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The treatment of Gummy Smile utilizing the DSD in Orthodontics and Bone Screw

The use of mini screws as temporary anchorage devices has revolutionized orthodontics. The following cases illustrates a type of orthodontic correction which was impossible to consider without surgery just a few years ago.

Using DSD in Orthodontics
Using DSD in Orthodontics

Gummy smile (excessive gingival display) is a condition in which a high lip-line exposes an abnormal amount of gingival tissue. Several potential factors could contribute to a gummy smile. For example, the muscle controlling the movement of the upper lip could be hyperactive, resulting in an upper lip that rises higher than normal. When this occurs, more of the gingival tissue is exposed when smiling. Other factors can include, but are not limited to, delayed passive eruption and factors related to the dentogingival complex.

Excessive gingiva display calculated scientifically before treatment
Excessive gingiva display calculated scientifically before treatment

The smile-line is determined by the shape and size of the lips, the facial muscles, shape and size of the teeth, and the gingival tissue. Ideally, an aesthetic smile line should reveal the least amount of gingival tissue possible. Gum tissue present in the smile-line should exhibit balance with the contours in harmony with the upper lip. Since a gummy smile can have a negative affect on the aesthetics of a smile, one needs to consider various treatment options available to correct the condition when desired by the patient. One such option is the use of the orthodontics and bone-screw as treatment option .

This article demonstrates the use of this treatment modality to aesthetically improve smiles that exhibit excessive gingival display.

Proper diagnosis is vital to the success of every potential aesthetic case.  The aesthetic issue was not a tooth problem, but a periodontal (gum) problem that had to be approached employing a periodontal treatment plan. The use of DigitalSmileDesign (DSD) helps in diagnosing, treatment planning and communicating with the patients.

All these patients underwent a smile assessment via the DSD protocol and revealed excessive gingival exposure when smiling according to patients themselves.

Purely orthodontics and bone-screws to correct the gummy smile without any surgery.
Purely orthodontics and bone-screws to correct the gummy smile without any surgery.

 

Orthodontics, Bone-screws and gum surgery
Orthodontics, Bone-screws and gum surgery

 

If necessary a double crown lengthening guide and procedure utilizing the digitally designed bone and soft tissue remodeling. – Denti-Pro Blog
If necessary a double crown lengthening guide and procedure utilizing the digitally designed bone and soft tissue remodeling. – Denti-Pro Blog

 

Gummy smile in usually orthognathic case. The facial profile is convex and the lower third of the face is long. Lips are strained when in the closed position.
Gummy smile in a usually orthognathic case. The facial profile is convex and the lower third of the face is long. Lips are strained when in the closed position.

 

This patient with upper jaw vertical excess. When he smiles, he shows a fair amount of gums in his upper front teeth after his openbite was corrected. He is not interested in orthognathic surgery.
This patient with upper jaw vertical excess. When he smiles, he shows a fair amount of gums in his upper front teeth after his openbite was corrected. He is not interested in orthognathic surgery.
Dr Kamsiah G Haider Prosthodontist, DSD Master & Instructor, BDS, MDSc

Dr. Kamsiah is also known as Dr. Kam is cosmetic dentist with over 30 years experience . Areas of interest are prosthodontics , dental implants and orthodontics as part of smile make over. . . . Dr. Kamsiah was a full time lecturer at the University of Malaya and an Associate Professor at the International Islamic University . She still lectures , mentors and conduct courses on the Digital Smile Design .

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