2.1.1. Diagnosis, treatment objectives, and treatment planning

Figures 1 and 2 explain the extra-oral, intra-oral clinical examination and radiographic assessment of the dentofacial components in 3Ds.

#### 2.1.2. Treatment objectives

balance of the facial features are equally important as intrinsic dentogingival, lips, and perioral

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

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,

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

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

2. Orthosurgical treatment modalities of vertical maxillary excess: gummy

Because not all dentofacial deformities are alike, different treatment modalities were developed and advances in surgical orthodontics added a new dimension to the health profession and assured patients' satisfaction. The following case series intended to share experience with

A healthy patient (39 year 9 month old) presented with a chief complaint of "I am not happy with my smile, arrangement of my teeth, and prominent chin." Cursory examination revealed that the patient has skeletal and dental class III malocclusion with reverse overjet, narrow maxilla, long face, concave profile, and gummy smile. The case was complicated by old extraction of lower left first molar. Thorough clinical examination and diagnostic data collected assured limitation of orthodontic treatment alone to achieve treatment objectives and therefore,

combined orthosurgical techniques offer better esthetics and long-term stability [9].

soft tissue components to be considered before designing a beautiful smile [1–3].

and smile arc are well preserved [6, 7].

126 Current Approaches in Orthodontics

be worth in terms of the additional risk and cost [11, 12].

surgery [10].

smile

2.1. Case #1

colleagues and students.

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 treatment planning and setting the treatment objectives.

Figure 2. Jarabak and McNamara lateral cephalometric analysis, as adjunctive to clinical examination, to assess objectively the sagittal and vertical dentofacial deformity.
