I'm mainly concerned about upper premolar extraction, not really lower, so far the proposed plan is 4 wisdom teeth + 4 premolar extraction.

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

https://preview.redd.it/2rm36v7ief1h1.png?width=301&format=png&auto=webp&s=b1466608dddc5b120118a411d770aeb86e71f5b8

https://preview.redd.it/6bj6mi9kef1h1.png?width=1080&format=png&auto=webp&s=d3d1bf6624cf9b6ecff080614ab1daf1860a696d

https://preview.redd.it/61nfjd3mef1h1.png?width=1080&format=png&auto=webp&s=5c733d2b3db67d06768ccd7325e189448a346068

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

https://preview.redd.it/dawrzaetix0h1.png?width=301&format=png&auto=webp&s=2c062b6b228ef1c293e1d59225d2dcb2bf677c4c

https://preview.redd.it/5j6ptn1wix0h1.png?width=1628&format=png&auto=webp&s=9724741e6ebb4e1009ea8f76d4143fb60c0aef8b

https://preview.redd.it/91llaaluix0h1.png?width=3078&format=png&auto=webp&s=904f5f68bc81802f6c9e3489423a9c1c0924343e