Why Are Extractions So Bad? And Why Does the Surgeon Want Me To Extract?

[candle1112]

My surgeon wants me to get extractions so she can move my lower mandible as far forward as possible to help open my airway for sleep apnea. But I am really resistant to extractions (I already have all my wisdom teeth out sot that' not an issue). I feel that the more teeth I can keep, the healthier my jaw bones will be as I get older and things start to disintegrate due to age.
The surgeon said she would listen to my arguments of why I am worried about extractions, but the fact that keeping all my teeth will keep my jaw bones nice and healthy is the only argument I have. And me telling her "extractions, bad" won't work to convince her.
As a quick background, before my bout of condylar reabsorption my teeth fit perfectly nicely with nice spacing on the bottom (I found some old dental molds of mine before condylar reabsorption set in to prove this). But because I lost a good portion of my condyles , my jaw dropped way down and back and left me with a very steep mandible plane and an class II overjet of 8mm.
In my mind, if my teeth fit together nicely before, there should be plenty of room there for my orthodontist to make them straight on the bottom and fit nicely again, and therefore, there should be no need for any extractions.
What am I missing? Why would the surgeon, want to extract when its possible to fit the teeth on the bottom nice and straight without any extractions?

[CK]

does she want to extract wisdom teeth? if so that is fairly normal and common. most people need that, i think in most causes it is required for lower jaw surgery.

but a competent surgeon and dentist should never need to perform extractions to help the bite.

[candle1112]

My wisdom teeth were already taken out many years ago but I don't have details on the extractions yet.
I will get the details and let you know.
I think her main reason is to advance the mandible as much as possible to cure the sleep apnea and allow for a little relapse. But I already have a 8mm overjet so she should be able to advance the jaw forward a lot already. Do you guys agree?
To be very fair to her, she is concerned most about the airway and she said she would be willing to do the surgery without extractions if I'm really against it, but the aesthetic result may not be as good as with the extractions. Do you know why.
The only thing I could find was something from one of Lazlos earlier posts (Ithink it came from you Lazlo). It came from a Dr. McDonalds website in Washington/B.C:

Need for Extractions
These will be decided at the start of treatment. In mandibular advancement cases where the lower lip is well ahead or forward of the chin prominence, consideration should be given to removing the lower first premolars. This will give a better esthetic profile post-surgery and may negate the need for a genioplasty.

I may be dense, but why would extractions give a better esthetic profile post-surgery? (Obviously, I really want a good esthetic result)

[Lazlo]

To be very fair to her, she is concerned most about the airway and she said she would be willing to do the surgery without extractions if I'm really against it, but the aesthetic result may not be as good as with the extractions. Do you know why.

[/quote]

Because she's a s**tty surgeon.

[falcao]

I don't know. I mean how could I know if I have less space for the tongue, it's hard to judge something like that. It doesn't feel like it. It seems the same to me as before.

I suppose the alveolar ridge is narrower in the bottom jaw, this would be a logical consequence of the extractions and pushing the lower teeth back... But I insist that the mandibular body is the same as before. It's not like the mandibular body will shrink following the extractions. Not unless you're 12 or 13 and you are still growing, I would assume, in which case the mandibular body may grow a bit less in width than it would have otherwise as it will have a bit less impetus to get wider (the bone loss from the extractions). However, I stopped growing ages ago and my mandibular body developed with a full set of teeth in both jaws. Even if there was some narrowing after the extractions, it's imperceptible to me, and trust me, I'm very perceptive. I don't appear in the slightest narrower in my lower face...My gums are also perfectly fine, I can tell that as a fact at least. No evidence of recession whatsoever.

I'm not saying people should jump into extractions easily, but it's not such an evil thing either...especially in many cases where the adult has stopped growing and has fully developed facial bones. I can't say anything about upper jaw extractions, as I haven't had any. I hope this makes sense.

[Lazlo]

I don't know. I mean how could I know if I have less space for the tongue, it's hard to judge something like that. It doesn't feel like it. It seems the same to me as before.

