Gummy smile. Open bite, class II and crossbite.
The patient came to our clinic feeling extremely self-conscious about her gummy smile. Even though she had a very significant malocclusion —an open bite with class II and a crossbite— her main concern was esthetic. That is very common: with malocclusions there are always functional causes that affect health, yet people tend to think only about appearance. She was very self-conscious about her gummy smile and, as she told us, about seeing her teeth pushed outwards. She had previously been told that in order to correct that case properly she would need major jaw surgery.
Diagnosis
At Clínica Peydro Herrero we approached the case in a far more conservative way, without extracting healthy teeth. The first step was to study the origin of the severe problem she had developed. We could see that the crossbite she had was entirely related to a lack of transverse development in the jaws. That lack of transverse development caused an exaggerated protrusion of the upper and lower incisors, which in turn caused the open bite and, facially, greatly increased her gummy smile. The case required neither extractions nor surgery: everything was more conservative and simpler, and that is how we did it.
The treatment plan was as follows:
– Clear aligner treatment with the Invisalign technique, without extractions and without surgery.– Achieve correct transverse development of the arches so as to allow a correct relationship between the upper and lower jaw.– Completely avoid any downward vertical movement of the upper incisors, so as not to increase the gummy smile.– Carry out intrusion of the molars and premolars in the upper arch so as to close the open bite without having to bring the upper incisors down.– Use the space gained through expansion to retract the upper and lower incisors, allowing the lip to settle in a more natural position and greatly disguising the gummy smile.– Achieve very wide dental arches that would allow us to design a full smile: what is known as a FULL MOUTH SMILE.
The case was solved in around 18 months of treatment and the result is simply spectacular. We have exceeded the patient’s expectations and designed a perfect smile, while also giving her an impeccable bite that will provide both looks and function for life.
