By Prof. Mohamed Bamashmous — Consultant Orthodontist, American Board of Orthodontics Diplomate (2014, renewed 2024), Professor & Chair of Dental Public Health at King Abdulaziz University, and co-founder of AQUA Dent Clinics on the Jeddah Corniche. Last updated: July 2026.

The 30-second summary

Protruding front teeth (an overjet beyond the normal 2–3 mm) can be corrected orthodontically in more than one way — and extraction is neither the only option nor the default. In my clinic the options are ranked to the case: interproximal reduction (IPR) for mild cases, molar distalization with clear aligners, temporary anchorage devices (TADs) for moderate-to-severe protrusion without extraction, growth modification with functional appliances for children and teens, premolar extraction when the protrusion genuinely needs that much space, and orthognathic surgery for severe skeletal cases. The decision is built on a digital cephalometric analysis and a face-and-lip assessment — not on one rule applied to everyone. Treatment usually takes 12–24 months, AQUA's published 2026 orthodontic range is SAR 12,000–39,000 by complexity, and your exact quote is set in writing after examination.

What is teeth protrusion — and how do we measure it?

Protrusion means the upper front teeth — sometimes together with the lowers — sit further forward than ideal. We measure it as overjet: the horizontal distance between upper and lower incisors. Normal is 2–3 mm; beyond that deserves assessment. There are two main types, and telling them apart is the foundation of choosing the right treatment:

Dental protrusion: the jaw bones are normally positioned but the teeth themselves tip forward — from crowding, childhood habits, or excess incisor inclination. The great majority of these cases are treated with orthodontics alone.
Skeletal protrusion: the upper jaw is forward or the lower jaw is set back (Class II). During growth this can be redirected with functional appliances; after growth is complete, severe cases may need combined surgical-orthodontic planning.
Bimaxillary protrusion: both upper and lower incisors incline forward with protrusive lips — a common pattern in our region, with its own protocol that usually relies on maximum-anchorage retraction of the front teeth.

And why treat it at all? Not only for appearance: research shows incisors protruding beyond 3 mm carry roughly double the risk of dental trauma in children during falls and sports, alongside difficulty closing the lips comfortably, dry anterior gums, and a real impact on smile confidence.

What causes protruding teeth?

Genetics / skeletal pattern: jaw sizes and their relationship (skeletal Class II) — the strongest factor.
Childhood habits: thumb or pacifier sucking beyond age 3–4 pushes the upper incisors forward.
Tongue thrust and infantile swallowing: repeated tongue pressure against the incisors.
Chronic mouth breathing: alters tongue posture, lip seal, and jaw growth pattern — suspected cases are referred for ENT evaluation.
Crowding: lack of space pushes some teeth forward out of the arch.

Diagnosis at AQUA — before any treatment decision

You cannot pick the right solution without a complete diagnosis, so every protrusion case here goes through four steps: (1) a clinical exam of the bite, face, and lips (do the lips close at rest? what does the profile look like?), (2) a digital cephalometric X-ray where we analyze jaw angles and incisor inclination (ANB, upper incisor angle) to precisely separate dental from skeletal protrusion, (3) a 3D digital scan (iTero) on which we measure space to the millimetre and simulate the outcome before starting, and (4) CBCT when indicated (assessing incisor bone before major retraction, or planning TAD placement). My fixed principle: we treat the face and the smile, not just the teeth.

The orthodontic solutions in detail — from simplest to most comprehensive

1) Interproximal reduction (IPR) — first line for mild cases

IPR (interproximal reduction) — also called enamel stripping or slenderizing — removes ultra-thin slices of enamel at the contact points between teeth: 0.2 to 0.5 mm per contact, well within scientifically safe limits (interproximal enamel is 1–2 mm thick and we use far less than half). Adding small slices across the arch yields 2 to 6 mm of space — enough to retract mildly-to-moderately protruded incisors without extracting any tooth.

When is it enough on its own? Protrusion needing up to roughly 3–4 mm of retraction, with mild crowding.
Is it safe? Yes, within professional limits — long-term studies show no increase in decay or sensitivity when performed with calibrated instruments and followed by polishing and fluoride.
Does it hurt? No — the procedure stays within enamel and needs no anesthesia.
How is it used? Usually inside an Invisalign or fixed-braces plan, not as a stand-alone procedure.

2) Molar distalization — gaining space with no extraction and no stripping

Instead of removing teeth or reducing enamel, we move the back molars backwards, creating space that is then used to retract the front teeth. Modern clear aligners (Invisalign) are excellent at precisely this movement — programmed sequential distalization, one tooth after another, supported by elastics the patient wears. We typically gain 2–4 mm per side, enough for many moderate protrusion cases. When more anchorage force is needed, we combine distalization with TADs (next).

3) Temporary anchorage devices (TADs) — maximum retraction without extraction

TADs are miniature bone screws (1.4–2 mm diameter) placed temporarily in the jaw bone under simple local anesthesia, acting as a 100% fixed anchorage point from which the front teeth are pulled back without the molars drifting forward and wasting space. This opens possibilities that used to require extraction:

En-masse retraction of all six front teeth in moderate-to-severe protrusion — without extraction.
In extraction cases, TADs guarantee the entire extraction space is used to retract the front teeth rather than being lost to molar drift.
A preferred tool in bimaxillary protrusion, where we need maximum possible retraction to improve lip posture.

