Thank you for your question and thanks for sending in photos as it really helps me understand your condition better. From the photos, it appears that you have a more prominent lower jaw compared to the upper jaw and there is a mild deviation of the lower jaw to the left of the face.Your teeth appear well aligned with minimal crowding on both the upper and lower jaw. I can understand your concern about extractions as your teeth alignment looks good!
The lower teeth are in front of the upper teeth by a small amount ( estimated based on the photos about 2mm).
There are 2 main reasons extraction of teeth may be necessary in your case. Firstly, your lower jaw is more prominent than the upper and you would need a lower jaw surgery to move the lower jaw backwards. In order for the surgeon to perform this surgery with greater confidence, the wisdom teeth in the lower jaw are usually indicated for removal. This is because with the wisdom teeth present, it is a weak point in the jaw and may make it challenging for the surgeon to make the necessary surgical split.This surgical procedure is usually at the position of the wisdom tooth, having the wisdom tooth removed 6 months prior to corrective jaw surgery ensures that the area is covered by bone and will have a more predictable surgical split.
Secondly, it appears that facially you would need the upper jaw to come forwards and the lower jaw to go backwards in order to get a more balanced profile. However, the distance between your upper and lower teeth does not appear to be enough for the necessary jaw movements. In my experience, the upper teeth tend to be slightly proclined or flared out to compensate for the more prominent lower jaw position. Hence it may be necessary to retract or bring the upper teeth backwards slightly to increase the distance between the upper and lower teeth hence giving the surgeon more leeway to perform the necessary jaw movements.Without the extractions, your surgeon may be limited by the teeth position and may not achieve the best facial results. It would be helpful to assess the inclination of the upper teeth with a lateral cephalogram before deciding if upper teeth extractions are necessary.
Hope this helps. All the best.
Warm regards,
Dr Priscilla Lu
Orthodontist at the Orthodontic Clinic
