This document describes the orthodontic treatment of a 31-year-old female patient with a gummy smile. To correct the gummy smile, the orthodontist intruded the entire maxillary dentition rather than just the anterior teeth. A midpalatal absolute anchorage system and modified lingual arch were used to achieve posterosuperior movement of the maxillary dentition over 18 months. This corrected the gummy smile and crowding. Follow-up after 21 months showed the results were stable despite the patient not wearing a maxillary retainer as prescribed.
Abstract: Immediate implant placement has been the acceptable procedure for the past two decades. Perhaps
the most important aspect of any implant surgery in accordance with the successful procedure is implant
surgery and bone to implant contact.The aim of this article is to describe a clinical case in which a fractured
maxillary canine was replaced by an immediately loaded postextraction implant using a simplified technique,
which permits a reduction of the number of implant components and consequently a lower cost of treatment,
while at the same time maintaining acceptable aesthetic and functional outcomes.
Key words: Immediate implant placement, Immediate loading, Immediate provisionalisation, Esthetics
Changes on Maxillary Sinus and Pharyngeal Airway Space after orthognathic sur...Turgut Novruzlu
Presentation about impact of Bimaxillary orthognathic surgery on Maxillary Sinuses and PAS. Evaluation with CBCT. Article investigation. 2018 Research, rejected null hypothesis that orthognathic surgeries does not affect dimensions maxillary sinuses and PAS. BSSO. Bilateral Split Sagittal Osteotomy, LeFort1
Maxillary procedures and soft tissue changes /certified fixed orthodontic cou...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Abstract: Immediate implant placement has been the acceptable procedure for the past two decades. Perhaps
the most important aspect of any implant surgery in accordance with the successful procedure is implant
surgery and bone to implant contact.The aim of this article is to describe a clinical case in which a fractured
maxillary canine was replaced by an immediately loaded postextraction implant using a simplified technique,
which permits a reduction of the number of implant components and consequently a lower cost of treatment,
while at the same time maintaining acceptable aesthetic and functional outcomes.
Key words: Immediate implant placement, Immediate loading, Immediate provisionalisation, Esthetics
Changes on Maxillary Sinus and Pharyngeal Airway Space after orthognathic sur...Turgut Novruzlu
Presentation about impact of Bimaxillary orthognathic surgery on Maxillary Sinuses and PAS. Evaluation with CBCT. Article investigation. 2018 Research, rejected null hypothesis that orthognathic surgeries does not affect dimensions maxillary sinuses and PAS. BSSO. Bilateral Split Sagittal Osteotomy, LeFort1
Maxillary procedures and soft tissue changes /certified fixed orthodontic cou...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Fabrication of functional complete dentures for edentulous patients who have undergone hemimandibulectomy is a very arduous and demanding endeavor.
The most challenging situation encountered during this procedure is the deviation of the mandible to the resected side. The deviation of the mandible to the resected side is directly proportional to the loss of tissues in the area hemi-mandibulectomy has been performed.
In cases with Cantor and Curtis classes II, III, IV, and V, guide flange prosthesis would be a treatment modality. For guide flange prosthesis to be effective, the sufficient number of posterior teeth that are periodontally sound should be present in the opposite arch.
In patients where reconstruction is not done after resection of the mandible, scar tissue formation occurs over a period of time that stiffens the tissues and worsens prosthetic rehabilitation, leading to compromised treatment planning.
orthodontic correction of class II div 1 extraction of 4 bicuspidsMaher Fouda
the different clinical steps of orthodontic correction of class II div 1 as treated by bicuspid extraction are presented as case report from the Atlas of orthodontic case reviews book
Evolution of orthognathic surgery /certified fixed orthodontic courses by Ind...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Surgical orthodontics ii /certified fixed orthodontic courses by Indian den...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Splints in orthodontics /certified fixed orthodontic courses by Indian denta...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Orthognathic surgery is the art and science of diagnosis , treatment planning and execution of treatment by combining both orthodontics and oral and maxillofacial surge
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Fabrication of functional complete dentures for edentulous patients who have undergone hemimandibulectomy is a very arduous and demanding endeavor.
The most challenging situation encountered during this procedure is the deviation of the mandible to the resected side. The deviation of the mandible to the resected side is directly proportional to the loss of tissues in the area hemi-mandibulectomy has been performed.
In cases with Cantor and Curtis classes II, III, IV, and V, guide flange prosthesis would be a treatment modality. For guide flange prosthesis to be effective, the sufficient number of posterior teeth that are periodontally sound should be present in the opposite arch.
