Initial situation
- Deep distal bite
- Pronounced incisor protrusion
- Central incisors noticeably pushed forward when smiling
The decision
Treatment was carried out with premolar extractions using the Damon bracket system, over approximately two years.
A well-planned extraction case can still deliver a balanced, stable smile five years out.
The result
The result exceeded expectations, producing a beautiful, balanced smile and a stable occlusion. A follow-up five years after debonding showed the outcome remained stable, with the aesthetics preserved and the tissues well adapted.
Long-term follow-up, even years after debonding, is valuable for confirming that an extraction-based correction of a deep bite and protrusion has truly held.
About skeletal expansion & MARPE
This case addresses incisor protrusion and a deep bite primarily in the sagittal and vertical dimensions rather than the transverse plane, but the same principle of staged, evidence-based planning applies. Extraction decisions for protrusion cases benefit from a full diagnostic workup that considers facial profile, arch length, and bite depth together. In cases like this, clinicians typically schedule long-term follow-up visits specifically to confirm that the corrected profile and bite depth remain stable over time.
Questions clinicians ask
Why choose premolar extraction for a deep bite with protrusion?
Extraction can provide the space needed to retract protruded incisors and reduce the bite depth in a way that is difficult to achieve with non-extraction mechanics alone.
How long should a case like this be followed after treatment?
Many clinicians schedule follow-up visits years after debonding, since profile and bite-depth corrections can be sensitive to long-term relapse.
Does extraction treatment always require about two years?
Treatment time varies by case complexity, and this duration reflects the specific severity of the bite and protrusion being treated.
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Original case shared by Dr. Mark Radzhabov on Instagram @orthodont_mark · Published for professional education.
