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littleyellowman
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Really need some serious help since I'm potentially getting my first 4 premolars extracted tomorrow. I will be eternally grateful since extractions could fuck me up.
Here's some info:
Ethnicity: 100% Chinese; Mandarin (brutal ik)
I've already had braces when I was 12 but noticed I have bimaxillary protrusion which makes me look like an ape and making my chin look even more recessed.
Then talked to my ortho and apparently since my teeth are really big there is crowding which causes my incisors to be flared out forward at greater angle, which in turn causes bimax protrusion.
See side X-ray here:
Here are why other methods apparently wouldn't work on me, according to my orthodontist:
Temporary Anchorage Devices (miniscrews): According to ortho, I don't have space for the teeth to actually go and I am not just a slight/mild case of protrusion and require more space to bring back incisors.
Maxillary Skeletal Expansion (MSE): Apparently palate is already decent in width and expanding it wouldn't do any good and wouldn't actually fix the protrusion, and would cause skeletal misalignment with jawline, etc.
Segmental Osteotomy to cut Alveolar Bone ( suggested by @BlackpillRemedy ): Ortho says I might as well just get extractions and that the recovery process is a lot more intensive if I were to do the invasive surgery. (I'm also 17)
The Plan:
Ortho says to extract the first 4 premolars (2 up 2 bottom symmetrically, not the 2nd premolars because apparently first ones are smaller). Then the front teeth will be retracted and brought back using braces to alleviate the incisor flaring at an excessive angle. The back molars (back teeth) will be brought FORWARDS as well to close the gap left by extraction. Then after ~2 years of braces it would be fixed.
Concerns
In this forum a lot of people are saying premolar extractions fucked them up and harmed facial aesthetics, causing:
Sunken face, appearing older
Retrusion of the maxilla and mandible and flatter midface
Bad under-eye support
Face becoming narrower
Cheeks are flatter (IS THIS GOOD BC HOLLOW CHEEKS OMG!??!)
loss of vertical dimension
reduction of the oral cavity
AND and health issues consequent to these structural changes (temporomandibular disorder, inadequate tongue space, obstructive sleep apnea, forward head posture, neck/posture issues (cervicalgia, cervical kyphosis), atypical deglutition, pronunciation/speech difficulties, somatic tinnitus and frequent headaches)
'Premolar Extraction/Retraction (PER) Effects on the Upper AirwayBhatia S, Jayan B, Chopra SS. Effect of retraction of anterior teeth on pharyngeal airway and hyoid bone position in Class I bimaxillary dentoalveolar protrusion Med J Armed Forces India. 2016 Dec;72(Suppl 1):S17-S23. doi: 10.1016/j.mjafi.2016.06.006. Epub 2016 Oct 17. PMID: 28050064; PMCID: PMC5192225."The size of the pharyngeal (velopharyngeal and glossopharyngeal) airway reduced and hyoid bone position changed after retraction of the incisors in extraction space in bimaxillary protrusive adult patients."Chen Y, Hong L, Wang CL, Zhang SJ, Cao C, Wei F, Lv T, Zhang F, Liu DX.Effect of large incisor retraction on upper airway morphology in adult bimaxillary protrusion patients - PMC.. Angle Orthod. 2012 Nov;82(6):964-70. doi: 10.2319/110211-675.1. Epub 2012 Mar 30. PMID: 22462464; PMCID: PMC8813144."Large incisor retraction leads to narrowing of the upper airway in adult bimaxillary protrusion patients."Choi JY, Lee K. (2022) Effects of Four First Premolar Extraction on the Upper Airway Dimension in a Non-Growing Class I Skeletal Patients: A Systematic Review. J Oral Med and Dent Res. 3(1):1-16.2022 systematic review of research on the airway and extractions. Concludes that premolar extraction/retraction can cause the narrowing of the pharyngeal airway, a change in the tongue position, and the reduction of oral cavity space, and hence is a risk for sleep apnea.Guilleminault Christian, Abad Vivien C., Chiu Hsiao-Yean, Peters Brandon, Quo Stacey. Missing teeth and pediatric obstructive sleep apnea"Our children with permanent teeth missing due to congenital agenesis or permanent teeth extraction had a smaller oral cavity, known to predispose to the collapse of the upper airway during sleep."Hang William M., Gelb Michael. Airway Centric® TMJ philosophy/Airway Centric® orthodontics ushers in the post- retraction world of orthodontics.Cranio. 2017 Mar;35(2):68-78. doi: 10.1080/08869634.2016.1192315. Epub 2016 Jun 30. PMID:27356671."We recommend that optimizing the airway for every patient and never doing any treatment [such as retraction] which will diminish the airway, even minutely, needs to become the standard of care in Airway Centric® Dentistry."Hu Z, Yin X, Liao J, Zhou C, Yang Z, Zou S.The effect of teeth extraction for orthodontic treatment on the upper airway: a systematic review. 2015 May;19(2):441-51. doi: 10.1007/s11325-015- 1122-1. Epub 2015 Jan 28. PMID: 25628011."Extractions followed by large retraction of the anterior teeth in adult bimaxillary protrusion cases could possibly lead to narrowing of the upper airway. Mesial movement of the molars [instead of retraction] to close the extractionspaces appeared to increase the posterior space for the tongue and enlarge the upper airway dimensions."Mortezai O, Shalli Z, Tofangchiha M, Alizadeh A, Pagnoni F, Reda R, Testarelli L. Effect of premolar extraction and anchorage type for orthodontic space closure on upper airway dimensions and position of hyoid bone in adults: a retrospective cephalometric assessment.PeerJ. 