A common clinic question: “Does lip protrusion always mean the jaws are the problem?”
Short answer: no. Dr. Saeed Anjari — Specialist in Orthodontics and Dentofacial Orthopedics — explains that protruding lips are sometimes driven by forward inclination and position of the front teeth, not necessarily by jawbone protrusion. Appearance alone is not a diagnosis, and treatment changes with the true cause.
This article walks through bimaxillary protrusion: definition, dental vs skeletal cause, how we diagnose, orthodontics vs surgery, and when extraction is considered — with video, before/after cephalometrics, and clinical photos.
Source: dentofacial orthopedics video with Dr. Saeed Anjari.
In the video, Dr. Saeed frames face-and-jaw orthodontics: not aligning a row of teeth alone, but reading the face, bite, and skeletal relationship before extraction or surgery decisions.
Bimaxillary protrusion (also called dentoalveolar or bialveolar protrusion) is a condition in which the upper and lower front teeth are proclined and protrusive relative to their bony bases, with greater lip prominence on the profile. Many patients seek care primarily to improve facial balance — not only to “straighten teeth.”
Common clinical findings include:
Clinically, diagnosis often starts from a triad — prominent lips, lip strain, and lip incompetence — then is refined with cephalometric analysis. Severity varies, so plans are individualized.
Causes are usually multifactorial:
Literature reviews note that the trait is more common in some Asian and African populations and less common in white Caucasian groups — but treatment decisions are always individual, based on face and occlusion, not statistics alone. Clinically, clear lip strain, marked incisor protrusion, or the patient’s wish for better facial balance warrants assessment.
The outward look can be similar, but the diagnosis is not:
| Type | Meaning | Treatment implication |
|---|---|---|
| Dentoalveolar | Tooth inclination/position (and supporting alveolar bone) is the main cause | Often managed within orthodontic / camouflage limits |
| Skeletal | A discrepancy in the jawbones themselves | May need orthognathic surgery with orthodontics if the gap is large |
Similar appearance ≠ the same diagnosis. Choosing treatment from a photo or from “lip protrusion” alone is a common mistake.
Accurate diagnosis combines clinical exam with measurements — not a single clue:
Understanding the patient’s main concern — profile, lip closure, smile, or bite — is part of successful planning.
Principle: treat the diagnosis, not appearance alone.
Before
After
Before & after: cephalometrics show teeth–jaw–profile relationships — not the smile photo alone.
Frontal
Right lateral
Oblique
Lateral — bite relationship
Left lateral
Clinical photos are separated: before group, then after group — each image uniform size, teeth only.
Before discussing extraction or surgery, clear goals are set. They may include:
As the anterior teeth retract, soft tissues usually flatten somewhat and the nasolabial angle often increases. Clinically, the lower lip tends to follow lower-incisor retraction more closely than the upper lip follows the upper incisors — so each arch is planned carefully.
After diagnosis, two main pathways appear — chosen by cause, not by wishing for a faster result:
Close collaboration between the orthodontist and oral/maxillofacial surgeon matters in severe cases. Not every protrusion needs surgery — and not every protrusion can be solved with braces alone if the skeleton is the problem.
No. Extraction is not a diagnosis and not an automatic decision — it is a treatment tool used only when needed.
In the literature, extraction of four premolars with incisor retraction is among the most successful plans for reducing dental and soft-tissue procumbency in appropriate cases. Mild or moderate cases — especially with an acceptable profile — may not need treatment, or may be managed without extractions if enough space can be created another way.
The decision depends on full assessment of:
Long-term stability improves with a normalized interincisal angle, lower-lip competence, and good buccal intercuspation — yet relapse risk remains real in these cases.
Long-term retention is therefore common: fixed retainers supported by removable vacuum-formed retainers in both arches, according to the doctor’s plan. Orthodontics does not end on debond day; retention is part of the result.
If lip protrusion, lip strain, or conflicting advice about surgery/extraction bothers you, start with a dentofacial orthopedics assessment.
At Joele Clinics in Jeddah, Dr. Saeed Anjari builds plans that separate dental from skeletal causes before choosing braces or surgery.
Lip protrusion is not always jaw protrusion. Bimaxillary protrusion needs structured diagnosis (face, lips, teeth, jaws, cephalometrics). Treatment starts from clear goals — lip competence, profile balance, and a stable bite — then orthodontics or surgery is chosen, with extraction only when needed and proper retention afterward. Watch the video and X-rays above, then book with Dr. Saeed Anjari.
Supporting educational reference: Yemitan et al. (2022). Bimaxillary protrusion: A literature review. DOI: 10.53771/ijbpsa.2022.3.2.0067.
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