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HomeAnswersOrthodontistprotruded teethIs surgery needed to correct the protruding upper front teeth?

Will I need corrective jaw surgery for the front tooth protruding forward while the rest are properly positioned?

The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

Dr. K. Shobana

Published At December 6, 2022
Reviewed AtOctober 10, 2023

Patient's Query

Hi, doctor,

All my teeth are correctly positioned. Only the front four teeth of my upper jaw protrude forward by approximately 6.5 mm. So will I need corrective jaw surgery? Or will braces be quite enough?

Hello,

Welcome to icliniq.com.

I understand your concern. As you mentioned that only the front four teeth of the upper jaw are your main concern, your treatment plan will be made according to it. The other corrections required will also be done, but the priority will be on the front teeth. As per your query, jaw surgeries are only suggested once the patient completes his or her growth. This is actually the correct time for you to visit a certified orthodontist to get a detailed checkup done and look for the best possible treatment plan after discussion. There could be various options for you at the current stage, which I would like to discuss. But for the same, I would like to have a look at your teeth and the side profile view of your face. That would enable me to diagnose the case and give you the best option possible. Kindly share the pictures, and we can discuss this further. Do reach out for further queries or clarifications. Do rate the response and drop feedback to enable us to enhance the quality of answers. Have a nice day. Kind regards.

Regarding follow up

Please share pictures of your teeth and side profile view of your face.

Patient's Query

Hi doctor,

Thanks for the reply. This is my side profile view of my teeth. Now please suggest if I require jaw surgery or not.

Hello,

Welcome back to icliniq.com.

Based on your profile (the attachments are hidden to protect patient's identity), you do need orthodontic corrections but do not require surgery for the same. Your front four teeth are outwardly placed. Your plan might involve the extraction of four teeth (two from the upper and two from the lower teeth), but I suggest not going with it immediately. You can ask the orthodontist to initially go with leveling and aligning of teeth, during which teeth align in the way they should be, and we do gain spaces when alignment is done. Following that, space closure has to be done, and if enough spaces are present, extraction will not be required. If the alignment does not give enough space to take the teeth back, we will go with four teeth extraction, as mentioned earlier. Hope this gives you clarity on your orthodontic treatment procedure. Do reach out for further information or clarifications if required. Have a nice day. Regards.

Patient's Query

Hi doctor,

Thanks for the reply.

So, doctor, you are saying surgeries are not required for this problem? I also think the same as all my teeth are in appropriate positions. Is my orthodontic problem very severe? Or is it common?

Hi,

Welcome back to icliniq.com.

Definitely, surgery is not required. It can be managed with braces or aligners based on your choice. Braces are metal or ceramic brackets placed on the teeth with wires that align the teeth, are fixed, and come with certain restrictions and instructions to be followed. Aligners are clear thermoplastic trays that align the teeth without any wires and come with lesser restrictions and instructions to be followed. Your teeth are at appropriate positions only. Just the inclination is a bit wrong. They are outwardly inclined. It is a moderate category issue and is seen frequently in orthodontic cases. Do not worry about any surgical procedures. It is not required for your case. Did you have any tongue-thrusting habits? Meaning unintentionally, you are pushing the tongue outward, which puts pressure on the teeth to incline forward.

Have a nice day.

Regards.

Patient's Query

Hi, doctor,

Thanks for the reply.

No doctor, I have no such habits like that. But I have a habit of biting my inner lips with my teeth.

Hi,

Welcome back to icliniq.com.

If there are no tongue-related habits, it is a good sign. Regarding lip biting habit, it is also due to the malalignment of teeth and how they close. Once you undergo orthodontic treatment, the alignment will be better, and it will not be proclined (meaning it will not be inclined forward the way they are). And the overjet (horizontal distance between the front and lower teeth) will be better, so lip-biting habits will also stop.

Hope this helps in your guidance to good orthodontic treatment.

Please let us know if you have any related queries.

Have a nice day.

Regards.

Patient's Query

Hi doctor,

Thanks for the reply.

