Extractions for lower jaw surgery?

[TheDancingQueen]

My orthodontist suggested that I can remove two of my bottom teeth and shift my teeth back and then perform jaw surgery to bring my lower teeth forward. Is there any issue with this? Is it preferable to do this rather than have bimax? Will I still achieve aesthetic results like this?

[Sergio-OMS]

I personally think a bimax allows for better aesthetic and occlusal results, and most surgeons and orthodontists around me think this way. But it is true that risks are higher and post-op is tougher.

[TheDancingQueen]

Based on my ceph is upper jaw surgery necessary?

[Post bimax]

I've heard pretty much nothing but bad things about extractions in cases where a bimax with no extractions is possible.

[GJ]

I've heard pretty much nothing but bad things about extractions in cases where a bimax with no extractions is possible.

Notrain reported success with lower jaw extractions and surgery only. It is possible based on what I've read, and in some cases it's the best option. I think it's best if the candidate has a class 2 jaw, dental crowding, and a short face/low mandible angle. CCW is might not be a great option in that situation because the face could compact more, so this might work. I've heard it's impossible to align the bite exact with this method, though.

[Lazlo]

yeah, i'm going to voice in here and say no f**king way. problem is that when the retract the lower teeth to close the space, your tongue will have less space and possibly overlap the bottom teeth at rest. terrible idea.

[GJ]

yeah, i'm going to voice in here and say no f**king way. problem is that when the retract the lower teeth to close the space, your tongue will have less space and possibly overlap the bottom teeth at rest. terrible idea.

Yeah, in general, I agree with this except for the situations I gave or if the person is adamant about single jaw only to reduce risk.

[TheDancingQueen]

So extractions are bad because it will cause problems with my bite and tongue position?  If a bsso will improve the way I look and I don't care about my bite is it still a bad option?

Or will extractions cause my lower third to look worse? Will the aesthetic benefits of a BSSO outweigh the negative effects of extractions?

[Gadwins]

You should definitly consult also a surgeon about that. Normally surgeon doesn't want to extract any teeth and suggest other solution. Better to hear both side before you decide.

[TheDancingQueen]

I just had a consultation with Dr. Caminiti and he recommended extractions on my lower teeth to create space  to move my lower jaw forward. He said my upper jaw was fine and that I didn't need a sliding genioplasty.

I would be fine with extractions but I always read on here that extractions should always be avoided. Would I look significantly worse with the extractions? Is there something I can do to counteract the negative effects of extractions? Wouldn't the aesthetic benefit of a BSSO outweigh the negative effects of extractions?

[GJ]

Extractions in the lower jaw only can be an option if you're class 2 and need a linear movement. That seems to be the best time to do that.
NoTrain had this procedure, so you should ask him.

[InvisalignOnly]

I would be fine with extractions but I always read on here that extractions should always be avoided. Would I look significantly worse with the extractions?

Sent you a PM.

[notrain]

Lower jaw premolar extractions followed by surgery are indicated in the following cases where one or more criteria are met:

- excessive curve of spee
- crowding
- protrusion (excessive tipping) of the incisors
- Class 2 jaw relationship

The point of this is that the lower jaw incisors need to be at or close a 90 degree angle in order to create a normal lip-chin relationship and chin prominence in general.
In some cases this is only possible by retraction of the lower front teeth after the 1st premolars are removed. "Surgery First" is impossible with this starting condition.

Extractions and counter clockwise rotation are also not mutually exclusive. If there is not enough overjet after extractions and space closure, the surgeon can still do CCW.
This was discussed in my case but I did end up not needing it. The caveat is that the occlusion afterwards will never be perfect because the 1st lower jaw molar will oppose the 2nd and 1st upper jaw premolars as opposed to the big molar which it would normally. The 2nd upper jaw Molar will be left unsupported. The teeth definately won't be able to mesh as well as they normally would and this can cause problems if the tongue gets between them (tongue thrust) which can open up the lateral bite.

[TheDancingQueen]

Did you have tongue thrust? And how common is it?
 

The caveat is that the occlusion afterwards will never be perfect because the 1st lower jaw molar will oppose the 2nd and 1st upper jaw premolars as opposed to the big molar which it would normally. The 2nd upper jaw Molar will be left unsupported. The teeth definately won't be able to mesh as well as they normally would and this can cause problems if the tongue gets between them (tongue thrust) which can open up the lateral bite.