Invisalign Extraction Orthodontic Treatment Review for Protrusive Mouth

Hello.

Today, I’ll talk about Invisalign extraction orthodontic treatment.

There seem to be people who say, “Extraction treatment absolutely cannot be done with Invisalign.”

Some of you may think extraction treatment is impossible with Invisalign, but that is not true.

I’m writing this post to break that preconception.

This patient came in for protrusive mouth correction.

Looking from the front, the upper teeth cover the lower teeth a lot.

The lower teeth are barely visible.

This type of malocclusion is called deep overbite.

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The upper teeth are also protruding a lot.

The alignment was not good either, so extraction treatment was recommended.

The plan was to extract the two upper premolars, and for the lower jaw, after removing impacted wisdom teeth, to place mini-screws and move the teeth backward without extracting premolars.

The orthodontic appliance was Invisalign, and the patient started wearing the aligners in March 2023.

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Eight months after starting treatment, as the front teeth moved into the extraction spaces, the originally deep front-tooth bite was observed to become even deeper.

To address this, although it had not been part of the original plan, two additional mini-screws were placed in the front teeth area and elastics were started.

There were periods when the patient did not wear the aligners properly, so the aligners did not fit well and we had to go back to an earlier set.

The attachments also did not fit well with the aligners, so we had to reattach them.

Each time aligners are remade, the wait for the new ones is more than a month.

That time is wasted, so it is best to minimize it as much as possible.

If aligners do not fit well and they are remade every time, the orthodontic treatment period becomes too long.

From March 2023 to May 2024, after wearing 52 aligners over 1 year and 2 months, here is the condition at the time of remake.

The deep overbite improved well.

The combination of mini-screws and elastics is a key technique for successful Invisalign extraction treatment.

It is not planned from the beginning, but it is an important tool used appropriately in the middle of treatment to control inappropriate tooth movement.

There is still some extraction space left, and further improvement in the front tooth angle is needed.

The lower molars moved well into the wisdom tooth space.

After waiting a month for the additional aligners to be made, the second set of aligners was started in June 2024.

After wearing the additional aligners for 7 months, treatment was completed in January 2025.

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Improved deep overbite and aligned midline

The protrusion of the front teeth also improved a lot.

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This is a before-and-after comparison.

The total treatment period was 1 year and 11 months, and the actual time wearing the aligners was 1 year and 9 months.

If the upper teeth protrude severely, the lower lip catches behind the upper teeth, so when the mouth is closed, the tips of the upper teeth show slightly.

This is a condition in which the lips cannot close comfortably, and it is called lip incompetence.

Let’s look at the before-and-after facial photos.

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Common concerns about extraction orthodontic treatment include nasolabial folds, lengthening of the philtrum, and the lips being pulled inward.

None of these are visible here.

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The lip protrusion was resolved, and it became easier to keep the mouth closed.

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The protrusive appearance was also resolved, and the lip volume was well maintained.

No one likes the unwanted side effect of extraction treatment, a sunken lip appearance.

Such side effects should be considered from the treatment planning stage.

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The improved front tooth angle stands out and gives a cleaner impression.

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A well-maintained smile line and proper buccal corridor are important parts of smile aesthetics.

This has been an introduction to the changes over 1 year and 11 months.

You are undergoing Invisalign treatment, but the aligners do not fit?

Don’t worry about that either.

With appropriate intervention and accurate judgment, Invisalign extraction treatment is possible.

This case achieved good results in less than 2 years with one remake.

Please get a consultation at a nearby orthodontic clinic.