Ortho and extractions

[startalk]

Hi

I want to ask you important question regarding extractions

So the first ortho I went suggested that I extract lower premolars ( I have slight class III but its not notcieable tbh)

I was reluctant because I read this forum alot before and I know about extraction=face change thing

However my second ortho favours the nonextraction methods but she does not know yet will I have to extract

I was curious, does extraction of the lower premolars for class III has any impact on facial changes?

I can see how would the extraction of upper premolars have impact on face ( Sunken cheeks, flat midface etc.) but I cannot see how would lower premolar extraction have impact on face (except maybe lower jaw narroving or smth)

Anybody care to explain

Also your advice, what should I do?

[PloskoPlus]

Potentially less space for your tongue.

[jsisr]

there will be less space for your tongue and it may result in more lower teeth show because of the space created between your teeth and lower lip

[Lazlo]

NO EXTRACTIONS EVER. RUN RUN RUN from any ortho trying to do this for you. It will make your life hell. Better to not even get jaw surgery or ortho if extractions are "necessary"

[GJ]

Lazlo is correct, except very rare cases where maybe 2 lower pre-molars make some sense.
Yours might be one of them, so you'd have to post more info.

[notrain]

I was curious, does extraction of the lower premolars for class III has any impact on facial changes?

Anybody care to explain

Also your advice, what should I do?

If you extract two lower teeth on a class 3 skeletal base, then the lower lip will retract during the ortho treatment, giving an increased chin prominence (looks a bit like a witch chin). This only applies to non surgical cases, if you are going for jaw surgery then these facial changes will get adressed during the surgery. Otherwise, they are permanent without surgery and general detrimental to your appearance. Essentially, you'll exchange facial harmony for a proper bite if you extract teeth on top of a skeletal malocclusion without jaw surgery.

[ditterbo]

What's worse (on the general topic, not to this patient here necessarily) - lower bicuspid extractions or significantly more CCW via massive posterior downgraft?  I presume the tradeoff is very specific to each individual.

[CCW]

What's worse (on the general topic, not to this patient here necessarily) - lower bicuspid extractions or significantly more CCW via massive posterior downgraft?  I presume the tradeoff is very specific to each individual.

Why would you extract healthy teeth if you can do it without extractions? Someone like Gunson would only ever recommend lower extractions for crowding when it's not possible to achieve a stable result without them. A less skilled surgeon would go for the extractions to allow for enough advancement.

[Lefortitude]

yeah dont even think about getting extractions except in RARE specific cases.  i had 5 teeth removed years ago because of crooked maxfacs, dentists and orthodontists.  I payed 2000 to back then and im still paying for it to this day.

[ditterbo]

Why would you extract healthy teeth if you can do it without extractions? Someone like Gunson would only ever recommend lower extractions for crowding when it's not possible to achieve a stable result without them. A less skilled surgeon would go for the extractions to allow for enough advancement.

Well for most surgeons, a 9-10mm posterior downgraft CCW is not considered stable, doable, safe for the TMJ's etc.. Which would have to be done to avoid extractions to allow the jaw to come forward with minimal advancement to the maxilla (maxilla only recessed 2-3mm). I don't have a hundred grand to spend on bimax, ortho etc. so Gunson is out. Also off-topic, but you know how much money you're missing out on, in middle age adult life or retirement, if you took that 100k and invested it long-term, in your 20's, instead of dumping it on bimax? Many hundreds of thousands of dollars. Ugh.

[CCW]

You should consider Raffaini and Alfaro in Europe. They'd be way cheaper than Gunson (even with travel and other expenses).

[kavan]

Well for most surgeons, a 9-10mm posterior downgraft CCW is not considered stable, doable, safe for the TMJ's etc.. Which would have to be done to avoid extractions to allow the jaw to come forward with minimal advancement to the maxilla (maxilla only recessed 2-3mm). I don't have a hundred grand to spend on bimax, ortho etc. so Gunson is out. Also off-topic, but you know how much money you're missing out on, in middle age adult life or retirement, if you took that 100k and invested it long-term, in your 20's, instead of dumping it on bimax? Many hundreds of thousands of dollars. Ugh.

I think you just have to decide whether or not you want bimax. I see it being an improvement whether or not you get the 10mm downgraft via Gunson or the extractions to the lower jaw to get it.

[ditterbo]

You should consider Raffaini and Alfaro in Europe. They'd be way cheaper than Gunson (even with travel and other expenses).

News flash on Alfaro: he's not really much cheaper than Gunson at all. I wonder where the discrepancy in information is, or maybe if he charges people very different rates.

I'm not getting extractions on an already narrow lower jaw + arch, so I can mentally torment myself some more with a newly cramped tongue that docs don't consider a medical problem at this point. Lazlo's description of that experience sounds terrible, for starters. If they can't get enough CCW in without extractions, then I'm looking at a 2-3mm increase at the pogonion with a better labiomental fold, per Relle's plan (and visual diagram so I'm not purely going off measurements). I'm not interested at that point unless my chin implant situation takes a turn for the worse. Thanks for the perspective though.
I'll just keep slowly looking for now.