proclined teeth with crowding

Presentation

Bimaxillary proclination is a dental term used when both upper and lower teeth are angled forwards causing the lips to procline forward.

It is most common amongst African and Asian populations.

It is usually due to the increased length of the bone that holds the teeth, the dentoalveolar process, but can be sometimes due to tongue thrust as well.

It can also be seen where the lips are full but loose/incompetent which can allow the forward tilting of the teeth.

Active lip seal with overactive oral muscle loading

The lip profile can be seen to have a reduced angle between the base of the nose and the upper lip. The lips can be seen to be actively trying to close the mouth.

Sometimes a patient may have difficulty in having a relaxed pose with the lips together due to the proclination.

In a study carried out in 2007, Chinese participants preferred a flatter smile than a bimaxillary protruded smile.

In another study larger than average teeth that do not fit in the dental arch, can lead to proclination and also crowding.

Healthy teeth prepared for aesthetic upper crowns

Patients can inadvertantly ask for smile makeovers or veneer treatment hoping that the protrusion can be reduced, but without gross tooth destruction it is ill advised.

Most adult patients would like this type of malocclusion corrected orthodontically, but would not want fixed braces if at all possible.

Invisalign orthodontics solution

Invisalign clear aligners can be of great help in reducing this dental problem.

Invisalign clear aligners

Space needs to be created to allow retraction of the teeth.

This can be done either by:

Pulling back all the teeth is possible if the wisdom teeth have been removed.

The amount of space at the back may be limited by the lower jaw.

interproximal enamel stripping of 0.4mm per contact

Stripping the enamel between teeth contacts; this can only give 4-5 mm backward placement. But some patients prefer this option.

2 premolars in grey planned for removal

The best option is the removal of 2 upper and 2 lower premolars. This can give a total of 10mm+ or more space allowing the front teeth to be angled backwards to near vertical.

blue shading is the initial position and grey the final

The spaces are closed during the process with the Invisalign aligners. At each aligner stage the space is reduced and the teeth crowding also less.

There are 41 aligners in total and can be changed every 7-10 days

Extractions allow you to have maximum profile reduction and change in crowding without damaging the enamel of the teeth.

Invisalign scan showing projected tooth movements

With the extraction of 4 premolars we were able to reduce the crowding and the profile. Notice the reduction of the lip profile and the nasolabial angle.

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