Abnormal periodontal changes incidental to total arch intrusion to treat a severe gummy smile

Abstract

This case report presents the treatment of a severe gummy smile in an 18-year-old female using nonsurgical orthodontic treatment with mini-implants and a modified palatal bar. The patient, who presented with protruding anterior teeth and excessive gingival exposure, opted for orthodontic treatment over surgery. Two mini-implants were placed in the midpalatal region near the maxillary molars to facilitate maxillary arch intrusion and retraction of the anterior teeth. A nickel-titanium archwire with a 45° gable bend, followed by a stainless-steel archwire with an intrusive cantilever, was used sequentially in conjunction with the Aichi-Gakuin palatal bar to achieve 5.0 mm of anterior intrusion and 2.5 mm of molar intrusion. Although the orthodontic treatment effectively corrected the gummy smile, significant periodontal changes were observed. The maxillary anterior teeth became embedded in the gingiva, requiring gingivectomy on the labial side and surgical crown lengthening with osteoplasty on the palatal side to restore the biologic width. No relapse occurred, and the treatment outcomes were stable 25 months posttreatment. This report highlights the potential for nonsurgical orthodontic treatment to correct a severe gummy smile and emphasizes the importance of managing periodontal tissue remodeling when substantial tooth intrusion is performed.