Classic orthodontic treatment (braces) can only align the teeth within each jaw. Normally the jaws have grown together in a way that teeth naturally occlude or come together as a Class I bite. In a retruded mandible (Class II bite), the lower teeth are set well back.

As the lower teeth are relatively back, the upper front teeth appear abnormally prominent and usually the only complaint of the parents  is "My child's front teeth are so bucky. Can you fix them doctor?".

To correct this, simple and quick orthodontics is to create space by removing upper premolar teeth. This allows the orthodontist to pull back the upper front teeth, sometimes using so much force that a head band has to be employed. Successful treatment is described as having achieved a "normal", or Class I incisor relationship.

Uncorrected Class II bite showing significant under- development of lower jaw. The jaw relationship makes the upper front teeth appear abnormally too forward.	Corrected Class II bite, now made Class I with dental extractions, & the upper front teeth unnaturally pulled back.	Final Class I occlusion with premolar extractions may look even, but it is very unstable long term, and can accentuate an abnormal facial profile. Notice how the left front tooth seems to want to "pop" forward to it's original natural position.

Such extractions and orthodontic treatment may achieve a Class I bite, but it does nothing to correct for the retruded mandible and sloping facial profile.

Non-surgical, orthodontic treatment of the incisor relationship that results from a retruded mandible (based on premolar extractions alone) may frankly produce an abnormally strange face & smile.

13 year old boy with retruded mandible, prior to commencement of orthodontic treatment	15 year old girl with premolar extractions, & commencement of classic orthodontic treatment	30 year old female with previous classic orthodontic treatment involving premolar extractions.

Consider the alternative to premolar tooth extractions...

If the orthodontist anticipates future orthognathic jaw surgery, premolar tooth extractions can be avoided, & teeth are straightened in a way that anticipates the future (surgically corrected) normal jaw position; not the current abnormal position.

Once jaw growth has ceased (at ~16-18 years), a mandibular operation is performed to instantly correct for the undergrown lower jaw, and to achieve a Class I occlusion with a normally proportioned facial profile (without the need to extract premolar teeth).

Other surgery may be able to be performed on patients aged 13-15 years, prior to initiation of orthodontic treatment. Speak to your surgeon to enquire whether jaw distraction surgery or classic orthognathic advancement surgery is more suitable for your child to correct for their retruded mandible.

The following examples illustrate classic mandibular advancement surgery, with inspired orthodontic treatment, provided without premolar extractions...

This 35 year old female complained of chronic jaw joint aches, and inability to properly chew. She was originally referred to have an orthodontic bite splint made because her dentist assumed her problems to arise from unconscious nocturnal grinding.The surgeon instead suggested to have her teeth straightened and have her jaw advanced surgically to provide for a normal bite... Read more

This 23 year old male originally presented only for wisdom teeth removal. The lower jaw was extremely short, and the teeth so crowded, that there was simply no room for the lower wisdom teeth to erupt; and so they were impacted and infected. The surgeon suggested that the patient consider orthodontics follow wisdom teeth surgery, but the patient seemed worried over the prospect of previous advice which was simply to remove the crowded upper teeth to create "room". The surgeon suggested that he reconsider orthodontics (but without the need for premolar extractions), and to consider instead jaw advancement surgery... Read more

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