Smile is more than a form of communication; it is kind of socialization
and attraction. Although moderate gummy smile can be quite acceptable and
esthetically pleasing if the gum is healthy, more pronounced cases are
less well tolerated and require treatment.
This document discusses gummy smile and its management. It begins with an introduction defining gummy smile and prevalence rates ranging from 10-26% depending on age, gender and ethnicity. Etiology includes altered passive eruption, vertical maxillary excess, hypertonic upper lip, skeletal abnormalities and dental factors. Diagnosis involves clinical exams and radiographs to determine the specific cause. Treatment options discussed include non-surgical methods like Botox and orthodontics as well as surgical options like gingivectomy, lip repositioning, orthognathic surgery and crown lengthening depending on the underlying etiology. The conclusion emphasizes the importance of correct diagnosis to determine the best treatment approach.
This document discusses gummy smiles, which refer to excessive gingival display during smiling. It defines gummy smiles and outlines different types of smile lines. Normal gingival display during smiling is 1-2mm. Gummy smiles show more than 4mm of gingiva. The document explores the etiology of gummy smiles, including excessive gum tissue, hyperactive lip muscles, excessive jaw growth, gum disease, and congenital factors. It notes that gummy smiles are more common in females and tend to improve with age. The document provides a checklist for diagnosing and treating gummy smiles, including assessing lip position, tooth exposure, smile arc, tooth proportions, and lip morphology. It includes a case report example
This presentation gives a brief description of the clinical features and causes of gummy smile conditions , their clinical and differential dignosis , as well as the different treatment methods that may be used to correct these problems .
Differential diagnosis and management of gummy smileAbhilasha Goyal
This document discusses the diagnosis and management of gummy smiles. It defines a gummy smile as excessive gingival display when smiling. There are multiple potential etiologies including altered passive eruption, a short upper lip, hyperactive upper lip, vertical maxillary excess, and loss of tooth torque. A thorough facial and intraoral examination is required to differentiate between these causes to guide treatment. Management depends on the specific diagnosis but may include gingivectomy, lip repositioning, orthodontics, orthognathic surgery, or Botox injections. An interdisciplinary approach is often needed to achieve stable correction of gummy smiles.
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
Dr. James McNamara developed a cephalometric analysis method in 1984 to evaluate orthodontic and orthognathic surgery patients. The analysis divides the craniofacial skeleton into five sections - maxilla to cranial base, maxilla to mandible, mandible to cranial base, dentition, and airway. Linear measurements of landmarks and planes are compared to normative standards to assess relationships. Advantages include using primarily linear measurements, being more sensitive to vertical changes, and providing growth guidelines that are easily explained.
This document discusses soft tissue analysis for orthodontic treatment planning. It covers clinical examination including natural head position, lip assessment, and frontal and profile views. Key measurements and landmarks are defined such as facial thirds, nasolabial angle, lip lengths, and chin position. Factors that influence soft tissues like tooth movement and growth are also addressed.
BURSTONE ANALYSIS : C.O.G.S ( HARD & SOFT TISSUE) DrFirdoshRozy
This document summarizes various cephalometric analyses used to evaluate hard and soft tissues of the craniofacial structures. It describes key landmarks, reference planes, linear and angular measurements taken, along with their clinical significance. The analyses described include horizontal skeletal analysis, vertical skeletal analysis, dental analysis, soft tissue facial form analysis, and lip position/form analysis. Standard values are provided for each measurement for orthodontic diagnosis and treatment planning.
This document discusses gummy smile and its management. It begins with an introduction defining gummy smile and prevalence rates ranging from 10-26% depending on age, gender and ethnicity. Etiology includes altered passive eruption, vertical maxillary excess, hypertonic upper lip, skeletal abnormalities and dental factors. Diagnosis involves clinical exams and radiographs to determine the specific cause. Treatment options discussed include non-surgical methods like Botox and orthodontics as well as surgical options like gingivectomy, lip repositioning, orthognathic surgery and crown lengthening depending on the underlying etiology. The conclusion emphasizes the importance of correct diagnosis to determine the best treatment approach.
This document discusses gummy smiles, which refer to excessive gingival display during smiling. It defines gummy smiles and outlines different types of smile lines. Normal gingival display during smiling is 1-2mm. Gummy smiles show more than 4mm of gingiva. The document explores the etiology of gummy smiles, including excessive gum tissue, hyperactive lip muscles, excessive jaw growth, gum disease, and congenital factors. It notes that gummy smiles are more common in females and tend to improve with age. The document provides a checklist for diagnosing and treating gummy smiles, including assessing lip position, tooth exposure, smile arc, tooth proportions, and lip morphology. It includes a case report example
This presentation gives a brief description of the clinical features and causes of gummy smile conditions , their clinical and differential dignosis , as well as the different treatment methods that may be used to correct these problems .
