Miniscrew mechanics for molar distalization and incisor intrusion in a patient with a Class II brachyfacial pattern and gummy smile

• Published in: American journal of orthodontics and dentofacial orthopedics Vol. 158; no. 2; pp. 273 - 285
• Main Authors: Paredes-Gallardo, Vanessa, Bellot-Arcís, Carlos, García-Sanz, Verónica
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.08.2020
• ISSN: 0889-5406; 1097-6752
• DOI: 10.1016/j.ajodo.2019.04.038

A gummy smile is one of the most problematic characteristics in patients with a Class II Division 2 malocclusion, and the correction of vertical position and incisor torque is often challenging for the orthodontist. This case report describes the orthodontic treatment of a 31-year-old woman, assisted by miniscrew mechanics for maxillary arch distalization and correction of a gummy smile with a brachyfacial pattern. Two different mechanics were used. Miniscrews were placed in both maxillary tuberosities, and the maxillary arch was successfully distalized, correcting the Class II relationship. Interradicular miniscrews were placed for maxillary and mandibular incisor intrusion to correct the gummy smile, overbite, and torque. Finally, periodontal surgery was performed to lengthen the maxillary incisor crowns. Satisfactory smile esthetics and good occlusion were achieved. Follow-up after 24 months confirmed that the outcome was stable. •The diagnosis of gummy smile etiology is crucial for accurate treatment planning.•Adequate vertical position and torque of incisors provide good stability.•Miniscrews facilitate the correction of Class II and incisor overeruption.•Gingivectomy improves smile esthetics when the altered passive eruption is diagnosed.