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Adult, Class I bimaxillary dentoalveolar protrusion

Réalisation de Dr Sylvain Chamberland, Orthodontist

Comprehensive treatment with 4 premolars extraction.

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  1. Goli says:

    Hello doctor
    I’m goli from Asia
    At first Please forgive me if my English is not good.
    I have a question ,I’m 33 with bimaxillary prutrosion ,
    my doctor told me for correction I have to extract 4 first premolars ,
    can you please tell me that my facial height specially my lower anterior facial height would be changed after that (shorter or longer?)and what happened to my lips ,do they become thinner or thicker?
    And what about my nose I would be appeared bigger and prutoded ?
    Thank you

  2. Bimaxillary protrusion

    Hi Goli,

    Sorry for the delay to answer you question.

    Extraction of 4 first premolar won’t have an effect on the vertical dimension. It will not increase or decrease. However, in some case with deep overbite and low mandibular plane, it might be ill advice to extraction in the lower arch.

    The goal, in a patient that have bimaxillary trotrusion is the reduce that protrusion. Therefore, it is expected that the extraction of 4 firs premolar will permits to rectract the anterior teeth and reduce the dentoalveolar protrusion, hence reducing the protrusion of proclination of the lips. This is somthing we want to happen in such cases. The thickness of you lip will remain about the same, but they will be less protruded.

    I would like to show you the result of 2 cases that had 4 first premolar extracted.

    You will notice that in case #1, the procumbency of the lower lip was reduced and the relationship with the upper lip imporved. By the way, case #1 is the case shown above with intraoral photos. The detailed treatment is available in french (follow the link).

    In case #2, the retraction of the teeth help to reduce the procumbency of both lips and help achieve contact of the lips at repose.

    In both cases, the vermillion of the lips is not thinner.

    Case 1:

    Bimaxillary dentoalveolar protrusion before and after treatment extraction of 4 premolars-Dr Chamberland orthodontist in Quebec City

    Case #2

    Bimaxillary dentoalveolar protrusion JuLyDer before and after extraction 4 premolars-Dr Chamberland orthodontist in Quebec City

  3. Goli says:

    hi doctor sylvain chamberland
    Thank you for your helpful explanation.

    1. Wow! that is quick. Glad it helped. DId you notice I edited a link to the treatment of case #1.

      Bonne journée

  4. Goli says:

    tnx a billion dr
    Can I send may cephalogram and OPG for you?i want to know your idea if I would be better or worse after that?

    1. Profile lip retruded to esthetic plane-Dr Chamberland orthodontist in Quebec City

      Thank you Goli for sending me the picture of your profile.

      I traced an tangent line from the tip of the nose to the tip of the chin. It is obvious that your lips are retruded relatively to this line. Your profile and your lip support DO NOT reprensent a bimaxillary protusion. Moreover, in your profile smile view, we see deep nasolabial fold. Extracting 4 premolars would be disastrous in your face. The lips would be more retruded, the nasolbial fold would appear deeper, the nose longer and the chin more prominent. And yes, in your case, your lips would likely becomme thinner. You are only 33 and you would suddenly look 63.

      Class I, intraoral view-Dr Chamberland orthodontist in Quebec City  The intraoral view show a nice class I relationship. Even your 3rd molars are in occlusion. There is nor significant crowding.

      Frankly, I don’t understand why you want an orthodontict treatment and I am amazed than an orthodontist recommended extraction.

      En resume, I do not recommend any orthodontic treatment for you.

  5. Anya says:

    hi doctor,

    with the orthodontic treatment for Bimaxillary protrusion

    how long do you need to use braces for, or it’s not necessary to use the traditional braces?

    1. It may take 24 to 30 months. Yes traditional braces is the appliance of choice. To see other exemple visit that link.

      1. Anya says:

        I understand, but since I work in the entertainment industry as an actress, it would be impossible for me to wear visible braces for more than 9months/1year

        is that the only viable option or can I wear for example Invisalign instead of traditional braces??
        maybe also lingual braces? is that possible ? or the only way is really the normal one

        thank you for the attention

        1. It is likely impossible to do such treatment in 9 months. I don’t think Invisalign is a good appliance in a treatment of 4 premolar extraction where the goal is to do maximum retraction of the anterior teeth.

          As for lingual braces, it may be possible, wut it will be very difficult to obtain a good labiolingual inclinationof the anterior teeth.

  6. Maya Hill says:

    Hi I also have protruding at the mouth and was wondering would this make my smile more gummy and can the braces with extractions be completed within 1year ?

    1. Extraction of 4 premolars and retraction of the incisors do not make a smile more gummy. If changes occurs, it may likely reduce the exposion of the gum on smiling.

