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Need opinions on whether 4 premolar extractions really make sense before DJS
Need opinions on whether upper premolar extractions really make sense before DJS
I’m a DJS case and I’m trying to think through whether 4 premolar extractions really make sense, especially the upper premolars.
Timeline:
- Oct 15: first ortho consult
- Dec 9: oral surgeon consult
- Feb 9: ortho sent updated letter to surgeon after we discussed goals
- Main goals from the start were to avoid extractions if possible and do double jaw advancement rather than just lower jaw surgery
- Surgeon originally seemed more conservative and mainly mentioned possible lower premolar extractions (34/44) if maximal mandibular advancement was needed
- After months of back-and-forth, ortho now wants 4 premolar extractions on top of wisdom teeth removal
My understanding:
- Upper jaw advancement itself is not limited by whether upper premolars are extracted
- The maxilla can still be advanced surgically
- The real question seems to be whether my upper incisors can be positioned safely and properly within the maxillary alveolar bone without upper premolar extraction
- A CBCT should at least help assess the safety/anatomical feasibility of moving the upper incisors back into proper position in bone
- Staff replied that CBCT would not help determine whether enough decompensation can be achieved with TADs only, but that feels like a different question from what I’m asking
So what I’m trying to figure out is:
If my upper incisors can be uprighted/repositioned safely within the upper jaw bone using TADs/IPR/non-extraction mechanics, then what exactly is the compromise of not extracting upper premolars?
Attached photo: upper arch, front and side xray
u/Full_Investigator284 — 1 day ago