Same number of teeth on each side

Hello,

I have a Class II malocclusion. Younger, I got an upper left premolar and a lower left premolar removed. They suggest to me, as a treatment, to get the two corresponding right premolars removed. And as I do not want any surgery, they suggest to me to reopen the space of the lower left premolar. I have a hard time understanding this. Because for me, I thought that there had to be the same number of teeth on each side. It seemed logical to me to simply remove both right premolars.

I would like to get your opinion.

Thank you!

Julie.

Good evening Julie,

You are clever and your question is pertinent.

You are right to pretend that someone should have the same number of teeth on each side, but it is not always the case and conditions (of malocclusions) exist where the extraction of 3 teeth is indicated (1 premolar on each side in the maxilla and 1 premolar on only one side in the mandible). When there is asymmetry in the molar and canine relationships between the right and left sides, the extraction of 3 teeth is often the best option. This makes it possible to cover the asymmetry. There are conditions where the extraction of only one premolar on only one side in the maxilla can be suited although it is less frequent. I do not want to get into the details to confuse you.

Let’s get back to your case. The removal of an upper premolar and a lower one on the side where there had not been any extraction is likely to be necessary. I admit that it puzzles me to have to reopen a space on the lower left side, unless you have an asymmetry to the left and that the addition of a premolar will make it possible to recenter the mandibular midline. In that case and since you do not want any surgery, would it be possible to extract an upper right premolar, not to extract any lower right premolar and reopen a space on the lower left side? This is the same as a covering treatment of a Class II with the extraction of only 2 upper premolars.

I do not know. I would have to examine you clinically.

Here is an example where I extracted 3 premolars to cover a mandibular asymmetry to the left. I took these pictures 8 years after the end of the orthodontic treatment. Notice the excellent occlusal stability.