Protrusive Mouth Invisalign Extraction Orthodontics, Gummy Smile, Gingival Display, Lip Incompetence, Chin Retrusion, Re-orthodontic Treatment

Hello, this is Yonsei Baro Dental Clinic, an Invisalign orthodontic clinic in Apgujeong.

If the protrusion is severe enough that the mouth cannot close comfortably, extraction orthodontic treatment is necessary.

As for the debate over whether extraction orthodontic treatment can really be done well with Invisalign or not, I’ll leave that to previous posts.

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Today, I’ll show a case in which protrusive mouth extraction orthodontic treatment was done while simultaneously improving a gummy smile through intrusion of the entire maxillary dentition and resolving a retruded chin.

This is a patient in their 20s who visited for orthodontic treatment in July 2023.

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They had previously undergone non-extraction orthodontic treatment a long time ago.

The front teeth are fairly aligned, and the midline is also almost correct.

The bite is in good condition, and

The dental arch is also quite well aligned.

From the intraoral photos alone, you might wonder why a re-orthodontic treatment would be needed, but what the patient wanted to correct even if it meant re-treatment was:

protrusive mouth

gummy smile.

In severe protrusion cases, lip incompetence can occur, where the lips cannot close comfortably, and as shown in the photo, tension builds in the chin, creating a chin dimple and chin wrinkling.

As a result, the chin can appear as if it is retruded.

For this part, it would be good to refer to the content on Cheongdam Dental Michelin’s YouTube channel.

The gummy smile was also quite severe, and to address the protrusion and gummy smile, four premolars were extracted before treatment began.

The treatment method chosen was Invisalign, and the first set consisted of 85 aligners.

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Treatment was carried out by replacing one aligner each week.

To improve the gummy smile in extraction orthodontic treatment, rubber bands that the patient can take on and off are prescribed along with orthodontic screws.

The patient diligently wore the aligners and rubber bands.

This is the appearance after wearing all 85 aligners over 1 year and 10 months until May 2025.

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The midline is well aligned, and

There is still a small space between the front teeth.

The molar occlusion is in good condition.

To eliminate the slightly remaining extraction space, we began making additional aligners.

There were 11 additional aligners, which were worn from June 2025 to September 2025.

And this month, the treatment was finally completed.

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The midline is well aligned, and

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The molar occlusion is good.

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

The total treatment period was 2 years and 2 months, and one remake was made.

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This includes the retainer as well.

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Now let’s look at the facial comparison.

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The bumpy chin wrinkling has disappeared.

The mouth closes much more comfortably, and the lips can be seen to have become thinner compared with the beginning.

Lip thinning is an unavoidable aspect of extraction orthodontic treatment for protrusion, but because the patient’s lips were originally full at the initial consultation, this thinning did not appear as a side effect.

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Seeing the lips finally close comfortably makes me feel relieved as well.

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What is noteworthy is the change in the shape of the chin.

As the protrusion improved and lip incompetence was resolved, the unnecessary tension in the chin also relaxed, contributing to the change in the jawline.

However, as seen in the superimposed X-ray images below, mandibular autorotation occurred due to intrusion of the entire maxillary dentition, and the chin actually moved forward.

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The gummy smile has been completely resolved, and the smile line and buccal corridor are appropriate.

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The beautiful angulation of the front teeth stands out.

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Over the 2 years and 2 months of treatment, there was no root resorption, and root parallelism is good.

Looking at the superimposed initial and final lateral X-rays, the upper front teeth can be seen to have intruded by about 3 mm and moved backward by 6 mm.

A 3 mm intrusion is quite a significant amount even in gummy smile correction, and the fact that there was no root resorption during treatment is precisely an advantage of Invisalign orthodontics.

Based on clinical experience, Invisalign orthodontics causes much less root resorption than Clippy C orthodontics. Of course, this is something that still requires research.

What deserves more attention than the amount of retraction or intrusion is that significant mandibular autorotation occurred.

The lower facial height was dramatically shortened, and the chin moved much farther forward due to mandibular rotation.

For an adult who is not in the growth period, this degree of mandibular position change without orthognathic surgery is a remarkable result.

I hope this post helps those considering extraction orthodontic treatment for protrusion.