Dr Daichi Yonezawa
Recently, there has been a growing demand for esthetics by patients to their smile. Gummy smile is one of frequent and difficult esthetic problems. Because the etiologies of gummy smile are different, such as: Excessive vertical bone growth, alveolar extrusion, short upper lip, upper lip hyperactivity, altered passive eruption and the combination of these factors, treatment methods are also different.This case report demonstrates the treatment of gummy smile with alveolar bone protrusion using orthodontic and periodontal surgical treatments.
A 26-year-female. Her chief complaint was esthetic problems caused by maxillary gums exposed when she was smiling, so called gummy smile. The patient had no history of systemic disease, dental disease and smoking. She didn’t hope the surgical procedure resulted in hospitalization.
Crowding of maxilla and mandibular anterior teeth.
Lingual inclination of lower molars.
Angle class II.
Deep over-bite (Over-bite was 7mm and over-jet was 4mm).
Treatment plan:
Bone-shaping in maxilla was planned to obtain physiological cervical line, after improving gummy and cant using mini screws. At that time, improvement of the gummy of both anterior and posterior area were also emphasized.
Frontal view was nearly symmetric and her upper lip was slightly protruded from the side. When she was smiling, there was remarkable gummy with cant with downward to the left.
1. Extraction of teeth (#14 and #24).
2. Leveling of maxilla and mandibular dental arch.
3. Placement of mini screws in the middle of the palate and buccal side of alveolar bone of maxillary molars to intrude molars,.
4. Intrusion, retraction and bite seating of the maxillary anterior teeth with orthodontic wire.
Clinical crown lengthening by bone plastic surgery.
Esthetic harmony with the lip line, the cervical line and the alveolar bone line was obtained by adjusting the occlusal plane and performing bone plastic surgery. As the result, the esthetic problem, which was her chief complaint, was resolved, furthermore, stable occlusion and cleansability was also accomplished. Change of vertical dimension could be minimized because intrusion of maxillary molars promoted compensatory extrusion of mandibular molars.
From the results of this case, it is suggested that adjustment of the occlusal plane by orthodontic treatment using the mini screw and correction of the cervical line using bone plastic surgery is effective for gummy smile patient with alveolar bone protrusions.