TADs are removed at the end of treatment and the site heals within days — a very minor in-clinic procedure.

4) Growth modification for children and teens — the golden window

In growing children (roughly ages 9–13), protrusion caused by a set-back lower jaw (the most common Class II pattern) can be treated with functional appliances such as the Twin Block, which guides the lower jaw forward — correcting the skeletal relationship itself rather than camouflaging it later. This is why I insist on a first orthodontic evaluation by age 7: catch a skeletal protrusion inside the golden window and you may spare the child an extraction or surgery later, while immediately reducing the doubled trauma risk of prominent incisors. (A second phase after all permanent teeth erupt completes the fine-tuning with braces or aligners.)

5) Premolar extraction — a legitimate option in its right place, not the rule

Let me say it plainly: extraction is not the enemy, but it is not the default either. When protrusion is severe (more than 6–7 mm of required retraction), or with marked bimaxillary protrusion and lips that cannot close, or crowding beyond what IPR and distalization can resolve — symmetric extraction of the first premolars becomes the path that provides genuinely sufficient space for a stable result and a balanced facial profile. The extraction spaces are fully closed within the plan, and long-term studies confirm that extraction orthodontics — when correctly indicated — does not weaken the teeth or harm the jaw joint. The decision is made on cephalometric numbers, not on habit.

6) Orthognathic surgery — for severe skeletal cases after growth

When protrusion in an adult is severely skeletal (a markedly set-back lower jaw or a clearly forward upper jaw), orthodontics alone can only partially camouflage it. Here we build a combined orthodontic-surgical plan: I prepare the teeth orthodontically before surgery (decompensation), a maxillofacial surgeon corrects the jaw position in a hospital setting, and we complete the final detailing afterwards. AQUA coordinates this entire journey with our hospital partners in Jeddah — and I personally supervise the orthodontic preparation and finishing stages.

What about veneers or crowns to "hide" protrusion?

A question I hear often. Veneers can mask a very slight irregularity in one tooth's shade or shape, but they do not correct the bite and do not treat true protrusion — and grinding down healthy teeth to cover an orthodontic problem sacrifices enamel that never comes back. Orthodontics treats the cause; if a minor cosmetic wish remains afterwards, our cosmetic team addresses it on teeth that are already in the right position.

How I choose the right solution for you — the decision framework

How many millimetres of retraction do we need? Up to 3–4 mm: IPR and/or aligner distalization. 4–7 mm: TADs ± distalization. Beyond 6–7 mm or clear bimaxillary protrusion: we seriously discuss extraction.
Dental or skeletal? The cephalometric analysis decides. Skeletal during growth → functional appliances. Severe skeletal after growth → surgical-orthodontic track.
What do your face and lips say? Lip posture and profile can flip the plan between two patients with identical numbers.
Your own priorities: treatment duration, appliance visibility (clear vs. metal), and daily compliance all enter the equation — and the suitable options are presented to you in writing, with their advantages and limits, before anything starts.

Duration and cost in Jeddah — transparently

Most protrusion cases are treated within 12–24 months with clear aligners or 18–30 months with fixed braces, depending on complexity. AQUA Dent Clinics' published 2026 orthodontic range is SAR 12,000–39,000 across all appliance types and complexity levels — your exact price is set in writing after the examination and imaging, with an itemized plan including alternatives. Children's functional-appliance treatment (Phase I) is priced separately at consultation.

After treatment: retention is not optional

Teeth that have moved want to move back — especially in protrusion cases treated by retraction. Retention is therefore part of the plan, not an add-on: a night retainer (clear, or a fixed wire behind the front teeth) worn daily at first, then nightly, a few nights a week for life. The first retainer is included in our full orthodontic packages, and a 6-monthly fit check protects the investment you made in your smile.

Questions my patients ask every week

Can protruding teeth be fixed without extraction?
Yes — in a large proportion of cases. IPR, molar distalization, and TADs now cover much of what used to be treated with extraction. The deciding factors are the millimetres of retraction required and the type of protrusion (dental vs. skeletal) after cephalometric analysis.

Does IPR (enamel stripping) weaken teeth or cause decay?
No — within professional limits (0.2–0.5 mm per contact). Long-term studies show no increase in decay or sensitivity, and the procedure is finished with polishing and fluoride application.

My 8-year-old's teeth stick out — should we wait until all permanent teeth erupt?
Don't wait. This is exactly the age I want to see: if the protrusion is skeletal, the growth-modification window is open now and closes at the end of the growth spurt — and prominent incisors face double the trauma risk until then.

Which is better for protrusion — Invisalign or metal braces?
Both reach the result in most cases. Clear aligners excel at programmed distalization and IPR-based plans; fixed braces are more precise for certain large root movements and complex extraction cases. The choice follows your required tooth movements and your daily compliance — 22 hours of wear is the non-negotiable condition for aligners.

I'm over forty — is it too late?
Not at all. Tooth movement doesn't stop with age as long as the gums and bone are healthy — we examine periodontal health first, then the same options available to any adult apply to you.

Book a protrusion assessment in Jeddah

At AQUA Dent Clinics on the Jeddah Corniche, orthodontics is led by three American Board (ABO) certified consultants. Your assessment includes the clinical exam, cephalometric X-ray, and digital scan — and you leave with a written plan covering every option suitable for your case (not just one). Book online, call 920035788, or WhatsApp us. Sun–Wed 1–9 PM · Thu 11 AM–6 PM.