Objective: Along with ideal occlusion, adequate gingival display with harmonious gingival line, balanced smile arc, and buccal corridor are key factors for an esthetic smile and facial attractiveness. This case report illustrates the esthetic improvement of smile of a Skeletal Class II malocclusion with un-esthetic smile.
Case: We report the case of a 25-year-old woman with Skeletal Class II malocclusion with un-esthetic smile including excessive gingival display and large buccal corridors with the chief complaint of awkward smile and protrusion. For camouflage treatment, total of four miniscrews were inserted between the maxillary premolars and the first molars for total distalization along with intrusion of maxillary dentition. Additionally, Gingivoplasty was performed to re-contour the gingival margins and to recover crown width/length ratio. After 19 months of treatment, the gingival display at smile was ideal and the consonant smile arc was maintained after treatment with reduction of buccal corridor. Three-dimensional superimposition to the cranial base using CBCT showed significant amount of total intrusion and distalization of the maxillary arch without changes in the occlusal plane, along with counterclockwise rotation of the mandible. The occlusion and the smile esthetics were stably maintained throughout the 15 months of follow-up period.
Summary : Total intrusion of the maxillary dentition along with distalization induced improvement of both the occlusion and the smile esthetics. In addition to the conventional cephalometrics superimposition, 3D superimposition was evaluated to validate the treatment outcome.