CASE · Orthodontics
Orthodontic Retreatment for a Protruding Mouth After Two Rounds of Braces (Case Study)
Braces three times can sound surprising, but it happens more often than people think. This man in his 30s still had a protruding mouth after two previous rounds of braces, including extraction treatment. This time we did not extract more teeth; we used mini-screws to move his entire arch back.
Case at a glance
- Concern: Wanted his mouth to look less protrusive (man in his 30s, third orthodontic treatment)
- History: two previous courses of braces, including extractions
- Diagnosis: mild residual protrusion; upper incisors pushing the lower lip outward; small spaces between teeth (possible relapse); a slightly deep bite
- Exams: side X-ray, panoramic X-ray and CT to confirm bone space behind the teeth
- Treatment: no extractions; level the arch, then move the whole arch back with mini-screws; light enamel reduction (IPR) to close black triangles
- Expected time: about 1.5 years
Why can a mouth still protrude after extraction braces?
Even after extraction treatment, protrusion can remain depending on the skeleton and tooth angles. His case was not severe, but the protrusion was visible in his facial photos and the alignment was not perfect. Most importantly, he really wanted his mouth to sit further back.
The side X-ray showed his upper incisors pushing his lower lip forward, which meant moving the upper front teeth back could let the lower lip settle back too.
Why no further extractions?
He had already had extractions. Removing more teeth could significantly reduce chewing efficiency. Instead, we chose to use the space left after wisdom tooth removal to move the whole arch back.
A 2D X-ray cannot show bone volume precisely, so we confirmed it with CT. Only after seeing enough bone behind the arch did we decide on non-extraction treatment.
How was the whole arch moved back?
First we leveled the arch. Pulling crooked teeth back makes them tip instead of moving bodily. His teeth were already fairly well aligned, so this phase went quickly.
Then, using mini-screws (TADs) in the bone as anchors, we pulled the whole arch back gradually with elastic chains. In conventional braces the teeth pull against each other, so moving one part back pushes another forward; anchoring to bone lets the whole arch move in one direction.
What did the result look like?
His teeth are aligned and the protrusion is clearly reduced. On the side X-rays, the upper incisors no longer push the lower lip, and the upper and lower lips are balanced. A small worn area on the upper left incisor will be repaired with composite.
At the end he told me he was glad he probably would not need braces again in his 40s.
Can anyone have non-extraction distalization?
The bone space behind the teeth differs from person to person. Many people have some room, but it must be confirmed on scans. Some orthodontists believe the arch cannot be moved back without extractions, but it is possible when the bone allows. Fees depend on the appliance and time and are quoted after an examination.
Frequently asked questions
Can retreatment really bring the lips back?
It depends on bone space and tooth angles. We measure the available movement on CT before deciding.
Will I need extractions again?
If teeth were already extracted, more extractions can reduce chewing function. He was treated without extractions.
Are the mini-screws removed?
Yes, after treatment. While in place they can cause inflammation or come loose.
How do I keep it from relapsing this time?
Wear your retainers as instructed and have them checked regularly.
About the reviewer
Dr. Sunmin Kim is the lead dentist at Ceramic Dental Clinic in Gangnam, Seoul, a board-certified orthodontist (Ministry of Health and Welfare, Korea) with a PhD from Tokyo Medical and Dental University. Our clinic is registered with the Ministry of Health and Welfare to treat international patients.
Important information
This is a real case. Results, treatment time and the number of visits vary from person to person.
During orthodontic treatment, temporary pain or discomfort, gum recession and root resorption can occur. Teeth can shift back if retainers are not worn after treatment. Mini-screws (TADs) can cause local inflammation or come loose.
Photos show teeth and X-rays only and are published with the patient’s consent.
Questions about your own teeth?
Send us photos of your teeth for a preliminary opinion. A final plan and quote are given after an in-person examination.
Ask on WhatsApp