Correction of a gummy smile and lip protrusion by orthodontic retreatment with lingual appliances and temporary skeletal anchorage devices

Abstract

A 28-year-old woman desired orthodontic retreatment for lip protrusion and excessive gingival display in both the anterior and posterior areas on full smiling. She had previously undergone an extraction orthodontic treatment for correction of open bite. She was diagnosed with skeletal Class Ⅱ hyperdivergence. To mimic LeFort Ⅰ maxillary impaction surgery, posterosuperior movement of the maxillary whole dentition was planned, and bodily distalization of both the maxillary and the mandibular whole dentitions to improve lip protrusion. A combination of lingual appliances, 2 appropriately fabricated power arms, and 1 midpalatal microimplant contributed to the posterosuperior intrusion and bodily distalization of the maxillary arch. With the use of lingual appliances, 2 lever arms, and 2 conventional microimplants, the mandibular arch was bodily distalized. The active treatment period was 37 months, and the results were stable 12 months after treatment.