Second premolar/bicuspid extractions. Anyone get this done?

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#1 Post by **BracesAgain** » Sat Apr 14, 2007 2:25 pm

It seems like I will need to get my 2nd premolars, aka bicuspids extracted. If you had this done, how long did it take for your gaps to close? I know that they need to move the 1st premolars back into the space created by the extraction and then they can move the front six teeth back. So, that will be a lot of time spent closing gaps... I'm worried.

#2 Post by **iBorg** » Sat Apr 14, 2007 2:50 pm

Funny, I'm exploring implants to replace these same teeth. When Mine were pulled back, my smile became hidden by my lips. Something you may want to ask about.

Mike

#3 Post by **dugsmom** » Sat Apr 14, 2007 3:04 pm

I almost considered doing the same (an option the ortho gave me) but I did my research and found out that a lot of people weren't happy with the results because their teeth are so far back that you can't see their teeth when they smile. It also changes your profile (that's what I read) and supposedly your face looks kinda concave. I don't know if that's true or not since i have not seen anyone who has had this done; I just read about it.

#4 Post by **jess214** » Sat Apr 14, 2007 3:54 pm

I've had all four bicuspids extracted.. I got my braces at the end of November, and my dentist only started working on closing the gaps at the beginning of last month (he was waiting for my teeth to straighten out the first three months before working on anything else, I guess?). He put in a spring connecting my top canine to the first molar on both sides to pull my canine back - nothing on the bottom yet - and just last week I was given elastics. There is an obvious gap on both sides of my top canines now (with one side obviously being the extraction gap) so there has been quite a bit of progress in just the past month. I'd describe the size of the "other" gap being as wide as.. say the width of a spaghetti strand? Haha I'm not very good at descriptions : P

#5 Post by **BracesAgain** » Sat Apr 14, 2007 5:23 pm

iBorg wrote:Funny, I'm exploring implants to replace these same teeth. When Mine were pulled back, my smile became hidden by my lips. Something you may want to ask about.

Mike

Hi iBorg, I actually just pm'd this message to you, but I meant to post it to the board:

I actually have a condition called "bimaxillary protrusion" where my teeth are leaning out of my mouth at such an angle that my front and bottom teeth barely overlap. Actually, at the position my teeth are currently in, I need to strain my chin to pull my lips over my teeth. Premolar extraction is commonly used to create space to pull the teeth back into a more normal position and reduce lip strain. Second premolar extraction usually creates less space than first premolar extraction, and my orthodontist gave me both options. I think I'm going with the second extraction, but I will be sure to ask how far back the teeth will be pulled. I still have more questions before committing to a treatment plan.

#6 Post by **iBorg** » Sat Apr 14, 2007 6:56 pm

Please understand I'm not trying to discourage all extractions. I'm sure there are some cases in which it is necessary. Yours sounds like a case in which this is the case.

I on the other hand was a victim of the common orthodontic practice of the late 70's-80's referred to as "four on the floor." If you were beyond a certain age instead of expanders and the like of today, orthos had the bicuspids pulled as a standard practice. During the late 90's studies showed a correlation between people who had this done and later developing TMJ problems. I have had severe medical problems due to my TMJ and the medicine required to deal with this. For me, at least, being braced is one of the best things to happen to me. It fits somewhere behind getting married and adopting our two children.

Because of my personal experience, I always encourage individuals to have more than one consultation with different orthodontic practices to confirm whether or not extractions are truly necessary.

Mike

#7 Post by **platinum** » Sat Apr 14, 2007 7:28 pm

What is "bimaxillary protrusion"?
My front teeth did not really touch each others either.

#8 Post by **BracesAgain** » Sat Apr 14, 2007 8:44 pm

Bimaxillary protrusion is when the teeth are positioned very forward in the mouth in comparison to the rest of the skeleton. My teeth are flared outwards, so if I look to the side, my top teeth look slanted like this: \ My bottom teeth are even more slanted outwards than my top teeth, to the point where I feel like they are "falling out of my mouth". I have consulted with about 5 orthodontists who have told me that removing teeth is not an outrageous proposal, especially because mainly my back teeth are contacting each other. Since I grind my teeth, I am wearing down the enamel on the biting surfaces of my molars and eventually I will crack or fracture those teeth and need to put on crowns. If they pull the teeth back into my mouth after extractions, it will provide better contact in the front of my mouth and the forces will be more evenly distributed. Also, since my teeth are pushed outwards, it has been causing my gums to recede quite badly. By positioning the teeth over the jaw bones, it will prevent future recession. I will definitely be getting gum grafts after orthodontic treatment because my teeth are very painful and sensitive to cold at the roots.

I wanted to add that I am not a candidate for expanders, since my teeth are already pushed far out from the jaw bone and the gums are receded. It would cause my teeth to become loose and the gum problem to worsen.

I do feel quite nervous, though, about the prospect of extractions...so I will be asking my orthodontist more questions.

#9 Post by **SimInsomniac** » Sun Apr 15, 2007 1:27 am

I had four premolars removed before I started with braces.
My ortho spent the first 16 months straightening my teeth with wire changes before he finally started work on the gaps. I still don't quite know why this took so long.

I've been powerchained since December and the gaps were greatly reduced by February, when I got my second. This one didn't have as much effect but my latest one is finally shutting all my remaining gaps within a couple of days, maybe it's the extra elasticity of a replacement. So I'm hoping by the time I go again in May I'm completely gap-free! You'd never know I had teeth taken out without inspecting closely.

Sim

#10 Post by **brady** » Sun Apr 15, 2007 1:56 am

Braced again-

I have an overbite as well (Class II), and I'm getting my upper 2nd bicuspids extracted on Wednesday, April 18th. SCARY, but I figure I'm as ready as I'll ever be. I plan on taking Valium the night before and the morning of to help prepare me...

I have been in braces about 4 months so far. My ortho straightened my teeth first, now we are extracting and pulling the upper teeth back. I asked my ortho about whether I would notice gaps btwn. each of my front teeth as the "big gaps" of the 2nd bicuspids start closing. He said gaps would not be noticeable btwn my front teeth and that he plans on moving them all together, but not sure if he's just saying that to make me feel better or what. I'll keep you posted.

Regarding the whole extraction issue and whether it's needed or not. I saw MANY (OK, 6) different ortho's prior to getting braced. 4 of them recommended extractions, 2 recommended lower jaw surgery instead. I did not want to go thru jaw surgery at my age (just turned 35), so I went the extraction route. I still have concerns about how my profile will look after it's all done, but I believe the change will be so subtle noone will even notice. Also, my ortho has said that by using elastics, the upper teeth will pull back a bit, and my lower teeth will pull forward a bit to help accommodate for the overbite. I think you should just trust the judgement of the ortho's you've seen. They know best how to treat your case. But I do recommend getting several opinions to help ease your mind.

One last thing, I've never been told that the 1st bicuspids needed to be moved first, then the rest of the teeth follow. I'll ask my ortho about this to double check, but I don't believe this to be true - at least in my case.

Later,
Brady