      A comprehensive orthodontic treatment with extraction of premolars usually take 20-28 months. It is almost impossible to do it in 1 year.

  7. Aya says:

    Hi doctor,
    I think i also have protruding mouth since i cannot close my lips properly. i am currently wearing braces and had 4 teeth extraction to fix it, it’s 2 years now. However, i am not quite sure whether it is a correct procedure or not. My overbite has become deeper after that (completely cover my lower teeth) and gum becomes more prominent when smiling.
    My question is, is this just a matter of time? Do i have to wear this braces longer? Can my teeth be fixed by just using metal braces?

    1. Extraction of 4 premolars and retraction of the anterior teeth was the way to do. However, the orthodontist should mange the mechanics while doing the retraction to avoid deepning of the bite. Yes he can mange to reopen the bite to achieve a normal overbite if he knows the menchanics. It seem he is struggling.

  8. Shweta says:

    Hello sir,
    I am a 28 yr old female and i wanted to know if lingual orthodontics is a suitable option for bimaxillary protrusion ..which is my case. Also i dont want any pm extraction.

    1. Realistic expectation

      If you have some crowding and bimaxillary protrusion and want to solve both problems, extraction of 4 premolars is likely the most realistic treatment plan. Lingual orthodontics may not be the best appliance to close extraction space.

      If you don’t want extraction, then you don’t have other choice but to remain with bimaxillary protrusion.

      1. shweta says:

        Thank you sir…
        sir i have a lot of spacing actually in my anteriors both upper and lower…

        1. When asking me a question. it is important that you provide as much information as you can so I can better understand the problem. Having bimax protrusion with lots of spacing is quite different than a bimax protrusion without spacing.
          Therefore, in your case, it is of outmost importance to close all the spacing by retracting the anterior teeth before any premolar extraction.

          1. shweta says:

            i will surely do that next time….
            thank you soo much for your advise doctor…:)

  9. Pratima sht says:

    Hello dr . I have had braces few years back without teeth extraction . But after getting out my braces i realized upper jaw protusion and the consultant said i had deep bite grade 2 . So can you please mention treatment options for the mentioned problem.

    1. Your queston is too vague. You probably mean that you have a class II malocclusion with deep bite and protruded upper jaw, but there is so many way to address such malocclusion, it is impossible to receommend a treatment without a clinical exam and xrays.
      You should consult an orthodontist.

  10. Cindy Nguyen says:

    Hello Dr,
    I have bimaxillary protrusion, incisor proclination edge to edge, dental midline is deviated to the right and crowding on the upper jaw with one canine is very high

    1/I would like to know the cost for the treatment plan in about 2 year with the choice of metal braces and ceramic braces?

    2/ Without teeth extraction (usually first or second pre- molars), is there any way to reduce the lip protrusion?

    3/Is there any effects of teeth extraction such as narrow airway, speech matter, tongue thrust, extruding lips or chin or drastic changes in facial support?

    4/Is there any way to reduce the length of treatment to 1.5 years? I have heard that people going with Invisalign use Acceledent technology to reduce the treatment length. Can it also apply to traditional braces?

    5/ Would the outcome be so different from the first and second pre-molars extraction treatment plan? Some orthodontics suggest the first prermolars taken out while others think it would be better with the second pre-molars extraction.Those saying the first bi-cupid extraction think that it will create a better harmony relationship between upper and lower jaws (the upper jaw usually covers up 2mm to the lower jaw).

    1. 1/ I don’t discuss the cost of treatment on the website.
      2/ A non extraction approach does NOT reduce the bimax protrusion
      3/ There will be chance in lip protrusion (reduction) chin contour (better contour)
      4/ Acceledent is now proven to be NON EFFECTIVE.
      5/ According to your description, chances are that extraction of the 1st premolar could be more effective for you.

  11. M Salhi says:

    Hi Dr,

    I started my orthodontics treatment based on wrong consultation to close premolaire space and I finished by having deep overlape with midline deviation and malocclusion.
    would you please tell me what is the best solution to correct this problems ?
    my age is now 34

    Thank you

  12. Natasha says:

    Hi Dr Sylvain!

    My teeth are protrusive, with slight overbite (roughly 4mm), my chin looks weak when not smiling, I find it hard to close my mouth on rest and sometimes excess gum shows when smiling. The gummy smile bothers me most. I am unsure however whether the excess gum display upon smiling is to do with me having bimaxillary protrusion or vertical maxillary excess. Would it be wiser to proceed with orthodontic treatment with 4 first premolar extractions (I am unsure whether this will get rid of the gummy smile) or to entertain the idea of getting orthognathic surgery to slightly shift my maxilla upward and eliminate the gummy smile for sure?

