In this presentation, a clinician (Speaker A) outlines a novel condition he calls Extraction Retraction Regret Syndrome (ERRS), which he argues has been observed since 1989 in patients undergoing orthodontic extraction space reopening. He describes the clinical workflow—starting with removable appliances to open extraction spaces, progressing to fixed braces that retract roots, and culminating in implant placement and veneers. The speaker defines ERRS as a preventable constellation of aesthetic, functional, and emotional signs and symptoms caused by reduced tongue and airway space due to orthodontic retraction. He enumerates numerous aesthetic changes (sunken, concave facial profile, narrowed smile, darkened corners, etc.), functional problems (headaches, TMJ disorders, breathing difficulties, sinus infections, OSA, balance issues, loss of vocal range), and emotional/psychological impacts (guilt, sadness, despair, rage, suicidal thoughts). A detailed patient case is presented: a 30‑year‑old woman who suffered 16 years, traveled nearly 3,000 miles for care, and documented her orthodontic, surgical, ENT, psychological, and medical history. The speaker concludes that ERRS is a real, preventable syndrome and that treatment options exist to address it.
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Welcome back. This segment is entitled, A New Syndrome. We've been reopening extraction spaces for patients since 1989, and this is a morph showing the process and how it's done. You can see from the occlusal view how we first use a removable appliance to open the spaces, and then we transition to braces, You can see here how implants get placed. This patient then got veneers on her teeth since she wanted to have the best-looking teeth she could have. From the side, you can see the process with removable appliances opening the spaces, followed by fixed braces with the braces angulated to get the roots out of the extraction spaces so implants can be placed. Over time, the space is completely opened up. The implant placement sites have room. From the front, you can see the process and how well the broadening occurs. You can see the implants get placed and everything gets restored. And you can compare the pre- and post-treatment in this picture. It's interesting, we've been doing this since 1989, and we have many people who do it for aesthetics alone, others who do it for aesthetics plus functional reasons. In this particular case, this woman did She did it entirely for aesthetics, but one of the, oh, by the way, Dr. Hang, comments was that she said she used to get 3 or 4 sinus infections a year, and after the spaces were opened, she has had none. We get many comments like this over the years of doing this. I'm a relative slow learner. I've been doing this for 28 years, and this is the first patient that we ever did it on. And it's taken me that period of time to finally realize that we're actually dealing with a syndrome here. A syndrome is a set of medical signs and symptoms that are correlated with each other and often with a specific disease. In this particular case, I've named the syndrome the Extraction Retraction Regret Syndrome, or ERRS. And I've defined it as a constellation of aesthetic, functional, and emotional signs and symptoms caused by tongue space airway reduction from orthodontic retraction, all of which are preventable. Because we call this now the Preventable Syndrome, because retraction is preventable. It is a choice. Let's consider some of the aesthetic challenges that we see. Here are some of them. People say their face is dished in. It's sunken in. It's witch-like or concave. The cheeks are flattened. Lips are thinner. The face is lengthened. The chin is recessed. The smile is narrower with dark corners of the mouth. The incisors are tipped back or pushed back. The smile is darker. There are wrinkles or lines appearing in the face. The nose appears to stick out. Someone says, I look like an old lady. Functional issues are every bit as important, if not more so. Headaches, neck aches, and ringing in the ears are very common. Clicking jaw joints, locking in the TMJs, limited opening, and degenerative joint disease are seen not infrequently. People will say, it feels like my teeth don't fit. I can't close my back teeth together. It feels like my lower jaw wants to be forward. Some people even describe having poor balance. Loss of high singing range. I've had one patient get their high range back when we reopened the extraction spaces. Some say, I can't sleep, or, I snore and I didn't before the treatment. Awake with panic attacks and a rapid heartbeat. Don't awake well rested. Feel like I'm drowning or choking to death. I can't breathe. I have no energy. I fall asleep at the computer worrying about losing my job because of OSA, or upper airway resistance syndrome. And many people have frequent sinus infections. Fibromyalgia diagnosis is not uncommon for many patients who've suffered for years. My jaw feels tight all the time. Forward head posture, and the forehead is tilted back in many patients just to keep their airway open so that they can breathe. And unfortunately, a number of them become addicted to painkillers. The emotional challenges occur for many patients over a period of time. Some start in the, in the beginning, but over time almost everyone has some serious emotional challenges. A feeling of guilt, gee, I should have known better. Or, my family would be better off without me, since my family has spent so much money on having— seeking a solution for my problem. Or sadness: I cry myself to sleep at night. Or despair: I don't care about a possible open bite if you reopen the spaces. I just want to be able to breathe and sleep. Rage or desire for revenge, or to start a class-action lawsuit: The desire to help others avoid the problem. I can't believe they are still doing this to people. And unfortunately, some patients have suicide thoughts when they've suffered for so long and they see no way to get a solution for their problem. Here's a title page from a 3-ring binder that a patient sent to me with 6 separate sections of of annotated pages documenting her orthodontic history, her facial cosmetic plastic surgery, her dental history, ear, nose, and throat, psychological, and medical. She was 30 years old and had suffered for 16 years before she found us. And interestingly, she was willing to travel 2,962 miles from her home in a certain town in Massachusetts to see us in in Agoura Hills, California to find a solution. That's just how motivated she is to, to have something done which can help her. And remember this, for many of these patients, it's all about just being able to breathe better. So, is it a new syndrome? I think it is. ERRS is a very real syndrome, and treatment is available to address it.
