Invisalign Extraction Orthodontics for Protrusive Mouth, Gummy Smile, and Gum Smile Correction

Hello.

Let me introduce Invisalign in Apgujeong.

Today’s topic is Invisalign extraction orthodontics for gummy smile correction and protrusive mouth.

When doing an initial Invisalign consultation, patients often ask about what they were told at another clinic.

One thing I hear often is:

They said Invisalign can’t move the roots.

If the roots cannot be moved, extraction orthodontic treatment cannot be done properly.

That is because the key to extraction orthodontics is moving the roots parallelly into the extraction space.

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There were two things the patient wanted to improve.

A protrusive mouth and a gummy smile with a lot of gum showing when smiling.

The overbite was severe, so the lower front teeth are covered by the upper teeth and cannot be seen.

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There are many different types of protrusive mouths, but when the front teeth are not flared forward and the gum area appears protruded, this is described as gum protrusion.

Two upper premolars are extracted, and Invisalign treatment begins.

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This photo was taken one week after the premolars were extracted, on the day the first Invisalign aligner was started.

Many patients worry that the extraction space will be visible after premolar extraction.

It is not visible in normal speech, and when smiling widely, it may or may not be visible depending on the shape and size of the smile.

The patient had good aligner compliance and wore them diligently.

In May 2023, the 9th month of the first set of aligners, there was a period when the patient could not wear them properly due to personal circumstances.

At that time, because the molars were seen tipping into the extraction space, all remaining aligners were discarded and the first set was remade.

After remaking the additional aligners and going through a one-month fabrication period, the second set of aligners was started in July 2023.

From this point on, mini-screws were placed in the upper front teeth and elastics were started together to actively correct the gummy smile.

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At the time of remaking, about half of the extraction space remained.

This is the result after wearing all of the first set of additional aligners for one year until July 2024.

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The overbite was resolved and most of the extraction space had disappeared, but the midline was still slightly off.

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There was still a slight gap in the extraction space.

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There was also an area where the molar occlusion was not fully settled, so it was remade once more.

After wearing all of the second set of additional aligners from August to December 2024, treatment was completed in December 2024.

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The midline is well aligned.

To correct the gummy smile, the upper front teeth were intruded, and the gums covered more of the teeth, making the tooth height shorter.

Now that orthodontic treatment is finished, gum contouring is done to refine the gum line.

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The occlusion is not good, and treatment is not yet complete.

Left - before treatment, Right - after treatment

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This is how it looks with the retainer in place as well.

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

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The improvement in the gummy smile is noticeable.

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A moderate lip line with only the protrusion improved, without being excessive

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It is confirmed that the roots moved parallelly into the extraction space without the molars tipping.

Can Invisalign move the roots?

Yes, it can.

Extraction orthodontics is a long-term treatment that takes about two years, and especially with treatments like Invisalign, there are cases where problems arise during periods of improper aligner wear and remaking becomes necessary.

So if the doctor handles these variables well and the patient wears the aligners diligently again, the results can be very good.