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I understand that the primary objective of intermolar width should be to gauge progress/expansion, so it doesn't matter how you define it and all you care about is increasing it. That being said, I had premolar extractions in my early teens and I'd like to compare myself to the Mike Mew numbers of 38mm (goal) and 42mm (ideal).
In general, by Mike Mew's definition, the distance between the inner surfaces of the first molars aka #6 is used for IMW. However, after premolar extractions and gap closure, the first molars become teeth #5 and the second molars become teeth #6. So how should IMW be calculated on the extraction patient so that it's comparable to a non-extraction patient?
this is a great question---did you get an answer? My intermolar width measuring from standard molar 1 is 30 mm---
But should I be measuring from m2? 30 mm is way way below the average.
@entelechy I haven't gotten an answer. My case is even more extreme. My molar 1 width is 26mm. It is unbelievably low compared to the numbers people post on here, even the lowest numbers Mike Mew talks about (28mm). My molar 2 width is 10mm greater though (36mm). Without an official answer on this, I believe that since the extracted premolar is smaller than the first molar, the translated number should be somewhere in the middle. In the meantime, I'm considering my IMW the average of m1 and m2, so 31mm. This is at the low end and is consistent with how narrow my palate is. Let me know your thoughts.
Your reflections have been so useful for me, and has led me to a revelation about my own case. Thank you!
First, my own m1 imw is actually 28 or 27: I just got a calypher and re-measured so we are in a similar boat.
My m2 imw is 35.
Now to respond to your question. First to explain how I get my answer:
I too had 4 premolar extractions and a reduced palate in consequence. My tongue is so trapped that I decided to put on braces again to expand the teeth forward. I am now in six months of braces, and have gotten 2-3 mm more forward expansion in the 5 anterior top teeth! I have also gotten spaces between these teeth and hence a wider palate in the front. This blessing means that I can easily place the tip of my tongue on the palate, and move my mandible forward a 2-3 mm as well.
now what happened next was a total mystery until your post! A couple months ago, I started having huge problems speaking. My tongue would get stuck between the two 2nd premolars. It was very upsetting! I have always had speech problems to some extent--but not this bad. I found certain words and sounds impossible to pronounce. I couldn't even read stories to kids. My tongue was even more trapped than before---and my teeth already were a cage. I thought the ortho had made a mistake and was pushing IN my molars instead of the reverse.
But then I figured out what really happened: because of the forward expansion, my tongue has moved forward with it. That means that the thicker part of the tongue is now between the 2nd premolars--and trapped between them as the width is SMALLER than between the lst molars. Whereas before, the tongue was stuck more back in my throat and the thick part was between the 1st molars.
It is your post that made me think about the different positions of the premolars and molars.
So what is the upshot? I think in your case, your are right, the pm2 imw is effectively the m1 imw of the Mews: because that is where the widest part of your tongue is probably currently positioned: that is, if your front teeth/maxilla were retracted like mine with elastics, and your tongue is back like mine.
However, if you are going to expand your anterior teeth forward and move your lower jaw forward as well , like I am, you are going to need that 35 imw between your premolars 2. The tongue is going to move forward.
I am DESPERATE to have that width now.
Can I please ask if you also have had the other consequences of a narrow palate that I have? I have seen 100 doctors in the last two years to figure out a host of related problems. The biggest is the tongue too far back in the mouth, which blocks the trachea: and has caused me to develop a forward head posture, with my chin tilted up---to open the airway. This has led to military neck (a reverse curve in the spine), and neck and shoulder pain. In other words, I was [Rude Language or Insults are not tolerated] by those premolar extractions big time.
Looking forward to hearing your own experience! And if you like we can chat sometime by whatsapp, and we can share our treatment plan ideas. I have done a lot of research--and interviewed almost all the experts on the topic--and have come up with what I think is a plan that may work.
No way I am not going to fix this! it is hell (and becomes so much worse when you get older).
and thanks again for your smart post!
I share the same symptoms as you - forward head posture, too little space for the tongue, tongue blocks the airway etc. However, these symptoms are shared by everyone with Craniofacial distrophy. Mike Mew calls extractions a "Red Herring" because they're not exactly the root cause of the problem. The root cause is tongue posture, and everyone who had extractions is messed up because they were already messed up, which is why they got extractions in the first place.
Here's my treatment plan for now - Mew, Hard Mew, Chin Tuck, Perfect Posture, Suction Hold etc. Dedicate myself to these things aggressively for the next two years and see what happens. You can see my other posts/comments where I talk about 'walking with an extreme chin tuck' and why I feel that this is the best strategy. If expansion is possible with the tongue at my age (27), I want to leave no stone unturned to achieve it. I do not want to use an appliance and I'll explain why.
1. The results from an appliance are not holistic/harmonious - Every appliance only creates one-dimensional expansion. Compare this to the tongue which (theoretically) creates expansion in the upward, forward and sagittal directions at the same time and in a holistic fashion which is consistent with the surrounding bones. I feel that you fell prey to this property of appliance-generated expansion: you had forward but not sagittal expansion, leading to your tongue being in a very awkward place now.
2. The results from an appliance may or may not be stable - Without proper tongue posture, the results from an appliance will not be stable. Well then, if aggressive posture is necessary for stable results, and can also be used to generate results, why not start there in the first place? Evidence is building up that this is possible in adults (helmut, Progress and Sailor's transformations).
Of course at the moment, I cannot confidently say that this treatment plan will work. But the day I achieve even 1mm of expansion, I don't see a reason why it cannot be scaled up.
I do not agree with you that the tongue is responsible for the consequences due to premolar extraction. Rather premolar extraction makes it impossible to have good tongue posture. See the study where 85% of people who have had extractions have "atypical swallowing" (google it).
One loses 1.4 centimeters of bone due to extraction, i.e. 1.4 less space for the tongue. This leads to incorrect tongue posture.
Whether incorrect tongue posture was there to begin with is a second issue. I had perfect teeth and occlusion before my extractions, so my own case is a fluke: mine was a case of an orthodontist inventing an excuse (4 impacted lst premolars, which is medically non-existent) to do extractions and give me braces. My own tongue posture was a piece of cake before the extractions; impossible afterwards, as I have a 40 mm tongue that cannot fit into a 28 mm. imw.
If you have had premolar extractions, please take this survey.
It is to raise social awareness. If the numbers are high enough (100,000 plus), it can put pressure on the orthodontic board to provide reversal treatment free of charge.
Could you please forward it onwards on social media?
Goal: 100,000 responses.
imw is defined by your first molar, not first premolar you want it to be as large as possible, it is limited only by your mandible. if it is over expanded, it will relapse back to it ideal imw distance
Hello--if anyone is interested in taking my survey on premolar extraction consequences, I send a full three page overview of ALL possible reversal techniques, from SFOT to MSE to FAGGA to Implants, pluses and minuses.
Here's the survey: https://forms.gle/F5LEdN9ujjiMu4Mt6
As for the info in my overview: it comes from interviews with over 150 doctors, from Won Moon to Bill Hang....and readings of hundreds of research articles in medical journals.