2023 Oct 23;11:e15960. doi: 10.7717/peerj.15960. PMID: 37901473; PMCID: PMC10601897.https://pubmed.ncbi.nlm.nih.gov/37901473/“A significant reduction in oropharyngeal, velopharyngeal, and hypopharyngeal airway dimensions was noted in groups I [40 class I patients with bimaxillary protrusion and maximum anchorage] , III [40 class II patients with maximum anchorage], and IV [22 skeletal class III patients with maximum anchorage] (P < 0.001), which was correlated with the magnitude of retraction of upper and lower incisors (r = 0.6- 0.8). In group II [40 class I patients with moderate crowding and anchorage], a significant increase was observed in oropharyngeal and velopharyngeal dimensions (P < 0.001). A significant increase in nasopharyngeal dimensions occurred in all groups (P < 0.001). Also, in groups I and III, the position of hyoid bone changed downwards and backwards, which was correlated with reduction in airway dimensions (r = 0.4 - 0.6). According to the present results, extraction orthodontic treatment affects upper airway dimensions and hyoid bone position. Maximum anchorage decreases airway dimensions while moderate anchorage increases airway dimensions” Ozbek MM, Memikoglu TU, Gögen H, Lowe AA, Baspinar E. Oropharyngeal airway dimensions and functional-orthopedic treatment in skeletal class II cases. Angle Orthod 1998;68:327-36.“Study concludes that with the closing extraction spaces, the maxilla and the mandible retrude, causing a retrognathic mandibular position and consequent constriction of the oropharyngeal airway.”https://pubmed.ncbi.nlm.nih.gov/9709833/Pliska BT, Tam IT, Lowe AA, Madson AM, Almeida FR. Effect of orthodontic treatment on the upper airway volume in adults. Am J Orthod Dentofacial Orthop. 2016;150(6):937-944.This study concludes that there is in general no difference between those who get extractions with orthodontic treatment and those who get orthodontic treatment alone: both lose 5% of airway volume which the authors consider an insignificant loss. However, the study did note a significant narrowing of the airway if the patient presents with moderate or little crowding, as the retraction and shrinkage of the dental arches and the [loss of oral cavity space] is “significant.”https://pubmed.ncbi.nlm.nih.gov/27894542/Sharma Krishna, Shrivastav Sunita, Sharma Narendra, Hotwani Kavita, Murrell Michael D. Effects of first premolar extraction on airway dimensions in young adolescents: A retrospective cephalometric appraisal. Contemp Clin Dent. 2014 Apr;5(2):190-4. doi: 10.4103/0976-237X.132314. PMID: 24963245; PMCID: PMC4067782.
Sharma Krishna, Shrivastav Sunita, Sharma Narendra, Hotwani Kavita, Murrell Michael D. Effects of first premolar extraction on airway dimensions in young adolescents: A retrospective cephalometric appraisal. Contemp Clin Dent. 2014 Apr;5(2):190-4. doi: 10.4103/0976-237X.132314. PMID: 24963245; PMCID: PMC4067782. "An existing strife is that orthodontic treatment can move the denture back in the mouth, reducing oral space and restricting pharyngeal volume. The present study probed this assertion, and analysis shows that the extraction of premolars has a detrimental effect on oropharyngeal structures… Extraction of four premolars did affect velopharyngeal, glossopharyngeal, hypopharyndgeal, and hyoid position in bimaxillary protrusive young adolescents. The velopharyngeal, glossopharyngeal, and hypopharyngeal airway became narrower following orthodontic therapy. The hyoid bone tends to move in a posterior and inferior direction. The other findings of our study also proved direct correlation of tongue to oropharynx and hypopharynx. Postextraction tongue position directly influenced the hyoid; this again can be attributed to anatomical dependence of hyoid with the hyoglossal muscle."Sun F. C., Yang W. Z., Ma Y. K. Effect of incisor retraction on three-dimensional morphology of upper airway and fluid dynamics in adult class Ⅰ patients with bimaxillary protrusion. 2018 Jun 9;53(6):398-403. Chinese. doi: 10.3760/cma.j.issn.1002- 0098.2018.06.007. PMID: 29886634."The oropharynx was constricted and the pharyngeal resistance was increased after incisor retraction in adult class I patients with bimaxillary protrusion."Wang Qingzhu, Jia Peizeng, Anderson Nina K., Wang Lin, Lin Jiuxiang. Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of Class I bimaxillary protrusion. Angle Orthod. 2012 Jan;82(1):115-21. doi: 10.2319/011011-13.1. Epub 2011 Jul 27. PMID: 21793712; PMCID: PMC8881045."The pharyngeal airway size became narrower after the treatment. Extraction of four premolars with retraction of incisors did affect velopharyngeal, glossopharyngeal, hypopharyngeal, and hyoid position in bimaxillary protrusive adult patients."Zheng Zhe, Liu Hong, Xu Qi, Wu Wei, Du Liling, Chen Hong, Zhang Yiwen, Dongxu Liu. Computational fluid dynamics simulation of the upper airway response to large incisor retraction in adult class I bimaxillary protrusion patients. Sci Rep. 2017 Apr 7;7:45706. doi: 10.1038/srep45706. PMID: 28387372; PMCID: PMC5384277."This study suggested that the risk of pharyngeal collapsing become higher after extraction treatment with maximum anchorage in bimaxillary protrusion adult patients. Those adverse changes should be taken into consideration especially for high-risk patients to avoid undesired weakening of the respiratory function in clinical treatment."
