Hello,

This is Apgujeong Yonsei Baro Dental Clinic, a Gangnam orthodontic clinic specializing in Invisalign.

Today’s topic is Invisalign extraction treatment for a protruding mouth.

During initial Invisalign consultations, patients often ask about what they were told at other dental clinics.

One question we hear frequently is:

“I heard that Invisalign cannot move the roots very well. Is that true?”

If the roots do not move, extraction treatment cannot be completed properly.

That is because the key to extraction treatment is moving the roots parallel to the extraction spaces.

With Invisalign, it is possible to develop an appropriate treatment plan and achieve effective root movement with proper treatment.

22.08

The patient wanted to correct two concerns:

A protruding mouth and a gummy smile, in which a large amount of gum shows when smiling.

The overbite was severe, so the lower front teeth were covered by the upper teeth and could not be seen.

22.08

There are various types of protruding mouths. When the front teeth are not flared forward but the area around the gums appears prominent, this is described as gum protrusion.

The two upper premolars were extracted before beginning Invisalign orthodontic treatment.

The Most Important Part of Extraction Treatment Is Root Movement

Extraction treatment does not simply move the crowns of the teeth backward.

Into the extraction spaces,

• the roots of the teeth must move along with the crowns,

• the teeth must not tip over, and

• the roots must be arranged parallel to one another

in order to achieve a stable result.

In other words, the key to extraction treatment is “root movement.”

22.09

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

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

They are not visible during normal conversation, and depending on the shape and size of the mouth when smiling broadly, they may or may not be visible.

This patient had excellent compliance and wore the aligners diligently.

In May 2023, nine months into the first set of aligners, there was a period when the patient was unable to wear them properly due to personal circumstances.

At that point, the molars could be seen tipping into the extraction spaces, so all of the remaining aligners were discarded and the first refinement set was produced.

After the additional aligners were manufactured, there was a one-month production period. The patient began wearing the second set in July 2023.

From this point, mini-screws were placed near the front teeth and elastics were used together to actively improve the gummy smile.

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At the time the refinement aligners were produced, approximately half of the extraction spaces remained.

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

24.07

The overbite had been corrected and most of the extraction spaces had disappeared, but the dental midline was still slightly misaligned.

24.07

A small gap remained in the extraction space,

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and there was an area where the molar occlusion was not fully contacting, so another refinement was made.

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

24.12

The dental midline is well aligned.

To correct the gummy smile, the upper front teeth were intruded, causing the gums to cover much of the teeth and making the visible tooth height shorter.

Now that orthodontic treatment is complete, the gum line will be refined through gum contouring.

Gum Contouring After Gummy Smile Improvement

After orthodontic treatment, gum contouring was performed to create natural-looking tooth length and an aesthetically balanced gum line.

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Treatment is not completed if the occlusion is not satisfactory.

Left – Before treatment / Right – After treatment

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This is the result after the retainers were also placed.

22.09–24.12

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

22.09–24.12

22.09–24.12

The improvement in the gummy smile is noticeable.

22.09–24.12

A balanced smile with the protruding appearance reduced without looking excessive.

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24.12

The teeth moved parallel to one another all the way to the roots, without the molars tipping into the extraction spaces.

Can Invisalign move the roots?

Yes, it can.

Managing Variables Is Important in Invisalign Extraction Treatment

Extraction treatment is generally a long-term treatment that takes approximately two years.

With Invisalign in particular, unexpected variables may arise if the patient is unable to wear the aligners for a sufficient amount of time.

However, even in these situations,

• accurately analyzing the current condition,

• producing additional aligners when necessary, and

• flexibly modifying the treatment plan

can still lead to a good result.

This is Apgujeong Yonsei Baro Dental Clinic, a Gangnam orthodontic clinic.