Differential diagnosis and management of gummy smileAbhilasha Goyal
This document discusses the diagnosis and management of gummy smiles. It defines a gummy smile as excessive gingival display when smiling. There are multiple potential etiologies including altered passive eruption, a short upper lip, hyperactive upper lip, vertical maxillary excess, and loss of tooth torque. A thorough facial and intraoral examination is required to differentiate between these causes to guide treatment. Management depends on the specific diagnosis but may include gingivectomy, lip repositioning, orthodontics, orthognathic surgery, or Botox injections. An interdisciplinary approach is often needed to achieve stable correction of gummy smiles.
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
Dr. James McNamara developed a cephalometric analysis method in 1984 to evaluate orthodontic and orthognathic surgery patients. The analysis divides the craniofacial skeleton into five sections - maxilla to cranial base, maxilla to mandible, mandible to cranial base, dentition, and airway. Linear measurements of landmarks and planes are compared to normative standards to assess relationships. Advantages include using primarily linear measurements, being more sensitive to vertical changes, and providing growth guidelines that are easily explained.
This document discusses soft tissue analysis for orthodontic treatment planning. It covers clinical examination including natural head position, lip assessment, and frontal and profile views. Key measurements and landmarks are defined such as facial thirds, nasolabial angle, lip lengths, and chin position. Factors that influence soft tissues like tooth movement and growth are also addressed.
BURSTONE ANALYSIS : C.O.G.S ( HARD & SOFT TISSUE) DrFirdoshRozy
This document summarizes various cephalometric analyses used to evaluate hard and soft tissues of the craniofacial structures. It describes key landmarks, reference planes, linear and angular measurements taken, along with their clinical significance. The analyses described include horizontal skeletal analysis, vertical skeletal analysis, dental analysis, soft tissue facial form analysis, and lip position/form analysis. Standard values are provided for each measurement for orthodontic diagnosis and treatment planning.
This document provides an overview of twin block therapy. It discusses the history, philosophy, design, construction, and stages of treatment using twin blocks. Twin blocks are functional appliances composed of separate upper and lower bite blocks. They are worn 24 hours a day to achieve rapid correction of malocclusions through forces transmitted to inclined planes covering the posterior teeth. Treatment typically involves an initial active phase followed by a support phase to stabilize results.
This document describes Dr. Duane Grummons' posteroanterior (PA) cephalometric analysis for evaluating facial asymmetry. The analysis involves constructing reference lines and planes to compare bilateral landmarks and structures. Measurements are made of linear distances, angles, ratios and volumetric comparisons. The comprehensive analysis evaluates multiple structures and parameters while the summary analysis focuses on key dental and skeletal factors. The analysis is useful for orthodontic-surgical treatment planning to determine the extent and location of asymmetries and surgical corrections needed.
Ricketts analysis /certified fixed orthodontic courses by Indian dental academy 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
This document discusses methods for assessing human growth, including direct measurements like anthropometry and vital staining, as well as indirect measurements like dental casts, photographs, and radiographs. It also covers assessing a patient's age based on chronological, somatotypic, morphologic, dental, sexual, facial, and skeletal age. Key methods discussed include hand-wrist radiographs, cervical vertebrae maturation, midpalatal suture closure, and frontal sinus development. The timing of growth spurts and their clinical importance in orthodontic treatment planning is also summarized.
The general indications for SARPE are skeletal maturity, transverse maxillary deficiency, excessive display of buccal corridors when smiling, and anterior crowding.
A quick overview of all components that make up the aesthetic considerations during orthodontic treatment.
Contents -
Introduction
History
Records for studying esthetics
Smile design wheel
Macro-aesthetics
Mini-aesthetics
Deep Overbite correction
Treatment of gummy smiles
Micro-aesthetics
Elements of a balanced smile
Six horizontal lines
Canine to lateral incisor
Premolar to canine
Influence of extractions on smile esthetics
Conclusion
Canine Impaction and Its Importance in OrthodonticsAnalhaq Shaikh
Canine Impaction, Its Importance in Orthodontics, Etiology, Diagnosis and Management.
by Dr Analhaq Shaikh, 2nd year Postgraduate student, Sharavathi Dental College and Hospital, Shimoga, Karnataka
Canine Impaction can also be termed as Shy Canine.
