Protrusions: Point Me In The Right Direction

One of the more common orthodontic issues we see in our office is a dental protrusion, where the upper front teeth extend significantly forward of the lower teeth. In many cases, a protrusion is accompanied by other complications such as tooth crowding, excessive spacing, or bite issues like:

• Open bite: where the back teeth touch, but the front teeth do not come together vertically

• Crossbite: where the upper teeth fit inside the lower teeth when biting

• Agenesis (missing teeth) or undersized teeth, which often occur alongside these malocclusions

What Causes a Protrusion?

The causes of protrusions generally fall into two main categories:

1. Dental Causes: This refers to issues with the position of the teeth themselves. For example, a prolonged thumb-sucking habit during childhood can cause the upper front teeth to tilt forward, leading to a protrusion.

2. Skeletal Causes: In some cases, the jaw bones are the underlying issue. A protrusion can occur if the upper jaw is positioned too far forward, the lower jaw is too far back, or both. Many cases involve a combination of dental and skeletal factors, each requiring a different treatment approach.

This is why the diagnostic skills of an experienced orthodontist are essential when evaluating and planning treatment for any type of malocclusion, including protrusions.

When Is the Best Time for Treatment?

Early intervention is often ideal. The sooner we can correct a child’s bite, the better the chance for healthy growth and development. In many cases, we recommend a two-phase treatment approach:

• Phase One (ages 6–9): The goal is to improve the bite relationship and guide jaw development while the child is still growing.

• Phase Two (ages 11–13): After the permanent teeth have erupted, we reassess and complete any necessary fine-tuning to achieve optimal function and aesthetics.

By using this staged approach, we can often avoid extracting permanent teeth and reduce the overall time braces need to be worn.

What About Teens and Adults?

If a protrusion isn’t addressed until all permanent teeth have come in—usually between ages 12 and 15—we can still achieve excellent results. Although the window for modifying jaw growth is more limited, there’s still an opportunity to work with the patient’s natural development.

For adults (age 18 and over), treatment depends on the severity and cause of the protrusion. If the issue is primarily dental, conventional braces or clear aligners may be sufficient. However, in more severe cases—especially those rooted in skeletal discrepancies—orthodontic treatment combined with jaw surgery may be required.

In these situations, we begin with orthodontics to align the teeth, then perform corrective jaw surgery, followed by a final phase of orthodontic refinement. While more complex, this comprehensive treatment can produce dramatic, life-changing results.