The argument against Extractions

[breezeblox]

Getting the MMA for OSA. I have consulted with two different surgeons - one who wants to extract teeth and another who does not want to extract teeth, rather do CCW.


I have heard from a number of people (including the 2nd surgeon) that extractions are definitely to be avoided. I’d like this thread be a collection of those opinions - this will help me and others who stumble upon this thread in the future. I’ll refrain from telling everyone the 2nd surgeon’s reasoning as I’m curious to hear everyone else’s opinions (hopefully backed up with some evidence) and reasoning first.


If you don’t have a mountain of evidence but simply an opinion, that’s fine too. Curious to hear everyone’s thoughts.

[Ember22]

I'm definitely no expert in this, but I'll share how I see it.
First, our teeth and the jaw bone support and bring shape to the face.
When we lose teeth, we will lose bone in the corresponding area and the size of the jaw would shrink.  This would affect our facial balance.

This woman had a horrible experience with extractions and had them reversed:
https://www.youtube.com/watch?v=_KBXVLRLkfA&t=6s
I don't think she had SARPE so that's probably a large part of it.


I was told the same by the surgeons I consulted with, and mentioned my hesitation regarding extractions to my orthodontist.  I didn't completely understand their explanation, and I'm still unclear as to how the extractions wouldn't negatively affect facial balance- especially as we age, I would think the change would be more prominent.

[kavan]

Well, in general, you want to choose the doctor who can do the CCW to extent where teeth DON'T need to be extracted. The type of CCW is usually a posterior downgraft as opposed to CCW of anterior impaction which is more straight forward for a maxfax to do.

In general, when they do want to extract, it's usually to the LOWER pre-molars as to make enough room for them to push the lower teeth backward enough so they can then later push the lower jaw forward enough to meet in occlusion. This generality usually applies to linear advancement, something where NO rotations are done to the upper jaw where they justify linear advancement 'because' the patient has sleep apnea even IF there could be aesthetic trade offs with that such as 'chimp lip' or the lower face looking too narrow from the front.

Of course, what ever SPECIFICS any one patient has can trump generalities as to which one to do and the generalities associated with NOT doing CCW and doing linear advancement instead do not imply every person will get the negative aesthetic sequella that others have had with linear advancement for sleep apnea.

[breezeblox]

Could you explain in more detail how extractions/linear advancement leads to the lower face looking too narrow?

[kavan]

Could you explain in more detail how extractions/linear advancement leads to the lower face looking too narrow?

No. Why should I  go through all the specific scenarios where that could happen just because you elect to WITHHOLD the surgeons reasoning to suggest CCW instead?

[breezeblox]

I can give his reasoning, but I didn't want his argument to color or affect any future commenter's thoughts.


His reasoning - from what I can recall, was that by extracting teeth, one effectively pushes the bite back. When the jaws are advanced forward, bite will not abnormally protude (described as a "baboon face" by one orthodontist) forward. While aesthetically all may initially appear fine, he said that by effectively pushing the bite backwards, you're not maximizing the space of the airway as much as possible.


This argument functional and not aesthetic, unlike yours. While *kind of* understand his argument, I don't understand yours but would like to. Could you explain how lateral advancement leads to a smaller looking lower-face?

[kavan]

I don't have an 'argument' as to be patently for or against LINEAR ADVANCEMENT (not 'lateral' advancement). So, I guess that wasn't understood.

I gave you the GENERALITIES and told you basically there could be aesthetic trade-offs such as chimp lip or lower face looking too narrow which are things some people getting linear advancement complain of. I also told you that SPECIFICS trump the generalities. So, one or the other will depend on what your specifics are.

Some time back you wanted to know why a wrap around implant wouldn't expand the (dental) arch. So, my experience explaining things to you is one where you don't understand the explanation. So, I can explain things but I can't understand it FOR you.

[ditterbo]

I can give his reasoning, but I didn't want his argument to color or affect any future commenter's thoughts.


His reasoning - from what I can recall, was that by extracting teeth, one effectively pushes the bite back. When the jaws are advanced forward, bite will not abnormally protude (described as a "baboon face" by one orthodontist) forward. While aesthetically all may initially appear fine, he said that by effectively pushing the bite backwards, you're not maximizing the space of the airway as much as possible.


This argument functional and not aesthetic, unlike yours. While *kind of* understand his argument, I don't understand yours but would like to. Could you explain how lateral advancement leads to a smaller looking lower-face?

CCW is said to work very well in opening the airway, generally speaking.