This article demonstrates the noninvasive means of correction of gummy smile and deep bite by using mini-implants in a relapsed patient. Intrusion of the maxillary arch was achieved by using mini-implants in the anterior and posterior region. Significant reduction in the gingival and incisal display was seen with improved smile esthetics and ideal overbite and overjet by the end of the treatment. The aim of the article is to present a case where gummy smile was effectively treated by mini-implants without undergoing invasive surgical procedures.
Adult patients seeking orthodontic treatment present with consistent esthetic demand even during treatment. Such a demand may be attributed to their professional and social life. This increasing demand for an esthetic appearance among adult orthodontic patients has led to the advent of invisible orthodontic treatment. Tooth-colored brackets, clear aligner therapy, and lingual orthodontic treatment are the invisible treatment options available. However, these brackets are not completely invisible and are known for staining and tie wing fracture. [1,2] Although clear aligners meet the esthetic demand, they cannot provide three-dimensional (3D) control of the teeth and they are limited to mild to moderate cases of malocclusions. [3] The best appliance to meet the esthetic requirements and to give complete 3D control to correct any kind of malocclusion is a fixed lingual appliance.As with any other technique, even lingual appliance therapy has its own disadvantages. One among which is control of the anterior teeth torque in extraction cases. [4] Lever arms extended close enough to the center of resistance of anterior segment in conjunction with mini-implants as absolute anchorage can help in minimizing torque loss and achieving controlled tooth movement with reliable force system in en masse retraction. [4,5] This article presents a case report of an adult patient treated successfully using customized lingual appliance therapy with lever arms and mini-implants.
dIAgnosIs And tReAtment PLAnA 29-year, 2-month-old male patient presented with a chief complaint of forwardly placed upper front teeth and crowding of lower front teeth. He had a convex profile with posterior divergence and acute nasolabial angle. Lips were protruded and incompetent. Cephalometric analysis showed mild skeletal Class II jaw base relationship (ANB angle, 4°), with normodivergent and horizontal growth pattern (ANS-PNS/ GO-GN -23°) and proclined upper and lower anterior teeth. On clinical examination, both canine and molar relationships were Class I on both sides with overbite of 3 mm and overjet of 3 mm. There was severe deep bite with lower anteriors hitting the gingival thirds of upper anterior teeth. Lower anterior teeth were crowded and mild spacing was observed in upper anteriors [Figures 1-3].The patient was given the diagnosis of Angle Class I malocclusion, with mild skeletal Class II jaw base relationship,
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