Hello and welcome to the Friday Focus. My name is Dr. “O” from E&S Orthodontics, your Phoenix Orthodontist, and today I’ll be talking about bimaxillary protrusion. I know this sounds like a big fancy word – it’s one that describes when the top and bottom teeth are flared out.

The reason we thought it was important to talk about bimaxillary protrusion is that a few months ago, I created a video on why you should not extract teeth and one of the comments that came through was what do you do in situations when the person is bimaxillary protrusive and have these flared upper and lower teeth. This was really interesting because I believe the question was posted by another orthodontist and I think they were trying to pigeon hole me into answering the question. Basically, I just don’t have a steadfast rule about why every person who presents as bimaxillary protrusive needs to have extractions. We treat on a “case by case” basis.

My Response . . . .

Anyway, my response to the person was that one of the first things to do is to assess a couple of different factors. For instance, it’s important to consider what kind of facial patterns a person has. Everyone has a different facial type. There are actually some facial types that benefit from having bimaxillary protrusive teeth because it protects how the teeth are situated in the mouth or in the jaw. For example, someone with a square jaw can stand being a little bit bimaxillary protrusive. Another factor that comes into play is different ethnicities, including African Americans and Asians, which tend to have more cases of bimaxillary protrusion. We take all these factors into consideration before we decide whether that person needs to have teeth taken out to treat bimaxillary protrusion.

The Effect of Bimaxillary Protrusion on the Facial Profile

The effects of bimaxillary protrusion can be so severe that it can push the teeth forward so much that even speech is affected. The negative effects it can have on the profile can also cause obvious appearance issues and low self-esteem. Improving facial aesthetics is typically the most important concern of patients seeing treatment for bimaxillary protrusion.

Considering Braces

Another factor that will play a part in the decision-making process is the type of braces you’re considering. If you’re using traditional braces, which a lot of doctor’s do, you’re limited on how you’re going to be able to treat bimaxillary protrusion and typically the only way you can do it is by taking out 4 teeth. I believe that that’s what the question was about that the doctor posted and what he trying to get me to say. While there are times when it is necessary to extract teeth, it really comes down to who that person is, how the teeth fit in the individuals face and how to achieve optimal functionality. So, I don’t think that as orthodontists we should say “oh, because you’re bimaxillary protrusive you need to have teeth taken out” because doing so can actually cause more harm than good. Taking out 4 teeth can end up creating an unstable bite for the patient’s facial type.

Extraction isn’t the Only Solution

Traditionally, bimaxillary protrusion, especially in adolescent patients, has been addressed by extracting the 4 first premolars, then retracting the anterior teeth. This practice has a tendency to retrude the lips and end up reducing the convexity of the face. In our opinion going this route isn’t worth considering if extraction can be avoided.

One of the many things that differentiates our office from others is that we can choose different bracket systems, other than traditional braces, in order to bring back the top and bottom teeth so that there isn’t as much flare without pulling teeth out. Because we can do that using Damon braces, H4 braces and other braces systems, we’re able to accomplish things that other orthodontists can’t.

Successful treatment of bimaxillary protrusion depends on carefully listening to the patient’s concerns and coming up with a personalized treatment plan. That’s what we do at E&S Orthodontics.

I hope this information helps alleviate some of your concerns because there are alternatives to pulling out teeth. So, the next time someone tells you that you’re bimaxillary protrusion, keep in mind that extracting teeth isn’t the only solution available to you to correct it.

Side Note

Just because your teeth are flared doesn’t mean you have bimaxillary protrusion so you might be getting the wrong diagnosis. There are a number of reasons that the teeth can flare out including severe crowding, if you have a thumb sucking habit, etc.

Listen, this is a really complicated subject and I’m not sure I can do it justice in a Friday Focus in 3 to 4 minutes. So, if you have any questions, drop us a line or leave a comment here. I’ll be answering as many questions as I can. If you’re in the area, give us a call to schedule a complimentary orthodontic consult and we’ll take care of you. In the meantime, have a great weekend.

Ousama El-Hillal
Ousama El-Hillal, referred to as Dr. O by patients, staff and friends is an Orthodontist at E&S Orthodontics. He founded E&S Orthodontics with Dr. Saavedra in 2004. He is driven to create Wide Beautiful Smiles Without Extractions.

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