In patients where reconstruction is not done after resection of the mandible, scar tissue formation occurs over a period of time that stiffens the tissues and worsens prosthetic rehabilitation, leading to compromised treatment planning.
orthodontic correction of class II div 1 extraction of 4 bicuspidsMaher Fouda
the different clinical steps of orthodontic correction of class II div 1 as treated by bicuspid extraction are presented as case report from the Atlas of orthodontic case reviews book
Evolution of orthognathic surgery /certified fixed orthodontic courses by Ind...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Surgical orthodontics ii /certified fixed orthodontic courses by Indian den...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Splints in orthodontics /certified fixed orthodontic courses by Indian denta...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Orthognathic surgery is the art and science of diagnosis , treatment planning and execution of treatment by combining both orthodontics and oral and maxillofacial surge
В данной презентации представлены основные возможности MS Office 2010. Отдельно рассмотрены функциональные возможности MS Outlook 2010, которые будут полезны для проектного менеджера.
Modern Treatment for Congenitally Missing Teeth : A Multidisciplinary Appro...Abu-Hussein Muhamad
The maxillary lateral incisor is the second most common congenitally absent tooth. There are several treatment options for replacing the missing maxillary lateral incisor, including canine substitution, tooth-supported restoration, or single-tooth implant. Dental implants are an appropriate treatment option for replacing missing maxillary lateral incisor teeth in adolescents when their dental and skeletal development is complete. This case report presents the treatment of a patient with congenitally missing maxillary lateral incisors using dental implants. Finally, the importance of interdisciplinary team treatment planning is emphasized as a requirement for achieving optimal final esthetics
Treatment concept by Watted for a controlled alignment of palatally impacted ...Abu-Hussein Muhamad
It is known that maxillary canines remain impacted more often than the mandibular canines, and the inclusion can be
buccal or palatal. The treatment focuses mainly on the exposure and on the orthodontic realignment of the impacted
tooth. There are situations when canines erupt spontaneously after their surgical discovery. The present paper has the
purpose of approaching aspects related to impacted upper permanent canines by a literature review, including
localization and treatment conducts.
Key words: Impacted canine, periodontal, surgical-orthodontic treatment.
치아교정을 통해서도 부정교합을 치료하는 동안 각진 턱이 갸름해지면서 사각턱이 개선될 수 있다는 사실의 논문입니다.
치아교정 중에 부가적인 효과로 자연스럽게 사각턱도 개선될 수 있다는 사실을 발견한 청아치과의 홍윤기박사팀이 2014년 미국임상교정학저널(Journal of Clinical Orthodontics)에 발표한 내용입니다.
Treatment of bimaxillary protrusion with lever-arm mechanics and micro-implant anchorage
Indications of orthognathic surgery and surgical proceduresMaherFouda1
this explains indications of performing orthognathic surgery.It also explains different surgical procedures for different severe forms of malocclusion .
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
2. Hong et al • Orthodontic treatment of gummy smile by maxillary total intrusion
www.e-kjo.org148 http://dx.doi.org/10.4041/kjod.2013.43.3.147
INTRODUCTION
In 1983, Creekmore and Eklund1
reported using a
metal implant to correct a deep overbite. They placed
a surgical vitallium bone screw just below the anterior
nasal spine and used elastic thread to elevate the
maxillary central incisors by approximately 6 mm while
tipping them 25o
labially, without causing infection,
pain, or other complications from the screw. However,
they cautioned that widespread use of this technique
would be premature.
Recently, mini-implants have been used to correct
gummy smiles or deep overbites through intrusion of
the upper incisors.2,3
In 2006, Kim et al.2
applied a seg
mental intrusive force between the maxillary central
incisors by using a mini-implant with segmented wires.
In 2010, Lin et al.3
introduced a combined approach
using skeletal anchorage to simultaneously control the
vertical dimension and to resolve gummy smiles of
skeletal origin in adult long-faced patients.
This case report presents the orthodontic treatment
of an adult patient whose gummy smile was corrected
by intruding the entire maxillary dentition using a
midpalatal absolute anchorage system (MAAS) and a
modified lingual arch.
