1. Introduction

Orthosurgical correction of dentofacial deformities aims to obtain more harmonious and esthetically pleasing facial proportions in addition to normal and stable functional occlusion. Facial esthetics cannot be considered apart from an attractive smile and vice versa.

Despite the variety of ethnic, racial, and individual perception of facial attractiveness and a pleasant smile, there are general consensus among health care professionals that harmony and

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balance of the facial features are equally important as intrinsic dentogingival, lips, and perioral soft tissue components to be considered before designing a beautiful smile [1–3].

combined orthosurgical correction was suggested and the patient agreed after detailed discus-

Orthosurgical Correction of Severe Vertical Maxillary Excess: Gummy Smile

http://dx.doi.org/10.5772/intechopen.80384

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Figures 1 and 2 explain the extra-oral, intra-oral clinical examination and radiographic assess-

The objectives were directed to the listed problems to include: achieving esthetic facial features and pleasant smile; in addition to restoring normal occlusion in three dimensions (3Ds) as a prerequisite to ideal lip-teeth relationship. Retaining the treatment outcome is equally important, and all measures were taken to establish effective retention means before appliance removal.

Figure 1. Initial clinical (extra-oral and intra-oral) and radiographic examination that allow to formulate an appropriate

Figure 2. Jarabak and McNamara lateral cephalometric analysis, as adjunctive to clinical examination, to assess objec-

sion and joint meeting with the clinicians.

ment of the dentofacial components in 3Ds.

treatment planning and setting the treatment objectives.

tively the sagittal and vertical dentofacial deformity.

2.1.2. Treatment objectives

2.1.1. Diagnosis, treatment objectives, and treatment planning

Gummy smile caused by vertical maxillary excess and dentofacial disharmony cannot be treated satisfactorily with adjunctive nonsurgical approaches such as botulinum toxin injection or a crown lengthening procedures or temporary anchorage devices (TDAs). An ideal treatment option for vertical maxillary excess (VME) is the reduction of the maxillary vertical excess by LeFort I osteotomy with superior maxillary repositioning [4, 5]. However, when gummy smile is not associated with severe skeletal discrepancy in three dimensions (3Ds), intrusion of anterior teeth using TDAs may be indicated provided that the anterior esthetic occlusal plane and smile arc are well preserved [6, 7].

Many nonsurgical orthodontic treatment modalities proposed to treat gummy smile in adult patients with severe skeletal facial problems were of limited use with no benefit on the skeletal vertical discrepancy [8]. Depending on the magnitude and severity of the gummy smile, combined orthosurgical techniques offer better esthetics and long-term stability [9].

Increased vertical dimension in class III cases is the most important and deciding factor to be considered when formulating a treatment planning and deciding the technique of orthognathic surgery [10].

Computer simulation of orthosurgical outcome which was once of great concern that showing predictions to patients might lead to unrealistic expectations and disappointments. Nowadays, image prediction is becoming more likely satisfying and acceptable as it allows patients to visualize possible soft tissue profile changes and help them to decide whether surgery would be worth in terms of the additional risk and cost [11, 12].
