A Child’s Protruding Teeth Correction Review: Difficulty Closing the Lips

Hello.

This is Apgujeong Yonsei Baro Dental Clinic, introducing

Gangnam clear aligners

and Invisalign First for children’s orthodontics in Gangnam.

Orthodontic treatment for children is not simply a treatment to straighten the teeth.

During growth, not only the teeth but also the jawbones and surrounding soft tissues change. Therefore, treatment at the appropriate time can improve protrusion and bite problems more favorably.

In particular, when a child is planning to live abroad or study overseas, the treatment plan must be prepared in greater detail. The number of appliances, timing of remakes, and retention plan must all be considered to complete treatment reliably.

23.10~24.12

In the middle of treatment, an unexpected plan to move abroad suddenly came up.

Although treatment had to be completed in one year and two months, fortunately, it ended successfully.

In October 2023, an 11-year-old child visited us for orthodontic treatment.

23.10

From the parent’s perspective, the main concern was the protrusion, and the front teeth were relatively large.

23.10

The lateral incisor indicated by the blue arrow was in crossbite, biting behind the lower tooth.

Because the upper front teeth were flared, or protruding, the child also had lip incompetence, making it difficult to close the lips comfortably. This had resulted in wrinkling and an uneven appearance of the chin muscle, known as a “walnut chin.”

Q. Can difficulty closing the lips also be improved with orthodontic treatment?

When the cause is dental protrusion, it may be improved. As the position and angle of the front teeth improve, less force is needed to close the lips, allowing them to close more comfortably.

23.10

Although there was no lack of space for the teeth to erupt, we decided to relieve the front-tooth protrusion to some extent through a small amount of arch expansion.

Complete resolution of the lip incompetence or protrusion might later require extraction-based orthodontic treatment, but the parent wanted non-extraction treatment.

Since there were no skeletal problems such as a small lower jaw, an underbite, or asymmetry, Invisalign First treatment began right away. The first appliance was started in November 2023.

This was the appearance after wearing the appliance for six months, through April 2024.

24.04

The dental midlines were well aligned,

24.04

and the permanent teeth were erupting well.

The flaring of the front teeth had also improved.

24.04

However, there was still a slight irregularity in the alignment of the lower front teeth, and we began fabricating additional appliances to further address the protrusion of the upper front teeth.

Around this time, the child and family made plans to move abroad, creating a situation in which treatment had to be completed by early 2025.

There was little time, but we had to do our best to achieve a good result.

We calculated the remaining time, established a remake treatment plan, and this was the appearance after wearing one additional set of appliances.

The additional appliances were worn for six months, from May through November 2024.

24.11

The lateral incisor indicated by the blue arrow was raised because its alignment had not been corrected. It showed an edge-to-edge bite with the lower tooth, and this bite interference caused the dental midlines to be slightly misaligned.

24.11

When the Invisalign appliance was worn, it was apparent that the lateral incisor indicated by the blue arrow was not fully seated in the appliance.

Because the appliance had not been seated sufficiently at the beginning of wear, the Invisalign appliance was unable to properly grip the tooth and had missed it.

The departure date was only two months away, and there was not enough time to remake the Invisalign appliance.

An MTA appliance was attached to the six upper front teeth, and the heights of the central and lateral incisors were adjusted over the course of one month.

Treatment was completed in December 2024.

24.12

Fortunately, the alignment was corrected in one month, the midlines were well aligned, and the lateral incisor had erupted into position well.

We do not conclude orthodontic treatment if the bite is not good.

24.12

Although this was orthodontic treatment for a child, the result was comparable to that of adult orthodontic treatment, so a fixed wire retainer was also provided in a manner comparable to adult treatment.

At the time orthodontic treatment ended, three primary teeth were still present.

Let’s look at the before-and-after comparison.

The treatment period was one year and two months.

23.10~24.12

The angles of the previously flared front teeth improved, resolving the protrusion.

23.10~24.12

23.10~24.12

With the protrusion of the front teeth resolved, the aesthetics of the smile improved.

24.12

The root parallelism was also satisfactory.

This is what the changes over one year and two months looked like on X-rays.

As the protrusion was resolved, the lips could close more comfortably.

23.10~24.12

The protrusion of the lips and the walnut chin appearance also improved.

The goal of Invisalign First treatment for children is not simply to straighten the front teeth.

It is more important to prevent malocclusion that may develop during growth and to create an environment in which the permanent teeth can erupt properly.

In this case, there was an unexpected variable—the family’s sudden move abroad during treatment. However, through detailed treatment planning and the appropriate use of auxiliary appliances, treatment was completed reliably within the planned period.

In particular, as the previously flared front teeth improved, the lips could close more comfortably, and the walnut chin appearance was naturally reduced as well.

If you are hesitating about orthodontic treatment because of plans to live or study abroad, rather than giving up, we recommend first consulting with an orthodontist to find out whether a treatment plan suited to your circumstances is possible.