DIAGNOSIS AND ETIOLOGY
A 31-year-old Korean female patient was concerned
about her gummy smile. She showed excessive gingival
display in both the anterior and posterior areas, occlusal
canting upon smiling, a straight profile, and facial
asymmetry from the frontal view (Figure 1). There
was no interlabial gap at the resting lip position. The
study model revealed bilateral Class I canine and molar
relationships with a 3.5 mm overbite, 3.0 mm overjet,
and a 1.5 mm midline discrepancy between the maxilla
and mandible (Figure 2). There were 0 mm and 1.3
mm arch length discrepancies in the maxillary and
mandibular arches, respectively. The patient had no
history of trauma or severe disease and no pathologic
signs were found within the temporomandibular joint or
in the mouth.
Cephalometric evaluation showed a skeletal Class
Figure 1. Pretreatment facial and intraoral photographs.
3. Hong et al • Orthodontic treatment of gummy smile by maxillary total intrusion
www.e-kjo.org 149http://dx.doi.org/10.4041/kjod.2013.43.3.147
I relationship, a large upper anterior dental height
(Is-Is’, distance from the incisal edge of the upper
central incisor to the palatal plane), and a significantly
decreased mandibular plane angle (Figure 3 and Table
1). With reference to the Frankfurt horizontal plane, the
upper incisors were within normal limits and the lower
incisors were flared.
TREATMENT OBJECTIVES
Our treatment goals consisted of improving the pa
tient’s smile esthetics while providing a harmonious
occlusion. The treatment objectives included reducing
her excessive gingival display, creating a normal overbite
and overjet relationship, correcting the dental midline
discrepancy, and relieving crowding.
TREATMENT ALTERNATIVES
Botulinum toxin type A injections were considered for
correction because the patient’s gummy smile seemed
to be a result of hyperactivity of the elevator muscles of
the upper lip. However, this neuromuscular approach for
correction was rejected because of the transitory nature
of the results. Orthodontic treatment was selected in
stead.
This patient showed excessive gingival display in both
the anterior and posterior areas with a large difference in
the gingival heights between the maxillary anterior and
posterior teeth. To correct the gummy smile, therefore,
we decided to intrude the entire upper dentition instead
of focusing only on the upper anterior teeth.
Two treatment options were discussed with the pa
tient. The first was traditional orthodontic treatment
Figure 2. Pretreatment dental casts.
Figure 3. Pretreatment cephalometric and panoramic
radiographs.
4. Hong et al • Orthodontic treatment of gummy smile by maxillary total intrusion
www.e-kjo.org150 http://dx.doi.org/10.4041/kjod.2013.43.3.147
combined with Le Fort I surgery to reduce the maxillary
height, which would, in turn, reduce the gingival ex
posure. The second option was orthodontic intrusion of
the entire maxillary dentition using miniscrew skeletal
anchorage. After a review of the risks and benefits of
the two options, the patient chose the latter more con
servative method.
The patient was eager to use an invisible orthodontic
appliance during the entire treatment period. Therefore,
for alignment and leveling, removable clear aligners and
lingual brackets were used for the maxilla and mandible,
respectively. A screw implant and a modified lingual arch
were then used for total intrusion of the maxillary arch.
TREATMENT PROGRESS
Fujita lingual brackets were bonded indirectly from the
mandibular first molar to first molar, and 0.018-inch slot
standard edgewise appliances were placed on the buccal
surfaces of the mandibular first and second molars.4,5
A
progression through mushroom archwires was initiated,
starting with 0.012-inch nickel titanium wire in the
occlusal slots of the lingual brackets, and 0.016- × 0.022-
inch stainless steel segmental wires were engaged in
Table 1. Cephalometric summary
Measurement Norms Pretreatment Posttreatment 21-month retention
Skeletal
SNA (o
) 81.6 85.0 84.0 85.4
SNB (o
) 79.2 81.3 81.5 81.9
ANB (o
) 2.5 3.7 2.5 3.5
FMA (o
) 24.3 18.0 19.5 19.9
NPo-FH (o
) 89.1 89.7 87.0 88.0
Dental
Overbite (mm) 1.8 3.5 1.0 1.5
Overjet (mm) 3.5 3.0 2.5 2.5
1-FH (o
) 116.0 114.5 111.8 116.4
FMIA (o
) 59.8 59.7 51.0 53.1
Interincisal (o
) 123.8 125.1 119.0 116.7
Is-Is’ (mm) 31.9 34.0 32.0 33.0
Mo-Ms (mm) 24.2 25.0 24.0 24.0
Soft tissue
Upper lip to E-line (mm) −0.9 0.0 −0.5 0.0
Lower lip to E-line (mm) 0.6 0.5 0.5 0.5
SNA, Sella-nasion-A point; SNB, sella-nasion-B point; ANB, A point-nasion-B point; FMA, Frankfurt-mandibular angle; NPo,
nasion-pogonion; FH, Frankfurt plane; FMIA, Frankfurt-mandibular incisor angle; Is-Is’, distance from the incisal edge of
the upper central incisor to the palatal plane; Mo-Ms, distance from the buccal cusp tip of the upper first molar to the palatal
plane.
