SKELETAL ANCHORAGE By Stanford Chen, DDS, FIADI, FICOI INTRUSION in Treating Gummy Smile Fig. 1 Fig. 2 experienced reversion to the original presurgical state. She describes her lip as having “reverted.” In addition to the surgical procedure, she has also had previous Botox treatment to relax the elevator muscles to reduce her gingival display. She had several orthodontic consultations that required orthognathic surgery as the only method to reduce her gingi-val display. I discussed orthognathic surgical options as well as skeletal anchorage to reduce her excessive gingival display. The patient otherwise has an uneventful health history as well as healthy dentition and soft tissue. Other issues such as Class II, deep bite, subtle facial protrusion, minimal lower crowding and a functional shift of the mandible to the right were discussed at the consultation. The patient had only about 3mm of lower crowding. For every 2mm of lower crowding, lower incisor edge advances 1mm. 1 For this reason, creating excessive facial protrusion was not considered a significant risk with a non-extraction treat-ment plan that included intrusion. Initial consideration of alternative treatment plans included E xcessive gingival display is a significant negative esthetic issue that can dramatically affect patient confi-dence in their smiles. While radiographs can be helpful, from an esthetics standpoint, radiographs may not provide adequate information on how the muscles interact with the teeth position nor the position of the teeth relative to the lip. Many patients with excessive gingival display or a “gummy smile” seek many options to reduce this display including crown lengthening, lip-repositioning surgical proce-dures, orthognathic surgical procedures, and Botox therapy. Here, we will explore a case using orthodontics and skeletal anchorage to reduce excessive gingival display. (Fig. 1) A 35-year-old female health professional presented with a chief complaint of “a gummy smile.” The patient has a history of having had a lip repositioning surgical procedure where she states that the results reducing the gingival display with this method only lasted six months for her before she 28 Summer 2019 JAOS
Journal of the American Orthodontic Society Summer 2019: Page 28
