The upper teeth protrude
Front upper teeth protrude forward. Such teeth are more often injured, and their appearance can greatly upset the child.
CONDITION / JAWS, MOUTH AND NECK
Distal bite and small lower jaw.
Distal bite - when the upper front teeth are far in front of the lower ones, because the lower jaw is too small or located behind or the upper one is pushed forward. In children, it is treated with orthodontic devices, in adults with a pronounced jaw defect, it is surgically extended, combining the operation with braces.
CONCEPTUAL VISUALIZATION- What it is
- The upper front teeth strongly protrude above the lower ones; the lower jaw is too small or pushed back.
- How common
- In a review of 53 studies — 19.56% of people with permanent teeth, in different studies from 2% to 63%.
- Who treats it
- Orthodontist; if the lower jaw is noticeably too small, an orthodontist and a maxillofacial surgeon.
- Urgency
- They are treated according to plan; urgently - only complications after surgery.
01 / WHAT IS ITWhat is
What is
distal bite.
With a distal bite, the upper front teeth are far ahead of the lower ones, the chin is slanted back, the profile is convex. Doctors call this a class II bite. In the UK, about a quarter of 12-year-olds have protruding upper teeth.
Prognathia is the case when the upper jaw protrudes forward. When the lower jaw is too small or located behind, we speak of retrognathia or underdevelopment of the lower jaw. From the outside, these options are easy to confuse, so the reason is clarified by the pictures.
This page is about jaw defects in teenagers and adults. Small mandible in infants (Pierre Robin sequence) and underdevelopment of half of the face have separate pages. The opposite condition, when the lower teeth are in front of the upper ones, is a mesial bite.
This is general information. The doctor will tell you what will suit you after the examination.
02 / SIGNSHow
How
distal bite presents.
Some of the signs are visible in the mirror, and some are noticed by relatives at night.
Slanted chin
The lower jaw and chin are pushed back, the profile is convex. If the teeth close normally, and only the chin is small, this is another condition.
A small chinChewing
Because of the position of the teeth, it can be more difficult to chew food and brush the teeth.
Snoring and pauses in breathing
Loud snoring, pauses in breathing, wheezing or choking sounds in sleep, and constant daytime fatigue are signs of sleep apnea that should be seen by a doctor.
03 / REASONSWhere does it come from?
Where does it come from?
distal bite.
The reason is sought both in the jaws and in the teeth: it depends on what to correct.
Heredity
In a review of 11 studies, 10 found certain genes to be associated with distal occlusion.
Small lower jaw
The lower jaw has grown smaller or is located behind. Then the bite is corrected by pushing it out.
Upper jaw in front
Sometimes the upper jaw itself protrudes forward - actually prognathia. Then the treatment plan is different.
Congenital conditions
In babies, a small lower jaw is part of the sequence of Pierre Robin: the tongue falls down, it is difficult for the child to breathe and eat.
Sequence by Pierre Robin
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
A distal bite does not require emergency care. It is necessary to act urgently after jaw surgery, and signs of sleep apnea are a reason to consult a doctor: without treatment, apnea can be serious.
103 immediately after jaw surgery, if:
- it became difficult to breathe, swallow or speak;
- swelling rapidly increases in the mouth or neck;
- bleeding from the mouth or from the wound does not stop.
Other situations:
Immediately - to the surgeon who operated, and if it does not work - to the waiting room: pain after surgery increases instead of decreasing. On the same day, to the surgeon: the temperature has risen to 38 °C and above or pus is coming from the wound. Scheduled — to the doctor: breathing stops and resumes in sleep, there are wheezing or choking sounds, and constant fatigue during the day. Scheduled — to the orthodontist: the upper teeth of the child or yours noticeably protrude above the lower ones.
05 / DIAGNOSTICSAs defined,
As defined,
where does the flaw come from?
- Review
How the teeth close, how far the upper ones protrude, what is the position of the chin and lower jaw.
- Photos and scans
Full-face and profile photo of the face, digital impressions of the teeth.
- Pictures and CT
They show which jaw is displaced — a small lower one or a protruding upper one — and to what extent.
- Sleep and breathing
If there is snoring and pauses in breathing, the doctor sends for a sleep examination: the severity of apnea is assessed by the number of breath stops per hour.
06 / TREATMENTHow to fix
How to fix
distal bite.
In children and adolescents, the bite is corrected with appliances and braces. In adults with a small lower jaw, braces along with an operation that pushes the jaw forward.
