Crowded Teeth Extraction Orthodontics, Clippy-C, Side Effects on Lip Appearance, Philtrum, Lips, and Gum Recession

Hello.

This is an orthodontic clinic in Apgujeong.

These days, when I do orthodontic consultations, the thing patients worry about the most is, "What if my lip appearance looks worse than before?"

In particular, after extraction orthodontics, patients worry most about side effects related to lip appearance, such as the mouth being pulled in too much, the face looking longer, the philtrum looking longer, or the lips being tucked in.

During the diagnostic process, when deciding between extraction and non-extraction, my first priority as a doctor is not treatment convenience, but the patient’s lip appearance.

Even if the case is difficult or requires a lot of work, I plan treatment based on the patient’s lip appearance.

23.07~25.04

Today, I will show you the treatment of a patient who had severe crowding and therefore needed extraction, but was worried about the mouth becoming too sunken in.

23.07

This patient came to the clinic for orthodontic treatment in July 2023.

The crowding was severe.

Because the gums were thin, recession had already occurred around some teeth, including the crowded teeth, despite the patient being in their early 20s.

In several areas, the gums had receded and the roots were exposed.

Gums that have receded once through orthodontic treatment do not grow back, but through extraction orthodontics, at the very least, the roots can be moved inward,

which can help prevent further recession.

The patient needed a lot of space to align the crowded teeth, and the gums were thin, so if treated without extraction, the gums could have receded even more.

23.07

Looking at the initial lip appearance, there was almost no lip protrusion, but for the reasons above, we decided on extraction orthodontics involving the removal of four premolars.

The patient understood the reason for extraction due to periodontal health issues, but requested that the mouth not be pulled in too much because of the extraction.

After choosing Clippy-C, we started treatment.

24.01

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

The upper teeth had more severe crowding than the lower teeth, so we bonded the upper arch first and aligned the crowded upper teeth for about four months before bonding the lower arch later. To make the time with brackets on the teeth as short as possible is more comfortable for the patient.

Throughout the treatment period, to minimize the front teeth being pulled backward, we moved the molars forward one by one into the extraction spaces.

By April 2025, the treatment was completed after 1 year and 9 months.

The midline is well aligned.

The molar occlusion is Class I, and the fit is very tight.

Now let’s look at the before-and-after comparison.

The total treatment period was 1 year and 9 months.

Although black triangles are unfortunate in areas where the teeth were severely overlapped, you can see that the gums have filled back in around many of the teeth that had gum recession.

It is generally said that once gums recede, they do not grow back.

However, if the cause of the gum recession was that the teeth were crowded and pushed out of position because there was not enough space, then through extraction orthodontics, as the teeth move from the crowded position to a more stable position, the gums may fill back in.

Of course, this is possible in a young adult in their early 20s.

Many people misunderstand extraction orthodontics as a treatment that removes healthy teeth, so they think it may be harmful to long-term dental health.

But in reality, by extracting teeth, the remaining teeth can be arranged in a more stable position, which helps periodontal health.

Now let’s look at the facial comparison.

Ideal smile line

Ideal front tooth angle

Overall, the lip appearance was well maintained.

Mild root resorption is visible in one or two front teeth.

Root parallelism is good.

I hope this post helps those who hesitate to even start orthodontic treatment because they are worried about the side effects of extraction orthodontics.