Do I need 4 premolars extracted before braces to fix my lower overcrowding? (Photo)

Question

I have and overbite and am most concerned about my profile. I do not want to get four perfectly healthy premolars extracted when I do not feel it is necessary for the top. Do I have severe overcrowding on the bottom front four teeth to merit extractions. I would much rather expand the lower arch because I don't like how prominent my nose is. Would 2 extractions on top and bottom make me look sunken or dishes in? What do you think?

Ira Shapira, DDS · Answer

I apologize for being lazy but I just copy and pasted an old answer to your post.You have narrow v-shaped arches and a very pretty face.  Extractions will probably create more problems that it solves.  Please read my previous e-mail below:MY ADVISE.....DO NOT AMPUTATE FOUR TEETH!!!!Every time I see a case like yours it makes my blood curdle.  You have an underdeveloped maxilla (upper arch) and you need orthopedic expansion.Amputating four teeth will not correct your underdeveloped jaws.  You have V-shaped arches rather than a classic U-Shaped palatal arch. Extraction of four teeth (four on the floor ortho) will actually tend to lead to a collapsed middle face.It will also increase your risk of chronic headaches, migraines, TMJ disorders, snoring and sleep apnea.  It can also cause forward head posture.You have an already reduced airway and it appears a forward head posture.  Ideally this is addressed between age 3 and 8 but can be addressed as an adult as well.I recently gave a lecture to ICCMO in San Diego on the "Common Developmental Aspects of Snoring, Sleep Apnea and TMJ disorders"  This affects every part of our body including sleep and brain development.  More and more science shows small airways being cause of ADD, ADHD and other disorders.You have a developmental orthopedic condition that should be addressed with Epigenetic Orthodontics not amputations.  I utilize the DNA Appliance because it works well for my patients and myself, is only worn 12-14 hours a day so it does not interfere with life, has been shown to grow bone orthopedically and airway pneumopedically, and it is very comfortable in terms of pain and discomfort being almost non-existent.It is also possible to utilize ALF or Bio-blocks, Schwartz, Frankel or other appliances but in my opinion the DNA is by far best for adult patients.  The mRNA version of the DNA has case studies showing cure of sleep apnea by orthopedic/ pneumopedic growth.There is two approaches to orthodontics, extraction contraction orthodontics and expansion orthopedic orthodonics.Thank You for your question.Ira L Shapira DDSDiplomate, American Academy of Pain ManagementDiplomate, American Board of Dental Sleep MedicineFellow & Regent, International College of CranioMandibular OrthopedicsChair, Alliance of TMD OrganizationsThinkBetterLife.com

Jared R. Gianquinto, DMD, MS - Account Suspended · Answer

There are several main indications for removing premolars to achieve the best orthodontic treatment results: Severe crowdingBite correction in non-growing patientsPrevention of bimaxillary protrusion (flared upper and lower teeth)Camouflage of underlying skeletal bite issuesRemoving perfectly healthy teeth is an irreversible decision that shouldn't be taken lightly. However, the needs for extraction to correct the bite, or improve the profile aren't as easily visualized in the treatment planning process as they are for crowding. Contemporary orthodontic treatment methods with expansion of the arches can reduce the need for extractions in certain situations, but may result in teeth that "stick out". Ultimately, the upper and lower jaws have limits to how much they can expand to accommodate teeth. The need for extractions isn't always cut-and-dry, since every patient responds to orthodontic treatment differently. In "borderline" cases where the need for extractions isn't immediately obvious, your orthodontist may recommend waiting until all of the teeth are aligned before guiding your decision toward removing teeth and closing space, or finishing with a non-extraction treatment plan. Be sure to bring up your concerns at your next appointment and discuss them with your orthodontist. Hope this helps! Dr. G

Do I need 4 premolars extracted before braces to fix my lower overcrowding? (Photo)

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Do I need 4 premolars extracted before braces to fix my lower overcrowding? (Photo)

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