Have you seen my face and teeth profile clearly? Is my picture hazy to see or understand? Have you understood clearly by seeing the pictures that I have attached? Are you sure that I will not require jaw surgery in my type of teeth resting position, overbite or overjet?

Hi,

Welcome back to icliniq.com.

Yes, the pictures are a bit hazy, but they give the details which are required. Definitely, you do not require jaw surgery. These are regular orthodontic cases where extraction of teeth and space closure works well. There are both things present in everyone's teeth: overjet as well as an overbite. Overjet is the horizontal distance between the upper and lower teeth. Overbite is the vertical overlap between upper and lower teeth.

Still, if you can send a complete side profile picture clicked through a friend or relative's assistance, which is clear, I can re-confirm the treatment plan. Side profile view of the patient, smiling and in normal resting. You can check how these pictures should look on the internet and ask the person to click for you at 90 degrees to the camera, and the full face should be visible (head to neck, nose to back of head).

Regards.

Patient's Query

Hi doctor,

Thanks for the reply.

Now, doctor, I have attached the two files as you have said to me (the attachments are hidden to protect the patient's identity). Please plan my treatment carefully and observe the pictures. Now please reconfirm If I need jaw surgery or not.

Hi,

Welcome back to icliniq.com.

Yes, I have seen your attached pictures (attachments are hidden to protect the patient's identity), and I am 100 percent sure you do not require any corrective jaw surgeries. I confirm that you do not require surgery. As your front teeth are outwardly inclined, I suggest braces or aligners for your treatment. Braces would be a better option, in my opinion. You will need to undergo extraction of teeth to gain some space to retract (pull back) your front teeth. This needs to be evaluated clinically to determine how many teeth need to be extracted. Either it would be the upper two teeth or a total of four teeth (upper two and lower two). With the attached photos, the chances of two teeth extraction are more (clinical confirmation will be required), but I would suggest not getting extraction done initially. Get the initial alignment done, followed by extraction and then the retraction process.

To summarize,

  • You have proclined upper front teeth.
  • You do not require any corrective jaw surgeries.
  • Braces or aligners are your options (braces more preferable, but you can decide otherwise).
  • Initial leveling and alignment of teeth.
  • Followed by extraction of teeth (two teeth it should be, less chance that four extractions are required).
  • Once extraction is done, retraction or space closure by pulling the teeth is suggested.
  • Followed by approximately one year of retainer therapy.
  • Total expected duration - 15 to 18 months of active treatment (it could be shorter as well, depending on how your teeth respond to the forces) followed by one year of retainer therapy.

Hope this clarifies your queries regarding the orthodontic treatment process.

Do inform me if some more details are required.

Have a nice day.

Regards.

Patient's Query

Hi doctor.

Thanks for the reply.

So, doctor, do I have an excess overjet or excess overbite? Is my case very complicated, or is it common in orthodontic cases?

And doctor, a relationship is made between you and me. So approximately in the next month, my braces will be fitted in my teeth. After that, I will contact you, and I will give you all the updates from time to time.

Hi,

Welcome back to icliniq.com.

You have an excess overjet. No, your case is not complicated but quite a regular one. No need to worry about it. I am glad to help you throughout your orthodontic treatment process.

Sure, do reach out for any queries or clarifications.

All the best for your braces.

Have a nice day.

Patient's Query

Hi doctor,

Thank you for the reply,

I was surfing the internet and saw a term named " Maloclussion." What is maloclussion? You have completely seen my teeth profile and face profile.

So doctor, please tell me if I have malocclusion and if then, which class of malocclusion do I have?

Hi,

Welcome back to icliniq.com.

Any teeth arrangement that is not ideal according to the standards and classification set by the scientists and international societies are termed as malocclusion. There are certain features to be checked to determine whether it falls under normal occlusion or malocclusion.

Most of the people in the world have malocclusion until they undergo orthodontic corrections. Even after orthodontic corrections, there are some cases which do not end up in ideal positions. One fact to keep in mind is, ideal occlusion is difficult to achieve and it varies from patient to patient if it can be achieved.

