Invisalign Extraction Orthodontic Review for Protrusive Mouth and Crowding

Hello,

This is Apgujeong Orthodontic Clinic.

Looking at the average treatment time for patients who completed extraction orthodontic treatment with Invisalign at our clinic, it is about 2 years and 6 months.

Of course, there are variations depending on age, the degree of malocclusion, and how long the appliance is worn.

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Today, I’d like to talk about an Invisalign extraction case that took 3 full years and 3 remakes in a situation where the skeletal disharmony was severe and appliance compliance was inconsistent.

2022.11

This patient came from a distant province for treatment of a protrusive mouth.

The upper teeth protrude significantly.

They stick out about 1 cm more than the lower teeth.

The normal gap between the upper and lower front teeth is 1–2 mm.

The lower arch has severe crowding.

Based on the skeletal analysis, this is a skeletal Class II malocclusion accompanied by severe forward protrusion of the maxilla.

Protrusion caused by maxillary excess is one of the more difficult types of protrusive-mouth correction.

Because the skeletal disharmony between the maxilla and mandible is severe and the lower jaw is relatively positioned backward, it is not easy to keep the upper front teeth at an ideal angle.

To resolve the upper-teeth protrusion to the point where the mouth cannot close properly and the severe crowding in the lower teeth, extraction of four premolars is unavoidable.

The treatment goal is to prevent the lower front teeth from moving any farther back from their current position,

and to use the extraction spaces to retract the upper teeth as much as possible in order to reduce the gap between the upper and lower front teeth.

You chose Invisalign orthodontics, and treatment begins.

23.06

This is the result after wearing all 72 aligners over 1 year and 6 months until May 2024.

24.05

The midline aligned well, and we proceeded after placing orthodontic screws to improve the overbite.

Because about 1 mm of extraction space remained on each side in the maxilla, we moved on to a remake.

Aside from a small amount of remaining extraction space, the root parallelism was good and there was no tipping of the molars, so up to that point it seemed likely that the total treatment period would not exceed 2 years.

After waiting about a month for the additional aligners to be made, this is the result after wearing all 23 additional aligners from June to October 2024.

24.10

During the additional aligner treatment period, the patient could not wear them as diligently as before, and although I asked them to wear the elastics all day, due to personal circumstances they only wore them while sleeping.

So even after wearing the additional aligners for 6 months, the overbite remained unchanged.

And the extraction spaces remained surprisingly unchanged.

Of course, I know that wearing a removable appliance for more than 20 hours a day is not easy. Still, what I always tell patients is that it is better to finish Invisalign treatment quickly and decisively.

We had no choice but to proceed with another remake, and this is the result after wearing all 17 additional aligners from November 2024 to June 2025.

2506

The midline became perfectly aligned.

The extraction spaces were also nearly gone.

However, a tiny space remained where dental floss could still fit loosely into the extraction site, so we decided to do a third remake.

At that time, the patient was also very busy with personal matters.

From July 2025 to January 2026, we finally completed treatment after managing to wear all 15 additional aligners.

26.01

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

The total treatment period was 3 years and 2 months, and there were 3 remakes.

2022.11~2026.01

2022.11~2026.01

The molar bite is good, with no open areas.

Let’s look at the facial comparison.

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The smile line, which had been mismatched with the shape of the mouth and appeared flat, was transformed into a smile line parallel to the lower lip.

2022.11~2026.01

The front teeth angles are appropriate, and

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The lip incompetence has been resolved, and now the mouth can finally close comfortably.

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A beautiful mouthline has been completed.

2022.11~2026.01

In a skeletal case with severe maxillary excess, orthodontic treatment cannot move the upper jaw bone inward, but at least the upper front teeth can be nicely retracted through orthodontics.

2022.11~2026.01

Over the 3-year treatment period, there was no root resorption, and root parallelism was good.

The reason I always include before-and-after panoramic X-rays in extraction orthodontic cases is

to reassure patients who come in after hearing the incorrect information that Invisalign cannot move roots.

The lower front teeth were maintained as planned without moving back even 1 mm, and the upper front teeth were retracted as much as possible within the limits allowed by the alveolar bone in order to meet the lower front teeth.

I hope this was helpful for those considering Invisalign extraction treatment for protrusive mouth correction.