Figure 4. Photographs of bite opening before (A) and after (B) intrusion of the six mandibular anterior teeth.
5. Hong et al • Orthodontic treatment of gummy smile by maxillary total intrusion
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the buccal standard edgewise appliances. For 5 months,
alignment of the mandibular teeth progressed with
gradual increases in archwire sizes. After alignment, the
lower dental midline shift to the left side had improved,
probably because there was more crowding in the left
anterior region of the mandible.
For correction of the rotated maxillary right and left
lateral incisors, 5 clear aligners made of 0.5 mm Essix
A+ (Dentsply, Bradenton, FL, USA) were fabricated and
delivered to the patient. After delivery of the fourth
aligner, composite resin was added on the mesiolingual
surface of the maxillary right lateral incisor. The purpose
of the added resin was to facilitate rotation of the
lateral incisor. After 5 months of treatment with clear
aligners, a clear retainer was used until placement of the
modified lingual arch in the maxilla.
After the initial alignment phase, there were occlusal
interferences between the modified lingual arch of the
maxilla and the mandibular anterior teeth (Figure 4A).
Thus, we decided to apply modified intrusive mechanics
with a lingual segmented-arch technique6
to open the
bite via intrusion of the six mandibular anterior teeth
(Figure 5).
After four months of intrusion of the six mandibular
anterior teeth, the MAAS was designed to achieve pos
Figure 5. Modified intrusive mechanics in the lingual
segmented-arch technique. In the occlusal slots of the
anterior and posterior lingual brackets, 0.018- × 0.018-
inch stainless steel segmental wires were engaged. Addi
tionally, 0.017- × 0.025-inch titanium-molybdenum-
aluminum intrusion springs were engaged in the inner
lingual slots of the first molar brackets and hooked to the
anterior segment between the lateral incisors and canines
to intrude the six mandibular anterior teeth.
IS, Intrusive spring; AS, anterior segment; PS, posterior
segment; BSS, buccal stabilizing segment.
Figure 6. Midpalatal absolute anchorage system for postero-superior movement of the maxillary dentition. A,
Orthodontic force was applied postero-superiorly to the maxillary arch by attaching power chains from the hooks of the
power arm to the spurs on the modified lingual arch; B, close-up view.
SMS, Safe-multifunctional-solid screw; M-LA, modified lingual arch; PA, power arm; PC, power chain.
Figure 7. Dimensions of the safe-multifunctional-solid
(SMS) screw implant. The SMS screw has a hexagonal
head with two cross-shaped 0.032- × 0.032-inch slots. Its
diameter is 2 mm and the available lengths are 4 and 5
mm, which can be varied depending on the thickness of
the mucosa in the insertion area.
6. Hong et al • Orthodontic treatment of gummy smile by maxillary total intrusion
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terosuperior movement of the maxillary dentition using
the safe-multifunctional-solid (SMS) screw (BioMaterials
Korea Inc., Seoul, Korea) in conjunction with a modified
lingual arch (Figure 6). The SMS screw (Figure 7)
was implanted at the intersection of a line extending
between the upper right and left first molars and the
midpalatal suture. An appropriate power arm fabricated
with a 0.032- × 0.032-inch stainless steel wire was fixed
onto the implanted SMS screw head with a ligature
wire. A 0.9 mm stainless steel modified lingual arch
appliance, with hooks at the canines and first molars,
was bonded from second molar to second molar in the
maxillary arch. An elastomeric chain was then suspended
from the power arm to the hook on the modified lingual
arch, with a force magnitude of 200 to 250 g. A total
force of 800 to 1,000 g was applied for 9 months to the
maxillary arch.
After an 18-month treatment period, all fixed ap
pliances and the screw implant were removed. As an
effective method of retention after intrusion treatment
has not yet been developed, a circumferential removable
retainer was delivered in the maxilla. For the mandible,
a 0.0175-inch multistranded stainless steel lingual fixed
retainer was bonded from canine to canine.
RESULTS
The patient’s smile esthetics were improved with a
harmonious occlusion at the end of treatment (Figures
8 and 9). A Class I occlusion was achieved, and the
overbite and overjet were overcorrected to an edge-to-
edge bite (Figure 10). The maxillary and mandibular
dental midlines were coincident with each other.
