You didn't specify how your orthodontics was done but I suspect that because you are unhappy with your narrow smile that bicuspid teeth were extracted instead of expanding your underdeveloped palate. I hear from patients every single week who are dissatisfied with their orthodontic treatment because they had bicuspids removed instead of expanding the palate. You ask if there are any other ramifications to bicuspid extractions instead of palatal expansion besides teeth that "aren't as esthetically pleasing". Unfortunately, the answer is a resounding YES. I see adult patients every week who had bicuspid extraction orthodontics who now experience TMJ dysfunction and sleep apnea, not to mention their displeasure with facial appearance, compromised profile, decrease in lip support, etc.There are very few orthodontists in America who will admit that bicuspid extraction orthodontics altars facial appearance or causes TMJ dysfunction. However, there have been orthodontists who have been sued by patients who had healthy TMJ's before bicuspid orthodontic treatment and TMJ dysfunction afterwards and lost the judgement. There have also been numerous studies done on identical twins where one twin was treated with bicuspid extraction orthodontics and the other with palatal expansion and in every case the twins no longer look like twins and the brother/sister who had palatal expansion has far more attractive facial features. There is irrefutable proof that bicuspid extraction orthodontics compromises facial aesthetics. Dental schools in America, including orthodontic schools, teach that adult palates can NOT be expanded because the maxillary suture (the split in the two bones of the palate where expansion occurs) fuse together at around the age of 21 in most patients (maybe even younger in women). This is simply NOT true. Current research clearly shows that the maxillary suture virtually NEVER closes. I have heard of colleagues who have treated patients with maxillary palatal expansion who are 80+ years old with GREAT SUCCESS. Success in palatal expansion means stable results that don't relapse. The key to palatal expansion is that it MUST be done slowly. Rapid palatal expansion does not work because it actually fractures the palatal suture which cause scar tissue to form and makes results not only painful but also unstable.In VERY FEW CASES is bicuspid extraction orthodontics the preferred treatment over palatal expansion. Straight teeth should NEVER be the only consideration for successful orthodontic treatment. Facial aesthetics, TMJ health, airway health and broad smiles are far better indicators of orthodontic success.Good luck!
