General Dentist doing Braces, Teeth sticking out! Help!

Presentation

Chief complaint. "I don't like how my teeth stick out and have been in braces for a few months. It looks worse than I started"

Diagnosis. Skeletal Class II malocclusion with severely proclined maxillary and mandibular incisors, 6 mm overjet, mild mandibular crowding, and an anterior open bite extending from premolar to premolar. Class I molar and Class II canine relationships are present.

Why I chose this approach

This patient came to me concerned that her teeth were becoming more prominent during braces treatment and that her front teeth no longer touched. My priority was to reassess the entire bite and establish a plan that addressed her concerns about both function and appearance. Her upper and lower front teeth were significantly flared, with increased overjet and an anterior open bite. Simply aligning the teeth was not enough; we needed to create space to bring the incisors into a more upright position while considering their supporting bone. She wanted to avoid extractions and preserve her facial appearance as much as possible. After evaluating her records and discussing the options, I chose a non-extraction approach using Invisalign, interproximal reduction, and limited distalization. Interproximal reduction, or IPR, involves carefully removing small amounts of enamel between selected teeth to create space. This provided room to retract and upright the front teeth, while moving the upper teeth backward contributed additional space. I removed her braces and transitioned to Invisalign so we could stage these movements, reduce the protrusion, and coordinate open-bite closure. The decision to avoid extractions reflected her preferences and the correction we judged achievable; extractions do not automatically flatten a face, but their effects on lip support and profile must be considered in an individual treatment plan. This case reinforces one of my strongest clinical principles: complete records and a clear treatment plan should come before tooth movement. Whether using braces or aligners, I need to understand where the space will come from, how the bite will fit together, and how the planned movements may affect the patient’s smile and profile. We ultimately reduced the incisor flaring, closed the open bite, and achieved Class I occlusion with improved overjet and overbite. The goal was a functional bite and a smile she felt comfortable with, while respecting her preference to avoid extractions.

Measurements

Cephalometric values before and after treatment
Measure	Norm	Pre	Post
SNA	82	84	84
SNB	80	78	78
ANB	2	7	7
Wits	0	4	0
SN-MP	32	32	30
U1-SN	102	125	112
L1-MP	90	114	106
Overjet (mm)	2–3	6	2
Overbite (mm)	2–3	-2	2

Treatment

Objectives. Distalize and retract the maxillary dentition, use mandibular IPR to create space for lower incisor retraction, align both arches, reduce the overjet, close the open bite, and achieve Class I occlusion.

Plan. Remove braces and transition to Invisalign. Sequentially distalize and retract the upper dentition, with IPR as needed, and perform lower IPR to create space for mandibular incisor retraction.

Appliances and materials

Invisalign

Outcome

Open bite closed, dental protrusion and incisor flaring reduced, and Class I occlusion achieved with ideal overjet and overbite, balanced lips, and functional occlusion.

Retention

Fixed L3-3 permanent retainer
Fixed U2-2 permanent retainer
Invisalign Vivera retainers to be worn at night

The U2–2 fixed retainer was extended to the upper left canine to maintain its corrected vertical position and rotation.