Overall superimposition of cephalometric tracings
showed posterosuperior movement of the maxillary
dentition with little skeletal change (Figure 11). In a
regional superimposition, the lower incisors were in
truded with a slight proclination while the lower molars
were extruded. As a result, the mandible did not rotate
counterclockwise. No marked root resorption was seen
in the panoramic radiograph (Figure 12).
At the retention visit, the patient reported that she was
Figure 8. Posttreatment facial and intraoral photographs.
7. Hong et al • Orthodontic treatment of gummy smile by maxillary total intrusion
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not compliant with the maxillary removable retainer;
however, the 21-month retention records showed good
stability without obvious relapse (Figures 13, 14, and
15).
DISCUSSION
The reasons for a gummy smile include excessive
maxillary vertical growth, over-eruption of the maxillary
Figure 9. Before (A) and after (B) postero-superior movement of the maxillary dentition. Gummy smile was improved
because of the postero-superior movement of the maxillary dentition. Note the decreased distance from the hooks of
the power arm to the spurs on the modified lingual arch.
Figure 10. Posttreatment dental casts.
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incisors, incomplete anatomic crown exposure, hyper
activity of the elevator muscles of the upper lip, or
a combination of these factors.7-9
A gummy smile of
skeletal origin requires orthognathic surgery for cor
rection. Dentoalveolar gummy smiles caused by over-
eruption of the maxillary incisors can be corrected by
intruding the extruded maxillary incisors. The den
togingival type of gummy smile is related to abnormal
dental eruption or lack of gingival recession and requires
lengthening of the anatomic crown. The neuromuscular
type of gummy smile is caused by hypercontractibility
or excessive muscle contraction and can be improved
temporarily by injecting botulinum toxin type A. As
lip incompetency was not observed in this patient, the
gummy smile seemed to be a result of hyperfunctional
upper lip elevator muscles and was improved using an
orthodontic approach mimicking Le Fort I maxillary
impaction surgery.
The use of screw mechanics for achieving the effect
of a Le Fort I impaction of the maxilla was proposed by
Lin et al.,3
in which multiple screws are necessary: two
miniscrews (diameter, 2 mm; length, 7 mm) are placed
between the roots of the maxillary second premolars and
first molars on both sides; two hook screws (diameter, 1.5
mm; length, 9 mm) are inserted into the buccal alveolus
between the maxillary first and second molars on both
sides; and two hook screws (diameter, 2 mm; length, 7
mm) are placed in the paramedian palatal area 2 mm
from the midpalatal suture, near the imaginary midline
between the maxillary first and second molars.
In this case report, MAAS using the SMS screw implant
accomplished the effect of a Le Fort I impaction of the
maxilla with the aid of a modified lingual arch. The
SMS screw withstood quite heavy orthodontic forces. An
appropriately formed 0.032- × 0.032-inch stainless steel
power arm was fixed to the head of the SMS screw and
provided the force application points for the required
absolute anchorage without using multiple screws. We
propose that the MAAS used in this case is a minimally
invasive alternative orthodontic approach that mimics Le
Fort I maxillary impaction surgery.
The center of resistance of the unit to be moved is the
basic point around which the arrangement of a force
system is established. By using the center of resistance
for the maxillary dentition from second molar to se
cond molar, as defined by Billiet et al.,10
various force
systems for maxillary postero-superior intrusion can be
established and a number of different clinical situations
Figure 11. Pretreatment and posttreatment cephalometric superimposition. A, Overall superimposition on the Sella-
Nasion plane at Sella; B, regional superimpositions on the palatal plane at ANS and on the mandibular plane at Menton.
Figure 12. Posttreatment cephalometric and panoramic
radiographs.
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Figure 13. Facial and intraoral photographs 21 months into retention.
Figure 14. Dental casts 21 months into retention.
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may arise. If the postero-superior intrusion force passes
anterior to the center of resistance for the maxillary
dentition, the anterior teeth will intrude more than the
posterior teeth and an anterior open bite will occur.
On the contrary, if the postero-superior intrusion force
is applied posterior to the center of resistance for the
maxillary dentition, more intrusion of the posterior than
the anterior teeth is generated, resulting in a posterior
open bite. The line of action of the postero-superior
intrusive force through the center of resistance for the
Figure 15. Posttreatment and 21-month retention cephalometric superimposition. A, Overall superimposition on the
Sella-Nasion plane at Sella; B, regional superimpositions on the palatal plane at ANS and on the mandibular plane at
Menton.
