Skeletal Anchorage for the Correction of Bimaxillary Protrusion and Gummy Smile

Abstract

Many methods of achieving maximum anchorage have been experimented by various clinicians through the years. Usage of mini implants has its own limitations, inconsistent results being the most common. However, anchorage using mini plates produced consistent results even though it requires a minor invasive surgical procedure. The aim was to retract and correct a gummy smile of 5 mm, diagnosed to be due to a vertical maxillary excess, with mini plates used bilaterally in the zygomatic buttress region. A modified “L” shaped surgical stainless steel mini plate was inserted and stabilized with 3 screws in the anterior region of the zygomatic buttress and sutured with the tip of the surgical plate exposed in the oral cavity for the attachment of an elastomeric chain to the arch wire. The gummy smile was fully corrected with minimal intrusion of maxillary anteriors. Cephalometrically, there was intrusion and retraction of maxillary incisors with absolutely no anchor loss. The modified surgical mini plate is an excellent tool for the successful correction of the gummy smile and also has proved to be a very efficient absolute anchorage system for en masse retraction.