Objective: This case report described interdisciplinary management for an adult with gummy smile.
Cases: A 40-year-old female had concern about her gummy smile and unaesthetic dental crowns. She was diagnosed with Angle Class II malocclusion, mandibular retrognathism with high mandibular plane angle, and generalized chronic periodontitis. Clinical examination showed excessive gingival display, large overjet, deep overbite, ill-fitted prostheses, and multiple missing teeth. Due to financial concern, patient rejected the option of orthognathic surgery to correct skeletal problem. Treatments started with periodontal phase I and phase II therapies. Provisional crowns were fabricated in accordance with the root axes prior to orthodontic treatment. Bilateral posterior mini-screws were inserted for upper anterior intrusion and retraction and lower wisdom teeth protraction. After achievement of normal overjet and overbite, maxillary anterior teeth received crown lengthening procedure. Definitive prosthetic rehabilitation consisted of crowns, fixed partial dentures, and a single implant. Superimpositions of lateral cephalometric radiographs showed intrusion of the entire maxillary dentition, retraction of maxillary anterior teeth, counterclockwise rotation of mandible, and protraction of bilateral mandibular wisdom teeth for approximately 8 mm.
Discussion and Summary: Lateral profile was improved by maxillary anterior retraction and counterclockwise rotation of mandible. Excessive gum display was corrected by maxillary anterior intrusion and crown lengthening procedure. Crown/root ratios of maxillary incisors were improved partly by incisal edge reduction.