Orthodontic Correction of Adult Gummy Smile with TADs and Periodontal Surgery

With the applications of skeletal anchorage system, genuine incisor intrusion is feasible to improve adult gummy smile, which was difficult to correct without orthognathic surgery in the past. Differential diagnosis and various treatment options should be fully discussed to decide the appropriate treatment modality. After significant amount of upper incisor intrusion, there might be an adverse effect on the crown height and width ratio. Esthetic periodontal surgery (gingivectomy, crown lengthening and/or alveoloplasty) would be indicated for restoring the appropriate crown height and width ratio and further reducing the excessive gingival display. Under the collaboration of anterior miniscrew anchorage and periodontal surgery, it greatly improves the possibility of orthodontic correction for gummy smile in adult patients.

Learning Objectives:

• Make a differential diagnosis on gummy smile and decide the appropriate treatment modality.
• Propose a combined intrusion and retraction force system with TADs, in conjunction with a periodontal surgery to solve adult gummy smile.
• Demonstrate closed technique of inserting the anterior subapical miniscrew.