The orthodontist advised extracting four teeth to treat high canines. Is it necessary?

Question

Hi doctor,

My daughter is 12 years old and she is having high canines. My orthodontist advised her to extract four teeth before starting her treatment. I need a second opinion to know whether it is really necessary and if necessary, please mention the teeth to be extracted to avoid having saggy cheeks in the future. I have taken X-rays before five days.

Answer 1

Hi,

Welcome to icliniq.com.

I have gone through the attachment and query (attachment removed to protect patient identity). After going through the X-ray of the lateral cephalogram, there is a proclination of upper and lower anteriors with highly placed canines. There is crowding of upper and lower anteriors. On considering the soft tissue and profile of the patient, there is a convexity profile and potentially competent lips. Ongoing through the findings, it suggests that she needs extraction. On considering labial orthodontic treatment, it is necessary to extract the first premolars of all four quadrants for alignment, leveling, and space closure. As there is excess tooth material, I would like to see more images of the upper arch after opening the mouth widely and clicking from down. I need to see images of lower teeth after the opening of mouth widely and clicking from above to evaluate space availability in full arch both in anterior and posterior. With one image, we cannot find space availability in the posterior segment.

Answer 2

Hi,

Welcome back to icliniq.com.

I have gone through the attachment. It is clear that the tooth material is excess in the upper arch and lower arch and so it needs extraction. As you have asked about wisdom tooth extraction, there is an incomplete development of wisdom teeth according to the OPG (orthopantamogram). Second molars are also not fully erupted. In cases of distalization, third molar extraction is done. Crowding is evident in the anterior side of the arch and so it comes under moderate category. So extraction of premolars helps to resolve crowding. Jaw growth and growth modification have to be done to have better results. But growth modification will not help in the majority of cases. Please mention your exact concern whether you think about esthetics or premolar extraction or appearance after extraction.