8 teeth extraction for braces when having underdeveloped chin. (photos)

Question

I would like to improve my profile and straighten my teeth at the same time. By seeing 3 orthodontists, I was recommended to extract all 4 wisdom teeth (which I already did), but they also wanted to extract other 4 teeth. I feel that by extracting 2 teeth from my upper arch, I would make my profile look even more weak (I would actually make my upper lip follow the lower one which is underdeveloped). What would you recommend? Is extracting 8 teeth in total a good approach?

Ira Shapira, DDS · Answer

I would strongly advise against making your mouth smaller by extracting four bicuspids.  This can lead to tongue crowding and subsequent sleep apnea and snoring, forward head posture, headaches, migraines and TMJ disorders.Read the NHLBI report "CARDIOVASCULAR AND SLEEP-RELATED
CONSEQUENCES OF TEMPOROMANDIBULAR
DISORDERS"I would suggest you get the physiological and cosmetic results with the Biomimetic application of Epigenetic Orthodontics/orthopedics through the DNA Appliance.  With your current profile it is likely you already have sleep disordered breathing.I would also consider releasing the Tongue Tie and seeing an Oral Myofunctional Therapist.Ira L Shapira DDS, D,ABDSM, D,AAPM, FICCMOChair, Alliance of TMD OrganizationsDiplomat, American Academy of Pain ManagementDiplomat, American Board of Dental Sleep MedicineRegent & Fellow, International College of CranioMandibular OrthopedicsBoard Eligible, American Academy of CranioFacial PainDental Section Editor, Sleep & Health JournalMember, American Equilibration SocietyMember, Academy of Applied Myofunctional Sciences

L. Matthew Schofield, DDS, MS · Answer

Hi, niko87!Your question and photos are greatly appreciated. Before making a treatment plan, the orthodontists should diagnose your problem according to your chief complaint and your complete exam. From your photos, in addition to the crowding and "overbite" that you're probably aware of, I see two additional items of concern which your treatment should address: proclination of the upper and lower incisors and mild hyperdivergency of the mandible resulting in mild lip strain on closure. I agree you have a reduced chin projection (i.e., "weak" chin) and I would want to make sure my treatment plan did not worsen that. I wouldn't hesitate to recommend four premolar extractions in your case considering the diagnosis. The extraction spaces will allow for uprighting of the incisors making them "stick out" less. Also, if vertical control is achieved (possibly through the assistance of skeletal anchorage) you may even see increased chin projection actually helping to improve your profile drastically.Please review these options with your orthodontic specialist. I'm sure you'll be extactic about the results you can acheive!Cheers!

8 teeth extraction for braces when having underdeveloped chin. (photos)

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8 teeth extraction for braces when having underdeveloped chin. (photos)

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