Orthodontic Treatment for Severe Protruding Mouth, Lip Incompetence, and Walnut Chin Creases with Extraction

Hello,

This is Apgujeong Orthodontic Clinic.

Today, we will share a treatment case of severe protruding mouth and lip incompetence.

What patients most worry about with extraction orthodontic treatment for a protruding mouth is

<Orthodontic treatment makes me hesitate because I’m afraid my front teeth will be pushed in too much and I’ll end up with a sunken or pursed appearance.> That’s usually the concern.

On the other hand, there are also cases where the protrusion and crowding are so severe that the front teeth need to be moved as far back as possible.

Today, I’ll talk about that second type of case.

Orthodontic Treatment for Severe Protruding Mouth, Lip Incompetence, and Walnut Chin Creases with Extraction

23.08~25.10

I will show you the process of achieving the best possible result while minimizing side effects in a complex case mixed with severe protrusion that makes it hard to close the mouth, walnut chin creases, a receding chin, deep overbite, and scissors bite.

This patient visited us in August 2023 for orthodontic treatment.

23.08

The upper and lower midlines are misaligned,

and there is a severe deep overbite, with the upper teeth covering the lower teeth so much that the lower teeth are barely visible.

The blue arrow indicates a scissors bite, where the upper and lower molars interlock in a crossed way.

The second molar indicated by the blue arrow was pushed outward, causing the scissors bite.

The front teeth are also quite crooked.

23.08

Most of all, the facial appearance shows a receding chin and lip incompetence caused by severe dental protrusion.

In other words, the mouth cannot comfortably close.

To close the mouth, the patient has to tense the chin, which creates wrinkled walnut-like creases on the chin, resulting in a walnut chin.

On skeletal analysis, the patient has a slight skeletal receding chin, but this chin muscle over-tension makes the receding chin appear more severe than it actually is.

We explained that extraction orthodontic treatment would involve removing four premolars, and then began treatment.

We explained that both Invisalign and Clippy-C would produce similar results and take a similar amount of time, and the patient chose Clippy-C.

This is the patient 10 months after starting treatment.

For smooth improvement of the scissors bite, extraction of impacted wisdom teeth was necessary, so the patient also had the wisdom teeth removed.

24.06

We are closing the extraction spaces while moving the front teeth backward.

To improve the scissors bite, orthodontic mini-screws are needed in the palate.

Because the situation required moving the front teeth as far back as possible, we placed orthodontic mini-screws not only in the palate but also on the cheek side and proceeded with treatment.

After continuing treatment like that, in November 2025 we finally finished treatment and removed the appliances.

25.11

The total treatment period was 2 years and 3 months.

At our clinic, extraction orthodontic treatment lasting more than 2 years is relatively rare.

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

The scissors bite was resolved as the molars indicated by the blue arrow moved toward the palate.

A fixed wire retainer has also been attached on top of the nicely aligned teeth.

The misaligned midlines are now perfectly aligned, and the deep overbite has been resolved, so the lower front teeth are now visible normally.

In addition, the irregular gumline of the lower front teeth, which had looked uneven because of uneven tooth heights, has been somewhat organized as the teeth were aligned.

As the scissors bite in the area indicated by the blue arrow improved, the molar bite now shows a tight Class I occlusion.

23.08~25.10

The front teeth, which had been severely protruded, have found their normal angle.

As the walnut chin crease (walnut chin) made the originally receding chin look even more severe than it really was, the chin line has clearly improved.

23.08~25.10

At last, the mouth closes comfortably.

23.08~25.10

The lip line has moved inward by an appropriate amount, without being excessive, and looks balanced and attractive.

When a protruding mouth is corrected, the nasolabial angle decreases, so the nose can also appear higher.

The front teeth moved back by more than 6 mm, which is more than in a typical extraction case, but no side effects such as a sunken appearance are seen after treatment.

The change in lip line is as dramatic as the change in the teeth.

As lip incompetence was resolved and the chin tension was released, the uneven chin line became smoother.

The panoramic X-ray shows good root parallelism and no root resorption.

In fact, when severely protruded front teeth are brought back to their normal angle, the tooth roots may appear longer on the panoramic X-ray, as in this case.

The more severe the protruding mouth, the greater the amount the front teeth need to be moved backward, and accordingly, the risk of side effects such as a sunken appearance or root resorption also increases.

However, if you meet a skilled doctor who considers not only aesthetics but also the health of the gums and teeth during treatment, good results without side effects can be achieved within a not-too-long period.

I hope this was helpful for those who are considering extraction orthodontic treatment for a protruding mouth.