The upper left first molar was distalized by an open coil spring from the first premolar, which was connected tightly with a miniscrew ( Figure 6). After 16 months, the upper left second molar was extracted and distalization of first molar began. The lower first premolars were also distalized from the first molars ( Figure 5). Based on this information, the patient was diagnosed with a skeletal Class II maxillary protrusion with a gummy smile. As shown in the cephalometric measurements, a skeletal Class II relationship (ANB angle, 6.6°) with labial inclination of lower incisors (IMPA, 109.2°) was evident ( Table 1). A panoramic radiograph showed the existence of upper right third molars ( Figure 4). The lower dental midline coincided with the facial midline, but the upper midline was shifted to the right by 2 mm ( Figure 3). The right molar relationship was Class I and the left was full Class II there was a little crowding in both arches. The intraoral photographs and dental casts revealed a 4.0-mm overjet and a 2.5-mm overbite. The pretreatment facial photographs showed a convex profile, an acute nasolabial angle, hypermentalis activity with closed lips ( Figure 1), and excessive gingival display in smiling ( Figure 2). However, the patient was not willing to undergo the surgery. We had previously recommended orthodontic treatment with orthognathic surgery. The patient, a female (age: 31 years 1 month), complained of a gummy smile. In this case report, we present the management of gummy smile and facial profile with skeletal Class II patients using miniscrew anchorage. Surgical invasion is minimal during miniscrew insertion, compared to that associated with placement of miniplates, because mucosa should be cut and a flap is required. Miniplates 7– 10 and miniscrews 11– 16 are now frequently used for establishing absolute anchorage for orthodontic tooth movement. 6 However, if the patients are unwilling to undergo surgical treatment, an alternative method must be considered to treat the gummy smile. In such cases, surgical therapy, such as that provided by a Le Fort impaction or maxillary gingivectomies, are often chosen to gain a good smile. If a gummy smile is characterized by overgrowth of anterior vertical maxillary excess, the outcome may not always be successful with conventional orthodontic therapy alone. 1– 5 Thus, proper diagnosis and treatment are important. Gummy smile is an esthetic problem for some patients and a frequent finding that can occur as a result of various intraoral or extraoral etiologies.
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