Rationale of total arch intrusion for gummy smile correction

Abstract

Excessive gingival display during smile, also referred to as gummy smile, is often perceived as esthetically unpleasant. While different etiological factors are known to be associated with gummy smile, it eventually results from an imbalance between the dentoalveolar hard tissue and the covering soft tissue. There are a number of different approaches to gummy smile correction. They range from a relatively simple and quick injection of Botulinum-toxin in the hyperactive lip elevator muscles to more invasive procedures such as maxillary impaction by orthognathic surgery. In the meanwhile, the surgical repositioning of the maxilla can be replaced by the intrusion of the whole maxillary arch with the help of orthodontic miniscrews. This article conveys the rationale, biomechanical evidence and clinical effect of total arch intrusion applied to the correction of gummy smile accompanied by lip incompetence.