I suppose the alveolar ridge is narrower in the bottom jaw, this would be a logical consequence of the extractions and pushing the lower teeth back... But I insist that the mandibular body is the same as before. It's not like the mandibular body will shrink following the extractions. Not unless you're 12 or 13 and you are still growing, I would assume, in which case the mandibular body may grow a bit less in width than it would have otherwise as it will have a bit less impetus to get wider (the bone loss from the extractions). However, I stopped growing ages ago and my mandibular body developed with a full set of teeth in both jaws. Even if there was some narrowing after the extractions, it's imperceptible to me, and trust me, I'm very perceptive. I don't appear in the slightest narrower in my lower face...My gums are also perfectly fine, I can tell that as a fact at least. No evidence of recession whatsoever.

I'm not saying people should jump into extractions easily, but it's not such an evil thing either...especially in many cases where the adult has stopped growing and has fully developed facial bones. I can't say anything about upper jaw extractions, as I haven't had any. I hope this makes sense.

maybe you luckily escaped. but i spoke with a doctor yesterday who said when you extract your bones will always narrow and shrink and it's very bad for your gums. Only the newer orthos know other techniques. Also your jaws can be grown at any age. Rapid palatal expansion, non even non surgical forms has been demonstrated in the past few months by th mainstream ortho community to work. You can widen mandible, and upper palate  --but yeah it's only for the more sophisticated orthos who know how to do this.

[Tiny]

I think in my case, if I hadn't had my molar extractions, I would have had impacted wisdom teeth as there would have been no room in my jaw for them, and so they would have been removed and I would wound up with the same number of teeth as I currently have.  The molar removal (which I had at 14) allowed my wisdom teeth to come in at 17 with no issues.  A BSSO at 16 is the only way I would have avoided extractions

It's not nice to think that the extractions might have made my mandible even smaller than it would have been 

I think in the UK they love to pull teeth - my sister got 2 biscupids removed and she is class 1 and didn't have bad crowding.  However, she didn't later on have impacted wisdom teeth - unlike my mother, who has similar teeth and didn't get extractions.  I think most of my friends who had braces also got bicuspid extractions; this was about 10 years ago.  I really hope now more orthos are moving towards expanding the jaws rather than removing the teeth

[candle1112]

Well I spoke with my orthodontist and she agreed that we would proceed with no extractions and reevaluate at in 6-8 months. She thinks she can prepare my teeth for the surgery without the extractions. I am much happier with this conservative approach.
As far as my surgery, the surgeon is definitely going to do double jaw so it is a Lefort 1 bringing the maxilla forward with an impaction in the back and then a counter-clockwise BSSO of the mandible with a genioplasty. She will work out the exact measurements in a couple of months were we see where we are with the orthodontics.
What do you guys think?
Here is my ceth so you can see my existing overjet and my very steep mandible.

[dantheman]

I don't know if this is an option, but if your problem is purely with sleep, have you considered a mouthguard to use at night? I'm also not talking about those cheap garbage pieces you can buy on the internet but rather one custom made by a dentist?

What's the cause of your condylar resorption?

[joa84]

Chorus(gospel) style: Don't do the extraction, oh whoa who, oh oh sho, just don't  let them take those precious little teeth, those prefoessional teeh the little itches take your teeth out\ (in the style of steel voice} "in a sky full of people only some don't have extractons, cause they're not crazy, they not crazy, they not crazy heheheehehheeeeey heeeey."

Hahaha  Tooo late for me unfortunately. I had 4 extracted!!

[sanddunes]

So did you end up choosing your surgeon for sure?  How was your consult with her compared to the one you had at UM?  Is she affordable?  It sounds like your treatment plan is pretty solid.  At least you are going over all of your options and are allowed to be an active participant in the process. 

[candle1112]

I don't know if this is an option, but if your problem is purely with sleep, have you considered a mouthguard to use at night? I'm also not talking about those cheap garbage pieces you can buy on the internet but rather one custom made by a dentist?

What's the cause of your condylar resorption?

Can't do the mouthguard unfortunately. Too severe an overjet and with my lack of jaw joint height, it would really screw my joints up.
The condylar resorption is caused by something called Idiopathic Condylar Resorption. Meaning, they really have no idea why it happened. It strikes quickly to women in their early 20's, does its damage and then stops. They think its related to progesterone or estrogen. Here is a good article on the syndrome:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1305829/

I'm so much luckier than others who have had that because I still have my disks and joints aesthetically its not as extreme as some, but it's not fun to live with the after affects such as sleep apnea, bad neck and shoulder pain and a non-existent bite.
But many of us  on this forum have similar symptoms that we are dealing with. We all can relate to each other.