Bimaxillary Protrusion Correction: Surgical vs. Non-Surgical Options - A Specialist's Guide
- Dr. Park
- Nov 15, 2024
- 4 min read
Hello, this is Dr. Park Jong-chul, a specialist in oral and maxillofacial surgery.
One of the main concerns patients have regarding oral and maxillofacial surgery is the correction of a protruding mouth.
A protruding mouth, as the name suggests, is when the gums and teeth protrude forward, making the mouth appear prominent. However, this is relative. A weak chin can also make the mouth look like it is protruding.
Therefore, it is difficult to include all protruding mouth cases within the medical category of bimaxillary protrusion.
This post will discuss protruding mouth symptoms in individuals with the following conditions. If you identify with any of these, please pay close attention.
Symptoms of a Protruding Mouth:
Excessive gingival display when smiling.
Difficulty closing the mouth without conscious effort. This can lead to:
Thickening of the lower lip due to straining to close the mouth.
Appearance of a "cobblestone" chin with wrinkles.
Misinterpretation of a thicker lower lip as a sullen or angry expression.
Treatment Options: ASO Surgery vs. Non-Surgical Orthodontics
To improve these symptoms, should one opt for ASO surgery or non-surgical orthodontic treatment?
Until just a decade ago, orthodontic treatment for protruding mouths was limited to cases where the bone structure was normal and only the teeth were tilted forward. In other words, if the maxilla itself was protruded or there was significant gingival exposure, it was generally believed that orthodontic treatment alone would be insufficient.
However, with the advancement of skeletal anchorage systems, many orthodontists are now achieving dramatic improvements in protruding mouths, challenging the traditional view.
As an oral and maxillofacial surgeon who performs surgery for protruding mouths, I acknowledge the remarkable skills of many orthodontists today.
However, like any procedure, orthodontic treatment for protruding mouths has potential side effects.
Moving teeth 5-6mm or more within the hard bone can cause root resorption or tooth discoloration. Therefore, it is crucial to seek treatment from an orthodontist experienced in this specific treatment.
Even skilled orthodontists may need to prolong treatment to minimize side effects, resulting in treatment times of 2 years or more. This means it takes a long time to achieve the desired aesthetic and functional results.
Furthermore, prolonged use of intraoral orthodontic appliances increases the risk of tooth decay and periodontal disease.
On the other hand, despite the inherent risks of an invasive procedure, protruding mouth surgery offers the advantage of noticeable changes within 2-3 months.
However, I believe that skilled orthodontists can now achieve this degree of tooth movement and facial change with non-surgical orthodontics.
The main difference between ASO surgery and orthodontic treatment for protruding mouths is the time it takes to achieve aesthetic facial changes.
With surgical correction, facial changes are typically complete within 2-3 months. If satisfied with these changes, treatment can be concluded with prosthetics without further orthodontic treatment. However, if additional orthodontic treatment is necessary to close the remaining space (usually around 2mm) to avoid excessive tooth reduction, the overall treatment time will be longer.
As you can see, there is minimal difference between the appearance at 3 months and 2 years 2 months post-op. Achieving this level of change with orthodontics alone within 3 months would be challenging.
Even after just 3 months post-op, we can achieve facial changes comparable to the final result.
Considerations for Protruding Mouth Treatment:
Finally, let's discuss factors requiring careful consideration before undergoing protruding mouth treatment.
First, it's important to check if the lips can close naturally without straining the chin and creating a "cobblestone" appearance.
For those who can close their lips effortlessly, like the individual in the photo, the following factors should be considered:
Philtrum Length: The philtrum may appear longer after surgery. However, for those who strain to close their lips, the philtrum may appear shorter. Philtrum length can vary depending on how it is assessed. Many patients with a protruding mouth strain the muscles around their lips when closing them, causing the upper lip to point downwards and making the philtrum look longer. Therefore, after treatment, when the lips can close naturally, the philtrum may actually appear shorter. It is important to assess philtrum length with the muscles around the lips completely relaxed. A longer philtrum means a thinner upper lip, which may result in the lower teeth being more visible when speaking, leading to a sunken appearance.
Lip Wrinkles: As the teeth and gums supporting the lips move backward, the tension around the lips decreases, potentially leading to fine lines around the lips.
Nasolabial Folds: I am skeptical about the claim that protruding mouth treatment improves nasolabial folds. These folds, also known as "smile lines" or "laugh lines," can be improved by adding volume with fillers, implants, or maxillary advancement surgery. However, it seems unlikely that protruding mouth treatment, which reduces volume, would improve them. The perception of improvement might stem from the overall rejuvenation of the face after treatment.
Conclusion:
We have discussed various considerations for protruding mouth treatment, focusing on the differences between ASO surgery and non-surgical extraction orthodontics. I hope this information has broadened your understanding. Thank you.
This photo illustrates the difference between straining to close the lips and closing them naturally after ASO Surgery.
Bimaxillary Protrusion Correction
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