2.4.3. Treatment planning

Because of the complexity and severity of dentofacial deformity, the healthcare team decided to follow the logic sequence of orthosurgical treatment phases, presurgical orthodontics to be followed by bimaxillary surgical phase. LeFort I osteotomy with superior repositioning of the maxilla intended to reduce the increased facial height and level the tipped back occlusal

Figure 25. Pretreatment extra and intraoral photos describing the severity of the dentofacial deformity and the problems to be solved.

plane; bilateral sagittal split osteotomy of the mandibular ramus to setback the prognathic mandible bringing narrower mandibular arch in favor of the normal transverse occlusion, anticlockwise rotation aided in correcting the open bite. Retentive means were designed to guarantee stable outcome (Figures 26–32).

#### 2.4.4. Conclusions

alone cannot be of benefit to you. A combined orthosurgical treatment modality was offered, and a joint meeting with the maxillofacial surgeon was arranged; details of the treatment phases, surgical risk, and cost effectiveness were explained to the patient who showed great interest in undergoing the treatment in a positive manner. The following figures reveal the steps and efforts exerted by the healthcare team and the cooperation of the patient that made

The diagnostic significance of clinically examining the dentofacial deformities lies in observing the soft and hard tissues functioning, so any abnormality is detected, and further investigations are assigned. Esthetic smile is a function of oral and perioral muscles and their relationship to the teeth and gingiva. Clinical examination of the patient revealed the severity of the skeletal, dentoalveolar, and soft tissues components as listed in Figure 25. However, objective judgment of the deformity necessitated other diagnostic aids including radiographs and study

To restore normal facial harmony and balance, correct the severe malocclusion, design a

Because of the complexity and severity of dentofacial deformity, the healthcare team decided to follow the logic sequence of orthosurgical treatment phases, presurgical orthodontics to be followed by bimaxillary surgical phase. LeFort I osteotomy with superior repositioning of the maxilla intended to reduce the increased facial height and level the tipped back occlusal

Figure 25. Pretreatment extra and intraoral photos describing the severity of the dentofacial deformity and the problems

models to measure the discrepancy and formulate appropriate.

pleasant smile, and insure life-long postoperative stability.

the achievement possible.

140 Current Approaches in Orthodontics

2.4.2. Treatment objectives

2.4.3. Treatment planning

to be solved.

2.4.1. Diagnosis

Mutual collaboration between healthcare providers allows for the proper selection of treatment modality relevant to the dentofacial deformity presented. Bimaxillary surgery helped in

Figure 26. Pretreatment lateral cephalometric and panoramic radiographs (essential diagnostic aids).


Figure 27. Pretreatment lateral ceph (McNamara) analysis and soft tissue surgical planning (prediction).

Figure 28. Initial bonding followed by inserting leveling arch wires to prepare the case for surgery.

Figure 29. Postsurgical occlusion and the role of inter-maxillary elastics in stabilizing the occlusion and then setup retentive means.

restoring harmony and balance of the face and establishing an ideal occlusal relationship. Patient cooperation and her family support were a key factor in achieving the satisfactory treatment outcome. Follow up for 5 year post treatment confirmed the successful procedures

Figure 32. Occlusion 3-year post retention. Pre and post treatment facial features.

Figure 31. Post treatment cephalometric analysis reflecting the restructural improvement of the profile.

Orthosurgical Correction of Severe Vertical Maxillary Excess: Gummy Smile

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

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The authors declare that there is no conflict of interest regarding the publication of this chapter.

performed.

Conflict of interest

Figure 30. Pre and post cephalometric and panoramic radiographs.

Orthosurgical Correction of Severe Vertical Maxillary Excess: Gummy Smile http://dx.doi.org/10.5772/intechopen.80384 143

Figure 31. Post treatment cephalometric analysis reflecting the restructural improvement of the profile.

Figure 32. Occlusion 3-year post retention. Pre and post treatment facial features.

restoring harmony and balance of the face and establishing an ideal occlusal relationship. Patient cooperation and her family support were a key factor in achieving the satisfactory treatment outcome. Follow up for 5 year post treatment confirmed the successful procedures performed.