01
Children and teenagers
Orthodontic treatment during growth.
- Sooner or later
- In a Cochrane review (27 studies, 1251 participants), there was no difference in bite after treatment between those treated at 7–11 years and those treated as teenagers. The advantage of early treatment is less injuries to the front teeth: new injuries were in 19% versus 30%.
- Functional devices
- Removable or non-removable mandibular retainers reduced protrusion of upper teeth in adolescents compared to no treatment; the quality of the evidence is low.
- Does the jaw grow from appliances
- In long-term follow-up (8 studies), the appliances improved the jaw ratio, but mandibular forward movement was insignificant; the quality of the evidence is very low.
02
Adults
When the growth of the jaws is complete.
- Braces without surgery
- An orthodontist can partially hide the defect by changing the inclination of the teeth. In a review of 9 studies in adults with a small mandible, surgery with braces changed the jaw relationship and profile more than braces alone.
- Sagittal osteotomy
- The lower jaw is dissected on both sides, pushed forward and fixed with plates or screws. This is the most common operation for a small or pushed back lower jaw.
- Distraction
- The jaw is dissected and gradually lengthened with the apparatus. It can be used to extend by 10 mm or more; in a review of 5 studies, lip numbness occurred less often after distraction than after sagittal osteotomy.
- Both jaws
- Sometimes both the upper and lower jaws are pushed forward. Such operations, as well as the advancement of only the lower one, in a review of 4 studies (132 patients) gave a stable result; the quality of the evidence is low.
03
Breathing and sleep apnea
- Wider airways
- After the mandible was extended in adults (20 studies), the airways expanded, most at the level of the oropharynx; the evidence is weak.
- Protrusion of the jaws during apnea
- In a meta-analysis of 31 studies (1,597 patients), after advancement of both jaws, the number of respiratory arrests per hour decreased by an average of 41.87; major complications and deaths have not been described.
04
Risks
- Numbness of the lips and chin
- One year after sagittal osteotomy, sensitivity according to objective tests was impaired in 12.8% (7 studies). After the protrusion of both jaws during apnea, numbness of the lower part of the face was first experienced by 83.40%, after a year or more - 32.73%.
- Resorption of the joint
- The head of the lower jaw in the joint can partially dissolve, and the bite returns. In 5 studies, this occurred in 0–4.2%; the risk is higher in young women with a small mandible and a steep slope of its lower edge (14 studies, low quality).
- Quality of life
- In a meta-analysis of 4 studies, 4–7 months after surgery, it significantly improved in patients of both classes of bite, although it was less in the case of the distal one according to some indicators.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
An orthodontist and a maxillofacial surgeon work together on a distal bite and underdevelopment of the lower jaw. At Dr. Valikhnovskyi Institute of Surgery's New Face facility, a maxillofacial surgeon evaluates the bite and chin, orders a CT scan and, if necessary, builds a 3D model to determine how far back the jaw is and whether surgery is needed. Braces and braces are installed and managed by an orthodontist, and examination and treatment of sleep apnea is carried out by a specialized doctor.
CLINIC SERVICE
A new face
Form, symmetry, facial expressions and functions after injuries, wounds, burns, removal of tumors and congenital changes.
View service
What we do for this condition
- Consultation of a maxillofacial surgeon — assessment of bite, chin and joint, conversation about snoring and sleep.
- CT of the facial skull — a three-dimensional image of the bones of the face, by which the position of the jaws is measured.
- Virtual planning — a three-dimensional model is built based on the CT scan and the computer determines in advance where and how much to extend the jaw.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How treatment works with us
- Photo onlineSend a photo of your face in your profile and a photo of closed teeth; if available - CT scan and the conclusion of a sleep examination.
- ConsultationExamination of the bite, chin and joint; CT of the facial skull.
- 3D modelUsing a CT scan, the surgeon models the jaws and shows how much the lower one lags behind.
- PlanTogether with an orthodontist: whether braces are enough, whether an operation is needed, which jaw and how much to move forward, or change the chin.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
How does a distal bite differ from a small chin?
With a distal bite, the teeth do not close like that: the upper ones are far ahead of the lower ones. If the bite is normal and only the chin is small, this is a different situation with a different treatment.
Should the child be treated early?
According to a Cochrane review, treatment at 7–11 years does not produce a better final bite than in adolescence, but reduces trauma to the anterior teeth. The orthodontist decides when to start.
Can an adult get by with braces?
