sleep Medicine
Regent & Fellow, International College of CranioMandibular Orthopedics
Board Eligible, American Academy of CranioFacial Pain
Dental Section Editor, Sleep & Health JournalMember Cranio Editorial Board, Journal of Craniomandibular and Sleep Practice
Member, American Equilibration Society
Member, Academy of Applied Myofunctional SciencesMember, Academy of Cosmetic DentistryLife Member, American Dental Association  ThinkBetterLife.com

When crooked teeth are straightened with out extractions, They always get moved forward and tipped forward from where they started.  That is OK for some patients, probably not a good idea in your case.  From the photos you provided, it appears that you have significant crowding and a significant skeletal imbalance.  In a non growing individual, this means that some compromises are usually necessary unless the treatment plan involves surgery.  All of this should have been discussed with you prior to the start of your treatment.  If not, ask for a consultation and be sure you understand your treatment plan, all of your treatment options as well as the compromises each treatment option involves. From the information provided, in my opinion, non extraction treatment in your case would not look good, be very unstable, and would likely lead to severe periodontal problems in the future.  Extractions may cause a minor facial change, but without 2 jaw surgery, this is your best option.  Also note, As an adult you jaw does not change with any type of non surgical orthodontics.  That means extractions do not "shrink" the jaw.  It also means that adult jaws can not be expanded (with out surgery).