You have a malocclusion that can be termed as class 1 malocclusion with upper anterior proclination (upper front teeth inclination). However, this is a provisional diagnosis and actual diagnosis may vary based on clinical examination.

Do reach out for further information.

Patient's Query

Hi doctor,

Thank you for the reply,

How can clinical examination vary? You have seen my whole face profile, right? Then how will it vary? Do I have a class 2 malocclusion?

Hi,

Welcome back to icliniq.com.

Through clinical examination, we can examine the whole set of teeth up to the last tooth erupted from all directions possible. However, in photos (attachment removed to protect the patient's identity), the view is limited. We cannot access all the areas possible.

There are many ways to classify malocclusion, wherein the molar classification is most widely used, and achieving the molar relation in photos is a bit difficult. The difference between class 1 and class 2 malocclusion is only about two to three mm. Hence, slight variation itself can change the malocclusion from one to two.

I hope this helps.

Patient's Query

Hi doctor,

Thank you for the reply,

On the internet, it is written that those who have malocclusion class 2 division 1 will need orthognathic jaw surgery. Is it correct?

Hi,

Welcome back to icliniq.com.

Yes. Class 2 cases might require orthognathic surgery, but there are certain factors to consider.

1. Age of the patient - Any case where the patient is growing or has just finished growth, surgery is not recommended. Only when the growth has completed, we think of surgical option. In general, surgery is not received until about 20 years of age. It may vary at times.

2. Severity of the malocclusion - Mild to moderate cases are handled without any surgical intervention. In mild cases, non extraction or extraction approach is taken.In moderate cases, extraction alongwith pulling back teeth with the help of mini implants (these are small dimension screws, which are placed in the mouth and removed once the work is done). Fixed functional appliance which is kept in mouth to take the lower bone forward. In severe cases, orthognathic surgery is recommended. In your case, we are not fulfilling any of these criteria. Neither you fall under the age category (still growth is pending) nor is your case under severe category. So, there is no chance surgery will be required or recommended by any orthodontist.

Patient's Query

Hi doctor,

Thank you for the reply,

Do I have no chance of jaw surgery, right? So doctor, what are the requirements for a person to get braces on? What is the use of X-ray? And how many brackets will I need in my case to fix it? (genuinely asking). Explain my treatment process in detail, assuming I have a malocclusion class 2 division 1 case.

Hi doctor,

Welcome back to icliniq.com.

You do not require surgery at all.

For a person to get braces, there is no such defined set of requirements. Going by the protocol, initially, there will be a check-up of your entire dentition and oral structures to check the present condition. Your malocclusion will be evaluated. You will be informed about the malocclusion and the need for cleaning (scaling) and filling (restoration) to be done (if required) before the start of orthodontic treatment.

You will have to undergo two sets of x-rays to evaluate the structures and bone conditions beneath the teeth, the status of teeth roots, and the growth status. Once these are done, you will be called in for the bonding of braces (fixing the braces on your teeth). All the teeth will require brackets on both the upper and lower jaws. However, some doctors avoid bonding the last molar. Some doctors bond both upper and lower together or within a week whilst some prefer upper bonding and some corrections in upper followed by lower bonding after some months.

After the bonding is done, you will be given certain do's and don'ts to be followed.

After a gap of three to four weeks, you will be called again for re-activating or change of wires (tightening of wires) based on the changes achieved. This process will go on till the alignment, and other results are achieved.

Following this, your braces will be removed, and you will be given a set of retainers to wear for about ten to 12 months, or a fixed retainer will be placed on your teeth on the back side for permanent retention.

Patient's Query

Hi doctor,

Thank you for the reply,

I have attached my molar view as possible. Please observe it if you can.

Does the treatment vary with the different malocclusions? If I have the same condition with malocclusion 1 and if I have the same condition with malocclusion 2 division 1, will the treatment change accordingly?

Hi,

Welcome back to icliniq.com.

I hope you are doing well.

Speaking in broad and generalized form, yes, treatment modalities change as per molar relation. And with molar change, it is not the only factor. Molar relation also affects other parameters. One of the most important parameters that change with molar relation is the overjet (horizontal distance between upper and lower teeth).

