Viable Treatment Alternative: Class II Correction with Extraction of Periodontally-Compromised Upper Central Incisors

A 37-year-old female patient presented for treatment to improve her smile with her chief complaint being reduction of the “gummy smile.” The overbite was also an issue she wished to address. She found herself unwilling to smile in social situations and was unsatisfied with other dental opinions about how she might be helped.

A weakness of the orthodontic specialty has been effective treatment of gingival display. In fact, a frequent complication of orthodontic treatment is that gingival display tends to get worse as a result of treatment. This has been especially problematic when attempting to retract the upper anterior teeth using traditional orthodontic mechanics. Orthognathic surgery is typically seen as the treatment modality of choice to help patients with this condition of excessive gingival display. This patient’s previously consulted dental and orthodontic opinions ONLY involved an orthognathic surgical option consisting of two maxillary jaw impaction surgeries, mandibular advancement surgery, and possibly augmentation genioplasty procedures. The patient was not willing to go through said procedures and was seeking other treatment alternatives. The dominant clinical finding was an excessive gingival display from super erupted upper incisors often referred to technically as Vertical Maxillary Excess (VME). The patient also presented with severe skeletal Class II (ANB= 11.5), Skeletal open bite, and lip incompetency. (Fig. 1)