    (Also I do like my midface volume so I think if I do get extractions I may not go for 50:50 space closure)

    1. The way I understand the description of your malocclusion, you will likely benefit from extraction of premolars, reduction of the dentoalveolar protrusion and orthognatic surgery that would include Le Fort 1 for superior repositionning of the maxilla, BSSO, and a genioplasty.
      I recommend 100% space closure.

  13. Cindy says:

    Hello Dr,

    My name is Cindy. I’m 38 years old. I have bimaxillary protrusion with the midline deviation and crowding in the lower anterior teeth. I got my 1 st premolars extracted except on the right lower where I got my 2 Nd premolars extracted. My orthodontist advised me to go for Invisalign and he showed me the clincheck results too. Can you please provide me your suggestion if Invisalign could work or the traditional metal braces . Thanks in advance.

    1. I would not use Invisalign in an extraction case. Moreover, at t38, it may be even more difficult. I recommend conventional braces.

  14. Neha says:

    Hi doctor, I have my upper lip protruded. The doctor says that i have to get two premolars extracted from the upper jaw is narrower. Lower jaw is fine so no removal of premolars is suggested. Though the doctor has first advised to go for the braces, but I work in entertainment industry and I can’t get the braces. So for invisalign, the orthodontic says I have to get my two premolars removed. Will that change my facial aesthetics in any way? Is it the right thing to do? Please help asap.

    1. If your upper lip are protruding and the treatment plan is to extract 2 maxillary premolars and retract the anterior teeth, chances are that it will reduce upper lip protrusion. I assumed that it is what you need.
      it may change facial esthetics in some manner.
      I don’t know if this is the right thing to do for you because I never met you and don’t have any photo or cephalogram. I will assume that your orthodontist know what he is doing.
      As for Invisalign, it is OK, but may not be the best appliance to retract with efficiency the anterior teeth.

  15. George says:

    Hi doctor,i have deep overbite and my maxilla protrude.. is there any treatment for my case? Thanks

    1. You may benefit from an orthodontic treatment that could include extraction of maxillary premolar or you may have retrusion of your mandible and you may benefit from orthognathic surgery to advance the mandible. All of this means comprehensive orthodotnic treatment.

  16. Tommy says:

    Hi Dr,
    How do you decide whether first or second premolar should be extracted for Bimaxillary protrusion?
    Extraction of which premolar in theory will achieve more retraction? as we were told to extract first pre molar by one orthodontist, 2nd premolar by another.
    Thank you!

    1. Extraction of 1st premolars will permit more retraction than extracting 2nd premolars. Therefore, if maximum retraction is needed, extraction of 1st premolars would be my 1st choice. If moderate retraction is needed, extraction of 2nd premolars will work fine. The caucasian female above had 1st premolars extraction. The afro-american female had maxillary 1st and mandibular 2nd premolar extracted. She was class II div 1 at baseline and need some camouflage of the class II relationship.
      I hope that help. There may be other subtle reason that may influence the choice, but without seeing a patient I can’t tell.

      1. Tommy says:

        Thanks you for your reply Dr Chamberland! I forgot to say it is for a 13 year old boy. Can I email you a copy of his X-ray?
        Many thanks!

        1. I am departing for vacation today. I doubt that I will be able to reply, but you can send it via facebook.com/drsylvainchamberland.
          PS: it is a cephalogram that I need. The pan may be of some help too.

  17. Jeelan S says:

    Hello doc,
    I have bimaxillary dentoalveolar protrusion and I also had my upper left second premolar removed quite a while back. Is there any chance the latter going to effect my treatment for protrusion.

    1. It could be indicated to remove 3 other teeth to obtain symmetry and retract anterior teeth.

  18. Kristie says:

    I was wondering, Can I get treatment even though I’m from America and speak English?

    If so, I have a problem. I’ve had my braces taken off almost a year ago but my orthodontist did not do a good job. I have an uneven jaw now. My lips protrude passed my chin and underneath my nose like in your examples. I haven’t had my teeth extracted or had surgery for my jaw but I am willing to.

    How long do you think treatment will be and how many options do I have? Thank you, have a nice day.

  19. Jackie says:

    Good day doctor I have a question.

    I have extracted 4 teeth to the back and is now wearing braces however I was told that I have a bimaxillary protrusion and have to extract 4 more teeth. I was also told that I had extra teeth. My question is since I have already extracted 4 molars do I have to extract the 4 premolars??

    1. It is not unsual to have the 4 wisdom teeth removed and 4 premolars. The removal of 4 teeht in the back has no effect on the bimax protrusion.

