Republication: Conservative Management of Skeletal Class II Malocclusion with Gummy Smile, Deep Bite, and a Palatally Impacted Maxillary Canine

Abstract

A 21-year-old female presented with chief complaints of crooked teeth, canine impaction, deep bite, and “gummy smile” (excessive maxillary gingival exposure when smiling). Increased facial convexity (15.5°), increased lower facial height (56%), and incompetent protrusive lips (E-line to upper left 2 mm, E-line to lower left 2 mm) were associated with a severe Class II malocclusion (nearly a full cusp bilaterally). There was 7.5 mm of overjet, 100% anterior deepbite, and a left posterior buccal crossbite. Cephalometrics revealed a skeletal discrepancy due to a protrusive maxilla and a retrusive mandible (SNA 85°, SNB 78°, and ANB 7°). Cone-beam computed tomography imaging revealed a palatally impacted right maxillary canine (UR3) near to the adjacent lateral incisor (UR2). The retained right primary canine (URc) was extracted. A simplified open-window technique was utilized to surgically expose its impacted successor. A maxillary anterior mini-screw provided anchorage to align the UR3 in its correct anatomical position. Nonextraction treatment with a passive self-ligating fixed appliance was indicated to align and level both arches. Anchorage provided by infrazygomatic crest bone screws, and maxillary anterior miniscrews were used for the correction of Class II malocclusion and gummy smile. To achieve more esthetic crown lengths in the maxillary anterior segment, gingivectomy was performed with a diode laser 2 months after fixed appliances were removed. This challenging skeletal Class II malocclusion with a Discrepancy Index of 38 was treated in 32 months to excellent outcomes: Cast-radiograph evaluation score of 25 and an pink and white dental esthetic score of 2. All facial and dental corrections were stable at the 6 months follow-up evaluation (Int J Orthod Implantol 2017;48:24-46). Republished with permission from: Ariel Wong, Chang CH, Roberts WE. Conservative Management of Skeletal Class II Malocclusion with Gummy Smile, Deep Bite, and a Palatally Impacted Maxillary Canine. Int J Orthod Implantol 2017;48:24-46.