Sharma Krishna, Shrivastav Sunita, Sharma Narendra, Hotwani Kavita, Murrell Michael D. Effects of first premolar extraction on airway dimensions in young adolescents: A retrospective cephalometric appraisal. Contemp Clin Dent. 2014 Apr;5(2):190-4. doi: 10.4103/0976-237X.132314. PMID: 24963245; PMCID: PMC4067782. "An existing strife is that orthodontic treatment can move the denture back in the mouth, reducing oral space and restricting pharyngeal volume. The present study probed this assertion, and analysis shows that the extraction of premolars has a detrimental effect on oropharyngeal structures… Extraction of four premolars did affect velopharyngeal, glossopharyngeal, hypopharyndgeal, and hyoid position in bimaxillary protrusive young adolescents. The velopharyngeal, glossopharyngeal, and hypopharyngeal airway became narrower following orthodontic therapy. The hyoid bone tends to move in a posterior and inferior direction. The other findings of our study also proved direct correlation of tongue to oropharynx and hypopharynx. Postextraction tongue position directly influenced the hyoid; this again can be attributed to anatomical dependence of hyoid with the hyoglossal muscle."Sun F. C., Yang W. Z., Ma Y. K. Effect of incisor retraction on three-dimensional morphology of upper airway and fluid dynamics in adult class Ⅰ patients with bimaxillary protrusion. 2018 Jun 9;53(6):398-403. Chinese. doi: 10.3760/cma.j.issn.1002- 0098.2018.06.007. PMID: 29886634."The oropharynx was constricted and the pharyngeal resistance was increased after incisor retraction in adult class I patients with bimaxillary protrusion."Wang Qingzhu, Jia Peizeng, Anderson Nina K., Wang Lin, Lin Jiuxiang. Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of Class I bimaxillary protrusion. Angle Orthod. 2012 Jan;82(1):115-21. doi: 10.2319/011011-13.1. Epub 2011 Jul 27. PMID: 21793712; PMCID: PMC8881045."The pharyngeal airway size became narrower after the treatment. Extraction of four premolars with retraction of incisors did affect velopharyngeal, glossopharyngeal, hypopharyngeal, and hyoid position in bimaxillary protrusive adult patients."Zheng Zhe, Liu Hong, Xu Qi, Wu Wei, Du Liling, Chen Hong, Zhang Yiwen, Dongxu Liu. Computational fluid dynamics simulation of the upper airway response to large incisor retraction in adult class I bimaxillary protrusion patients. Sci Rep. 2017 Apr 7;7:45706. doi: 10.1038/srep45706. PMID: 28387372; PMCID: PMC5384277."This study suggested that the risk of pharyngeal collapsing become higher after extraction treatment with maximum anchorage in bimaxillary protrusion adult patients. Those adverse changes should be taken into consideration especially for high-risk patients to avoid undesired weakening of the respiratory function in clinical treatment."
MORE PHOTOS
I don't want to recess my face since I'm pretty sure I can my ratios with a genio potentially? And then can raise my nose bridge higher (forward if viewed on the side) to fix proportions.
Please help what should I do? Ortho says why not extract and fix bimax protrusion and THEN worry about getting genio done and all that... but I'm scared it could fuck up my face and make everything recess or make my already long face (due to my lower jaw developping downwards through mouthbreathing) even more narrower and disproportionate. My gonial angle is also too large. Maybe protrusion could be fixed by bringing lower jaw up and forwards paired with genio? I just don't want to do anything that will fuck up my face and bone structure in the long term. I can provide more info and photos if needed. THANKS IN ADVANCE