Braces can partially hide the defect by changing the inclination of the teeth. The position of the jaw itself and the profile, according to a review of 9 studies, were more strongly changed by surgery together with braces.
Will surgery help with snoring and apnea?
Protrusion of the jaws is also used in apnea: in a meta-analysis of 31 studies, breathing stops became significantly less. But apnea is first examined, and the decision is made together with the doctor who treats it.
Will the chin go numb after surgery?
This is possible. One year after sagittal osteotomy, the sensitivity according to objective tests remained impaired in 12.8%, and after protrusion of both jaws during apnea, numbness remained in 32.73% after a year or more.
Can the bite return?
Protrusion of the lower jaw in studies gave a stable result. One of the reasons for return is resorption of the articular process: 0–4.2% in 5 studies. After removing the braces, a retainer is worn so that the teeth do not move back.
What is distraction and who is it made for?
The jaw is dissected and every day it is spread little by little with an apparatus, and it lengthens. It can be used for large protrusion - from 10 mm, and in babies with a very small jaw - when it is difficult for the child to breathe.
Sources
17 sources · reviews, guidelines and researchshowCollapse
- Global distribution of malocclusion traits: A systematic reviewDental Press Journal of Orthodontics, 2018doi:10.1590/2177-6709.23.6.40.e1-10.onl ↗
- Orthodontic treatment for prominent upper front teeth (Class II malocclusion) in children and adolescentsCochrane Database of Systematic Reviews, 2018doi:10.1002/14651858.CD003452.pub4 ↗
- Long-term effects of functional appliances in treated versus untreated patients with Class II malocclusion: A systematic review and meta-analysisPLOS ONE, 2019doi:10.1371/journal.pone.0221624 ↗
- Systematic review on the genetic factors associated with skeletal Class II malocclusionIndian Journal of Dental Research, 2021doi:10.4103/ijdr.IJDR_59_20 ↗
- Orthodontic camouflage versus orthodontic-orthognathic surgical treatment in class II malocclusion: a systematic review and meta-analysisInternational Journal of Oral and Maxillofacial Surgery, 2018doi:10.1016/j.ijom.2017.09.003 ↗
- Distraction Osteogenesis versus Bilateral Sagittal Split Osteotomy: A Systematic Review Comparing the Skeletal Stability and Post-Operative ComplicationsJournal of Pharmacy and Bioallied Sciences, 2025doi:10.4103/jpbs.jpbs_1358_24 ↗
- Relapse in class II orthognathic surgery: a systematic reviewBMC Oral Health, 2022doi:10.1186/s12903-022-02636-x ↗
- Evaluation of condylar resorption rates after orthognathic surgery in class II and III dentofacial deformities: A systematic reviewJournal of Cranio-Maxillofacial Surgery, 2018doi:10.1016/j.jcms.2018.02.002 ↗
- Condylar resorption in orthognathic patients after mandibular bilateral sagittal split osteotomy: a systematic reviewEuropean Journal of Orthodontics, 2017doi:10.1093/ejo/cjw045 ↗
- Neurosensory disturbance of the inferior alveolar nerve after bilateral sagittal split osteotomy: a systematic reviewJournal of Oral and Maxillofacial Surgery, 2007doi:10.1016/j.joms.2007.05.009 ↗
- Effects of surgical mandibular advancement on the upper airways of adult class II patients: A systematic review with meta-analysisJournal of Oral Rehabilitation, 2021doi:10.1111/joor.13140 ↗
- Maxillomandibular Advancement Safety and Effectiveness in Obstructive Sleep Apnea: Systematic Review and Meta-AnalysisOtolaryngology–Head and Neck Surgery, 2025doi:10.1002/ohn.1114 ↗
- Oral Health-Related Quality of Life Changes in Patients with Dentofacial Deformities Class II and III after Orthognathic Surgery: A Systematic Review and Meta-AnalysisInternational Journal of Environmental Research and Public Health, 2022doi:10.3390/ijerph19041940 ↗
- Sleep apnoeaNHS, 2026nhs.uk/conditions/sleep-apnoea ↗
- Dental abscessNHS, 2026nhs.uk/conditions/dental-abscess ↗
- Cuts and grazesNHS, 2026nhs.uk/conditions/cuts-and-grazes ↗
- BracesNHS, 2026nhs.uk/tests-and-treatments/braces ↗
The figures on the page are from these sources.
Upper teeth
come forward?
Send a photo of your face in your profile and a photo of your teeth closed. The doctor will tell you what can be changed and where to start.