In class 1 relation, they should be almost normal to mild increased.

In class 2 relations, they are mostly increased more than normal.

In class 3 relations, they are in less than normal to negative overjet (meaning upper teeth behind the lower teeth).

The amount of overjet also plays a role in deciding the treatment plan from multiple options of the non-extraction plan, two teeth extraction plan, or a four teeth extraction plan.

So yes, molar relation along with other factors, change in different malocclusions, and all of them have a role in deciding the treatment plan.

Please note that it is not just the molar relation or overjet or any other factor individually, but combined effects of all are seen to decide the plan.

There must have been some error in attaching the pictures. I have not received any. Please re-send the pictures you were mentioning about.

Have a nice day.

Patient's Query

Hi doctor,

Thank you for the reply,

Pictures are a bit hazy, but I hope you can get the molar view.

Now please tell me about my malocclusion class.

Hi,

Welcome back to icliniq.com.

Your molar relation is class 1 on the right side and slightly shifted from class 1 on the left side. But the shift is very minimal so it will be considered as class 1 only on both sides. Considering the spaces in the front teeth, I would suggest starting the treatment as non-extraction and aligning the teeth, and closing the spaces.

As treatment progresses, re-evaluation will be done, and further treatment will be decided.

Patient's Query

Hi doctor,

Thank you for the reply,

The pictures are a bit hazy, but I hope you have completely observed my molar profile. If my relation is class 1, then I guess it falls under a common class. As class 1 malocclusion is common in 70 % of orthodontic cases. Are you sure that I have class 1 malocclusion?

Hi,

Welcome back to icliniq.com.

Considering the evidence of research, class 1 molars relationships are the most common.

I am absolutely sure that you have class 1 malocclusion with upper anterior proclination and spacing.

Patient's Query

Hi doctor,

Thank you for the reply,

So genuinely asking if I will get my teeth completely cured? And doctor many years ago I have fallen off my bicycle, and because of that, there is a hairline crack in my both front tooth. It is almost invisible. Will I be able to get braces then, also?

Hi,

Welcome back to icliniq.com.

Yes, your entire dentition will be corrected nicely. It will be a joint effort wherein the doctor and patient both have to contribute. The doctor will be seeing you only once a month, and for the rest 27 days or so, it will be your responsibility to follow all his or her instructions properly and maintain the braces.

If both sides do their job properly, definitely good results will be seen.

As you mentioned that you had a fall, and the crack is almost invisible, it could be a cause for the front teeth to incline more than normal. It is just a probability.

For this particular reason, we ask the patient to get the X-ray done. Sometimes, from the front view, it seems there is no issue with the teeth, but underlying in the bone, there might be some damage. So, pre-treatment X-ray will give us the entire condition of your teeth from clinical as well as bone level.

Yes, you can still have braces even if you have a crack. If the problem had been serious, you would have had some pain. But that is not the scenario, so most X-rays should be normal. And if everything seems alright, you can get the braces done, and after the completion of the treatment, you can get masking done to hide the crack (if visible) entirely.

Do mention the orthodontist about the fall in the history so that he or she can examine it again.

Everything should be good.

Patient's Query

Hi doctor,

Thank you for the reply,

The crack is not even vertical. It is horizontal only, and it is also on the lower side. So I guess there would not be a problem. Am I right?

Hi,

Welcome back to icliniq.com.

It seems your query was partially posted.

I have seen the photos (attachment removed to protect the patient's identity) and what I could make out from previous versions was that there is a tooth chipped off of the lower edge on the right side front tooth. This crack is a regular chip-off, and it should not be an issue. The X-ray would tell us the exact cause, although clinically, it looks normal. It would be helpful if you could send me a picture of your teeth from the front view and a smiling photo to re-assess the teeth and facial relations and guide you better.

And what is your complete query, as this one reached me partially?

