Management of vertical maxillary excess with ‘surgery only’ approach

In a previous post we looked at the orthodontic management of VME with miniscrews.

Increased gingival show/exposure can be caused by variety of aetiologies. It goes without saying that an essential part of successful management is accurate diagnosis. Some of the aetiologies include a short or hypermobile upper lip, altered passive eruption, vertical maxillary excess (VME), dentoalveolar extrusion, and gingival hyperplasia, with the most common aetiology being VME. VME may be anterior, posterior and/or total.

Here, we will look at a case that required surgical approach in its management. As a general rule, VME of more than 3mm is difficult to manage with orthodontics alone. Of course, intrusion of more than 3mm can still be achieved, however, we have to respect the biological limits, i.e. how much can we intrude teeth before increasing the risk of root resorption?

Patients with anterior VME, usually have normal lower anterior face height, the main presentation is increased gingival show at rest and smiling. On the other hand, posterior or total VME can be associated with increased lower face height and reduced overbite, as well as increased gingival show.

In this case, a ‘surgery only’ approach was applied. The patient had relatively good alignment and arch coordination. The main feature that required correction was the VME.

Anterior VME as can be seen radiographically.

Anterior VME associated with 6mm gingival exposure on smiling.

Relatively good alignment with the main issue being VME with the associated increased gingival exposure.

Pre-surgical preparation; brackets placed pre-operatively for the purpose of peri-operative intermaxillary fixation.

Immediate post-operative settling with intermaxillary elastics. Class II elastics on the right and box elastics on the left.

Final occlusion.

Smile enhancement with 60% incisor exposure on smiling post-operatively.

For patients:

Vertical maxillary excess (gummy smile), also known as a gummy smile, is a condition where there is an excessive display of gum tissue when smiling due to overgrowth of the upper jaw bone. This can lead to aesthetic concerns and dental issues. Treatment options may include orthodontic procedures, orthognathic surgery, or a combination of both to correct the underlying skeletal discrepancy and achieve a balanced smile.

Having a gummy smile can be a concern for some individuals, affecting their confidence and self-esteem. This condition, known as excessive gingival display, occurs when a significant amount of gum tissue is exposed when smiling. Fortunately, orthodontic treatments such as braces or clear aligners can help correct a gummy smile, bringing the teeth and gums into proper alignment to achieve a more balanced and aesthetically pleasing smile. A comprehensive evaluation by an orthodontic specialist is crucial to determine the most appropriate treatment plan for each individual case.