  20. Jeff says:

    Hi Dr. Chamberland,
    Would I be able to forward you my cephalometric xray, panoramic xray, and several pictures of myself to determine whether I am to be considered bimaxillary protrusive, and whether I would benefit from some variety of treatment?

    1. You can send it via my professional facebook page. If you dod so, it means that you accept that I can use some of the xray and intraoral photo to answer on this web page. I WILL NOT publish your face or identity.

  21. deepak says:

    in which treatment to cure case 2 in this picture doctor

    1. If you mean the afroamerican person, she received a comprehensive treatment with 4 premolar extraction.

  22. Prabodh says:

    Hi Dr. Sylvain,

    Is there any way to find out whether an adult will suffer from obstructive sleep apnea before the extraction of first 4 premolars for treating bimaxillary protrusion?

      1. Prabodh says:

        How long will it take to treat bimaxillary protrusion given that the patient has front teeth vertical (not flared) and normal occlusion?

        1. It will depends on the ability of your orthodontist, but such case usually adult case take 24-30 months in general.

  23. Patricia Lam says:

    Hi Dr. Sylvain,

    I am 24 year old female in Ontario.
    Back in highschool, I sought treatment for what I think is bimaxillary portrusion (my lips don’t close at rest & my front and lower teeth stick out). They took x-rays and eventually, my dentist had my four 2nd molars extracted in order to have my 4 wisdom teeth grow in naturally. It was after the extraction of the four 2nd molars (backmost teeth), that I got my braces put on. I had them on for about 2 years, but still noticed my teeth were sticking out, and my lips still don’t close at rest after they were taken off.

    My teeth apparently have Class 1 alignment or something like that, but I can’t help but be unsatisfied about the overall aesthetic look of my teeth and mouth area of my face as it still portrudes.

    I was wondering if the best approach would be the extraction of the 2nd premolars/braces again or if no extraction/Invisalign would work, as I would rather not get braces again, at my age especially.
    Would pictures help demonstrate my situation?

    Best Regards,

    1. Chances are it would have been a better decision to extract 4 premolars (the 1st or the 2nd) to reduce your bimax protrusion rather than extracting the 4 second molars hoping it will favour eruption of the 3rd molars. It occurs oftent that a bimax prothusion get 4 premolars extracted at the start of treatment and 4 3rd molar extracted at the end ot the treatment.

      If you feel that your teeth are sticking out, that you have difficulty to close your lips, it is still time to extract 4 premolars. I can’t tell if it would be preferable to remove the 1st or the 2nd without seeing you.
      A non estraction innvisalign will not help.
      I thinks braces and extraction may likely be the best solution for you.

  24. Shubham chaubey says:

    Sir,i have had my braces 6 month ago..but i don’t find any change..dentist has suggested me for pre molar extraction..but my father is not getting ready for it.. please help me …whether I should have extraction or not?

    1. If you have protrusion of your lips and dentition, chances are that you may need extraction of 4 premolars. What is the problem with your father?

  25. wenbing says:

    Good day Doctor.
    I have protruding gum (judging from the test that my mouth are not fully closed when i relax my lips as well as gummy smile. I completed invisalign 3 years ago, however, the gums were not visbibly retracted. Doctor said this is due to not extracting teeth. And even if i did extract teeth, it may not guarantee results because afterall it is my upper jaw issue. so now, i look exactly like case #2.
    however, i refuse to do jaw operation. is there any non invasive correction for me to do? pls advise! thank you.

  26. There is no magic. If your gums/ teeth/ lips looks protruded chance are that you need extraction and full comprehensive orthodontic treatment.

    If you have excessive showing of gum at rest and on smile, chances are that you have a vertical maxillary excess, hence you need orthognathic surgery and a comprehensive ortho treatment with or without extraction.

    That is likely your choice.

  27. Diambote says:

    Je suis actuellement un traitement orthodontique avec des bagues, cependant j’ai une protrusion bi maxillaire et tous les orthodontistes que j’ai consulté refusent l’extraction pour mon cas car selon eux il y’a un risque avec ma boîte à langue.
    Qu’avec l’extraction ma langue n’ait plus de place, donc en ce moment mon traitement ne sert qu’à refermer les espaces entres mes dents et je pense que cela ne permettra pas de reculer l’arch dentaire afin d’avoir « un bon profil »

    1. SI vous avez une protrusion dentoalvéolaire bimaxillaire, et que votre dentition et vos lèvres sont proéminentes, je n’aurais aucun problème à procéder à des extractions et rétracter votre dentition.
      Voici un exemple sur ce lien:

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