Figure 16. Cephalometric radiograph taken after the
midpalatal absolute anchorage system was placed in situ.
CR, Collective center of resistance of the maxillary
dentition; LAIF1, the line of action of the postero-superior
orthodontic force distal to the center of resistance of the
maxillary arch; LAIF2, the line of action of the postero-
superior orthodontic force mesial to the center of
resistance of the maxillary arch.
Figure 17. The effect of bracket position and location of
the point of force application on tooth movement. In the
labial system, the intrusive force against the incisors is
applied anterior to the center of resistance and therefore
the incisors tend to tip forward as they intrude. Lingual
intrusive force is applied close to the center of resistance
of the incisors and the incisors are well intruded with
little flaring. The possibility of flaring of the incisors is
lower with lingual than labial mechanisms.
CR, Center of resistance; Fa, labial intrusive force; Fb,
lingual intrusive force; m and M, moment.
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maxillary dentition will generate uniform intrusion in
both anterior and posterior teeth. However, in clinically
practice, it is difficult to precisely establish the line of
action of the postero-superior intrusive force through
the center of resistance for the maxillary dentition.
Therefore, in this case, both the positioning of the
hooks on the modified lingual arch and the shape of the
power arm were determined using a lateral cephalogram,
so that the applied anterior and posterior forces would
move the upper arch posteriorly and superiorly with
respect to the center of resistance of the entire upper
dentition (Figure 16). In addition, the magnitude of
the anterior and posterior forces was adjusted so as not
to rotate the maxillary dentition clockwise or coun
terclockwise. As a result, uniform intrusion of both
anterior and posterior teeth occurred with no anterior
or posterior open bite resulting during postero-superior
intrusion of the maxillary dentition.
In a lingual force system, the intrusive force is applied
close to the center of resistance of the lower anterior
teeth because of the position of the lingual brackets
in relation to the center of the tooth (Figure 17), and
the anterior teeth are well intruded with little flaring.
However, the lower incisors were intruded with slight
proclination in this case. Slight proclination of the lower
incisors seemed to occur during alignment because the
lower anterior teeth were aligned for five months prior
to the intrusive mechanics.
The median and paramedian areas of the posterior
palate consist of cortical bone, which is thick and dense
enough to support screw implants and can sustain heavy
orthodontic forces. These areas have no anatomical
structures such as nerves, blood vessels, or roots that can
impede the placement of screw implants. Furthermore,
most of the soft tissue is keratinized and thinner than 1
mm. Therefore, the posterior region of the mid-palatal
suture is safe and solid for inserting screw implants.
Because the histomorphology of the palate shows that
the median palatal region is the best location for ortho
dontic implants, many osseointegrated implants have
been used for palatal anchorage.11-13
However, these
systems require a waiting period of over two weeks -
immediate loading is impossible - and the methods
of placement and removal of the implant are rather
complicated and time consuming, as well as costly for
the patient, because they require surgical intervention.
Recently, miniscrews have been widely used in pala
tal skeletal anchorage because they are relatively easy
to insert and remove, and force can be applied to them
almost immediately.14-16
These devices have demon
strated potential for direct or indirect skeletal anchorage
to move individual teeth. As shown in this case report,
however, the MAAS using the SMS screw can drive heavy
orthodontic forces to move whole dental arches in any
direction with the assistance of a power arm.
With the advent of absolute anchorage, it has become
feasible to perform orthodontic intrusion of the maxil
lary posterior teeth for correction of the anterior open
bite. A number of studies17-19
showed little disparity
between orthodontic and surgical approaches, and re
ported that relapse occurred in most cases during
the first year of retention. However, because there
is no effective way to retain an intruded tooth, a
tooth displaced intrusively is much less stable than
one displaced either mesiodistally or rotationally.20
Therefore, each case should be carefully evaluated while
considering strategies to improve stability, such as slow
intrusive movement, overcorrection, longer retention
periods, and active retention methods. Although this
patient had not worn the maxillary circumferential
removable retainer, the results were stable at 21 months
post-treatment. This seemed likely due to slow intrusive
movement (9 months) of the maxillary arch.
CONCLUSION
The MAAS can correct gummy smiles by total intrusion
of the maxillary arch and has several advantages: it is a
minimally invasive treatment modality that reduces the
number of screw implants needed, it withstands heavy
orthodontic forces and provides orthodontic forces in
any required direction.
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