Can’t Close the Mouth? Lip Incompetence? Walnut Chin Orthodontic Correction?

Hello,

Today I’ll share a story about Clippy-C extraction orthodontic treatment.

2309~2506

It would be good to focus on the process of comfortably closing the mouth.

I’ll also show why it is important to pay attention to brushing during Clippy-C orthodontic treatment.

The patient visited in the fall of 2023 for orthodontic treatment.

23.09

The two front teeth look very large.

In fact, the patient’s front teeth are not actually large. Teeth follow strict perspective rules inside the mouth, so if they protrude farther forward than the other teeth, they can look relatively larger.

The front teeth are severely protruded.

Because the protrusion was limited to the upper teeth, we decided to proceed with orthodontic treatment after extracting two upper premolars only.

The patient chose Clippy-C braces, and treatment began.

This is what it looked like 9 months after starting treatment.

The whitish area around the bracket indicated by the blue arrow is a demineralized area caused by inadequate brushing.

It is also called tooth decay, and in reality it is early-stage cavities.

Unlike Invisalign, Clippy-C braces make it difficult to thoroughly clean around the appliances and attachments when brushing.

This is why, for patients with a lot of cavities and poor brushing habits, Invisalign is often recommended over Clippy-C when the diagnosis is otherwise the same.

For patients showing this kind of early cavity formation, we regularly apply fluoride and place emphasis on brushing instruction.

24.06

About half of the extraction spaces had closed.

Below, alignment was being carried out without extraction.

The treatment was completed after 1 year and 9 months.

25.06

The midline is well aligned.

The front teeth, which had looked especially large, were cleared of suspicion once the protrusion was resolved and they became neatly aligned.

25.06

The bite is good.

Sometimes I get asked whether extraction orthodontic treatment with premolars requires removing four teeth for the bite to fit. In cases where only the upper teeth are protrusive, orthodontic treatment with only two upper extractions can also finish with a good bite.

However, do you see the white marks in the areas indicated by the blue arrow where brushing was not done well during treatment? Excluding the square-shaped area where the brackets were attached, the surrounding area has become mottled with early cavities.

If management goes well going forward, it should not be a major problem, but some areas will need resin treatment.

Even though the clinic performs scaling and applies fluoride every month during visits for areas around brackets where brushing is difficult, if daily brushing is not done properly, there is only so much that can be done.

Let’s look at the facial profile changes.

23.09~25.06

When protruding front teeth make it difficult to close the mouth comfortably, it is called lip incompetence.

The protruded upper front teeth rest against the lower lip, making mouth closure feel awkward.

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If lip incompetence is present, a walnut chin wrinkle forms on the tip of the chin. Closing the mouth feels unnatural.

Through extraction orthodontic treatment, the front tooth protrusion was resolved and the lip line became more attractive, allowing the mouth to finally close comfortably.

There was no root resorption, and root parallelism is good.

23.09~25.06

As the protruding mouth was resolved, the lip line became more attractive.

I hope this was helpful for those considering extraction orthodontic treatment for protruding teeth.