Patient's Query

Hi doctor,

Thank you for the reply,

The crack is so minimal that it seems like a scratch only. It is not even vertical that runs up to the roots. It runs horizontally and also in the lower part of my teeth. Suppose my teeth had a crack from beneath. Is there any alternate treatment for it? Will I be able to get braces? Are there any other alternative treatment options available? And also, how many months does it take to heal a gum after teeth scaling?

You will see a small scratch on my right front tooth. Does it affect my treatment?

Hi,

Welcome back to icliniq.com.

The crack is minimal and should not affect the orthodontic treatment in any way. There is a chip off on the lower edge of the tooth, which will be filled with composite before the treatment initiation. The other teeth on the lower edge have some projections (called as mamelons) which are seen in primary teeth (milk teeth) and are generally gone in permanent teeth. However, you can get it straightened according to your wish and get the orthodontic treatment after this.

You can get the orthodontic treatment done with this.

Generally, gums heal within a week of scaling. It may sometimes take about five days and sometimes about ten to 12 days or so. But a general time period is seven days. It will not affect your orthodontic treatment in anyway.

Patient's Query

Hi doctor,

Thank you for the reply,

What about my misalignment? Is it skeletal or dental? I guess it is not a skeletal issue. It is a dental issue. Please confirm.

Hi,

Welcome back to icliniq.com.

I hope you are doing well.

Malocclusions are categorized into skeletal and dental. For every patient, there will be a particular class in the skeletal category and in the dental category, namely, class I, class II, and class III. In your case, as we previously discussed about molar relation, similarly, a skeletal relation is also there.

You have a skeletal class II base on which molars have erupted in a class I relation. Hence, a way of describing your case is 'class I malocclusion on a class II basis.' When we make the teeth move, the underlying bone also undergoes certain changes. Hence, when we retract your front teeth and close all spaces, the bone will also move. And your skeletal class II condition will slowly change to a skeletal class I condition.

Accurate diagnosis of skeletal bases can be made only through X-ray.

I hope this helps you understand your case better.

Patient's Query

Hi doctor,

Thank you for the reply,

Which type of skeletal base is the most common? Malocclusion-1 is the most common type of dental malocclusion.

In a similar way, which skeletal base is the most common in orthodontic patients?

Is skeletal base class very severe?

What are the requirements for a patient to get braces based on teeth root and growth of teeth?

I cannot smile or talk freely because of my protruding teeth. Will I be able to smile after braces?

Hi,

Welcome back to icliniq.com.

Bones and skeleton gives us the basic framework of the body and on that muscles and other tissue gives us the body structure. Similarly, skeletal base gives the basic shape of the face and other muscles and teeth gives us the other looks. Just like dental relations, skeletal relations also have classification and class 1 being most common while class 2 and class 3 are less common. Skeletal relation is also categorised into similar way of mild, moderate and severe. For your case, you have a mild skeletal class 2 base, which can be modified to class 1 by closing of all the spaces in the front teeth and pulling back the teeth. As teeth moves, bones also reshape themselves and skeletal relations change due to this. For a patient to get braces, there are some checkpoints which may affect the start of the treatment. Tooth root - If the tooth root is not formed atleast 60 % of the actual length, we should not start the treatment. Teeth growth - crown of the teeth develops first and tooth root takes about two to three years more than crown to develop. So, if crown develops at 10 years, root will be fully developed by 12 to 13 years. Atleast six teeth in upper and six teeth in lower jaws should be permanent to start the treatment in early ages around six to seven years of age. That is under preventive orthodontics. On the higher side, there is no such restrictions as long as patient bone levels are good and oral hygiene is maintained. I do completely understand that you might be feeling a bit awkward to smile due to teeth proclination. It would reduce your self-esteem and confidence to smile socially. There would be instances where your lower lip would be stuck within upper teeth (called as 'lip trap'). But be assured, once you undergo orthodontic treatment, your teeth alignment and spaces would be closed and there will be a huge boost in your confidence and you can smile all the time. Your smile and teeth with facial looks will be completely restored.

I hope this would help you.

Thanks and regards.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Mayank Khandelwal
Dr. Mayank Khandelwal

Orthodontist

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