Short answer: A retruded jaw means the lower or upper jaw is positioned back relative to the rest of the face and the opposing jaw. Genetics, growth differences and habits such as mouth breathing play a role. In growing children, jaw development can be guided with functional appliances; in adults whose growth is complete, orthodontic camouflage or orthognathic surgery planned together with orthodontics is used. The method is determined by an examination and X-ray analysis.
A retruded jaw is a common orthodontic condition that affects the facial profile, the bite and sometimes breathing. In some people it appears only as a slight difference in profile, while in others it comes with problems such as difficulty chewing, a pronounced overjet of the front teeth or snoring. The most decisive factor in treatment is age: what can be done while growth continues is quite different from what can be done after growth is complete. In this article we explain step by step how treatment of a retruded jaw is planned according to age.
What is a retruded jaw?
A retruded jaw is when the lower or upper jaw is positioned back, or has not developed sufficiently, relative to the other parts of the facial skeleton and the opposing jaw. In dentistry this is usually considered a skeletal discrepancy; that is, the problem lies not only in how the teeth are arranged but in the size or position of the jawbones.
The main causes are:
- Genetics: Jaw structure is largely inherited. It is common for a parent to have a similar profile.
- Growth differences: The lower and upper jaws can grow at different rates. Insufficient development of one causes it to sit back relative to the other.
- Mouth breathing: Breathing through the mouth for long periods because of enlarged adenoids or tonsils can affect jaw development by changing the position of the tongue and lips.
- Habits: Prolonged thumb sucking, pacifier use or tongue thrusting puts pressure especially on the upper jaw and front teeth.
- Early loss of baby teeth: Losing baby teeth prematurely can negatively affect the development of the dental arches.
The difference between lower and upper jaw retrusion
Lower jaw retrusion and upper jaw retrusion create almost opposite appearances in the face and bite, and their treatment approaches also differ.
Lower jaw retrusion
In lower jaw retrusion (retrognathia), the lower jaw sits back relative to the upper jaw. In orthodontics it is usually called a "Class II" bite. Typical findings are:
- The upper front teeth sitting markedly in front of the lower teeth
- A chin that sits back when viewed from the side and a convex profile
- Deep bite: the upper front teeth covering the lower front teeth excessively
- Strain in the chin area when closing the lips
Lower jaw retrusion and deep bite are often seen together. We covered this relationship and the role of clear aligners in this situation in detail in our article treating deep bite with clear aligners.
Upper jaw retrusion
In upper jaw retrusion, the upper jaw has not developed sufficiently forward or sideways. As a result, the lower teeth may close in front of the upper teeth; this is known as a "Class III" bite. The middle of the face may look sunken, and the lower jaw may be perceived as protruding even if it is actually of normal size. A narrow upper jaw can also cause crossbite in the side teeth.
The two conditions are distinguished not only by an intraoral examination but also with a lateral skull X-ray called a cephalometric X-ray and, when necessary, three-dimensional imaging. This is because different skeletal causes can lie behind a similar appearance of the teeth.
Early treatment in children
The main advantage of treating a retruded jaw in children is that growth is still ongoing; during this period, jaw development can be guided to a certain extent. For this reason, a first orthodontic assessment is recommended at around age 7.
For lower jaw retrusion
For lower jaw retrusion, the period of the growth spurt is usually targeted; this mostly falls between ages 10-12 in girls and 11-14 in boys. Functional appliances position the lower jaw forward, aiming to support jaw development in this direction and correct the bite. These appliances can be removable or fixed. In some growing teenagers, a similar aim can be pursued with wings added to clear aligners that guide the lower jaw forward; at our clinic this option is assessed with the Invisalign system.
For upper jaw retrusion
For upper jaw retrusion, the timing of intervention is earlier. Appliances aimed at widening the upper jaw and, when necessary, face masks that guide the upper jaw forward usually give more effective results between ages 6 and 10. At these ages, the growth centers in the jawbone respond better to external forces.
Early treatment does not always eliminate the need for later treatment; however, it can reduce the severity of the problem, correct front teeth positioned where they are vulnerable to trauma and, in some patients, reduce the need for surgery later. It is also important to assess underlying causes such as mouth breathing together with an ear, nose and throat specialist at an early stage.
Orthodontic camouflage in adults
In adults whose growth is complete, it is not possible to change the size of the jawbone with orthodontic appliances; however, in mild and moderate jaw retrusion, orthodontic camouflage can position the teeth to balance the jaw discrepancy. The aim is to achieve a functional bite and a balanced smile without changing the skeletal structure.
The main methods used in camouflage treatment:
- Changing the angles and positions of the teeth
- Gaining space with planned tooth extractions when necessary
- Correcting the bite with elastics between the jaws
- Opening the deep bite and repositioning the front teeth
These treatments can be done with fixed braces or, in suitable cases, clear aligners. If you are curious about the limits of the effect of clear aligners on jaw structure, our article do clear aligners correct jaw structure will help you set realistic expectations. In short: aligners move teeth; they do not change the size of the bone.
When is orthognathic surgery needed?
Orthognathic surgery is considered in adults whose skeletal discrepancy is pronounced and for whom moving the teeth alone would not be enough functionally or aesthetically. Jaw surgery is performed by an oral and maxillofacial surgeon and is almost always planned together with orthodontic treatment.
Situations in which surgery may be considered:
- Difficulty chewing and biting due to a pronounced jaw discrepancy
- Inability to close the lips without strain
- Advanced cases in which camouflage would negatively affect the facial profile
- Breathing problems related to a retruded jaw; in this case assessment by a sleep specialist and an ear, nose and throat specialist is also needed
The process usually proceeds in three stages: pre-surgical orthodontics to align the teeth within their own jaws, surgical repositioning of the jaws and post-surgical orthodontics to fine-tune the bite. Surgery waits until growth is complete; this usually corresponds to the end of adolescence in girls and a somewhat later period in boys.
Which path to follow is decided together according to the degree of jaw discrepancy, age, facial profile and the patient's expectations. The treatment duration and fee are communicated in writing after a comprehensive examination and planning.
When should you have an examination in Ankara if you notice a retruded jaw?
If you see signs in your child such as a chin that sits back, a pronounced overjet of the front teeth, mouth breathing or the lower teeth closing in front of the upper teeth, an early orthodontic assessment is important so the growth period is not missed; in adults, difficulty chewing or dissatisfaction with the profile is also reason enough for an examination. At our polyclinic in Park Oran Ofis in Oran, Funda Pekyılmaz Sarıkaya, specialist orthodontist (Uzm. Dt.), performs the necessary X-ray analyses and explains the options suited to age and situation; when needed, joint planning is done with jaw surgery. Appointment information is on our contact page.
Frequently asked questions
Does a retruded jaw correct itself?
In most cases a skeletal retruded jaw does not correct itself. Some mild differences may decrease during growth; however, an orthodontic assessment is needed to monitor this and to guide it if necessary.
Can a retruded jaw be treated without surgery?
Treatment without surgery is often possible with functional appliances in growing children, and with orthodontic camouflage in mild and moderate cases in adults. Advanced skeletal discrepancies, however, may require surgery.
What is the ideal age to treat a retruded jaw?
Intervention is usually more effective between ages 6 and 10 for upper jaw retrusion, and during the growth spurt, mostly between ages 10 and 14, for lower jaw retrusion. For this reason, a first orthodontic check-up is recommended at around age 7.
Do clear aligners correct a retruded jaw?
Clear aligners move teeth; they do not change the size of the jawbone. They can be used for camouflage in mild cases in adults, and in some growing teenagers with features that guide the lower jaw; suitability is determined by an examination.