1. Arch space analysis methods estimate tooth size and jaw size relationships. Space analysis compares available space to required space for proper tooth alignment.
2. Methods are classified by tooth size estimation method, arch length estimation method, developmental stage, and estimation/digitization method.
3. Common methods include measurements from radiographs, prediction tables using erupted tooth sizes, and combinations of methods. Nance analysis accounts for space changes between deciduous and permanent dentitions.
This document contains information about Holdaway's soft tissue analysis. It lists various soft tissue landmarks and measurements used to analyze the facial profile, including the facial angle, nose prominence, lip thickness, H-angle, and chin thickness. The table compares the patient's measurements to normal ranges and indicates inferences, such as a slightly retrognathic lower jaw and increased upper lip thickness. An ideal facial profile according to Holdaway is described, with measurements within normal ranges and no lip strain on closure. The document sources are listed as papers by Holdaway and Athanasiou on soft tissue cephalometric analysis.
Adult psychological considerations in orthodonticspayal ostwal
This document discusses various psychological considerations in orthodontic treatment. It addresses how facial aesthetics influence self-perception and social interactions. Malocclusion can lead to teasing and impact self-esteem. Treatment compliance and pain management are important, and different psychological factors like habits, disorders, and substance abuse may influence orthodontic cases. Headgear use can be embarrassing but patients understand its importance for proper alignment. An orthodontist must consider various psychosocial aspects to provide effective care.
This document lists common skeletal dental measurements and their normal ranges, including the facial angle, angle of convexity, A-B plane, mandibular plane, Y-axis, cant of occlusal plane, interincisal angle, incisor-occlusal plane angle, incisor-mandibular plane angle, protrusion of maxillary incisors. Average values are provided for each measurement.
1. There are several methods for predicting surgical outcomes of orthognathic surgery, including manual tracings, computer software programs, and video imaging.
2. Studies have found that current prediction methods tend to be inaccurate, especially in predicting soft tissue changes like lip and chin positions. Predictions often differ from actual outcomes by 2mm or more.
3. While prediction images can help communicate treatment plans to patients, they may also unintentionally create unrealistic expectations that are not always achieved. More accurate prediction methods are still needed.
COGS analysis (Cephelometrics for orthognathic surgery) / fixed orthodontics ...Indian dental academy
This document provides an overview of the COGS (Cephalometrics for Orthognathic Surgery) analysis. It begins with an introduction to cephalometrics and then describes the various landmarks, measurements, and analyses used in COGS. The COGS analysis examines both hard and soft tissues, including cranial base, skeletal, dental, soft tissue, and facial forms analyses. It uses linear and angular measurements to evaluate features like jaw positions, facial heights and widths, tooth angulations, and overall facial contour. The document outlines the typical landmarks, reference planes, and normative values for each measurement in the COGS analysis.
Moyer's analysis is a commonly used mixed dentition analysis technique. It uses the mesiodistal widths of the mandibular incisors to predict the combined widths of the canines and premolars using probability tables. Several studies have evaluated the accuracy of Moyer's analysis for different populations and found it often overestimates tooth sizes. New regression equations have been developed to more accurately predict tooth widths for specific ethnic groups. Alternative mixed dentition analysis methods use radiographs or formulas to estimate unerupted tooth sizes with varying degrees of accuracy depending on the population.
This document discusses soft tissue analysis in orthodontic treatment planning and diagnosis. It begins by explaining the importance of soft tissue evaluation in addition to traditional hard tissue analysis. It then describes various clinical examination techniques for analyzing the soft tissues of the face, including at the frontal view, lower third of the face, and profile view. It also discusses several cephalometric analyses that can be used to evaluate soft tissues, such as the E-line and H-line. Overall, the document emphasizes the need to consider soft tissue changes during treatment planning to achieve optimal facial esthetics.
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
Steiner developed a cephalometric analysis method in 1953 using landmarks on the anterior cranial base. His analysis consisted of three parts: skeletal analysis measuring angles of the maxilla and mandible, dental analysis of upper and lower incisor positions, and soft tissue analysis using the "S line". The Steiner method provided a way to compensate for skeletal discrepancies by altering incisor positions to achieve normal occlusion. It was most effective for smaller malocclusions and not larger skeletal discrepancies.
This document discusses Steiner's acceptable compromises for compensating for sagittal discrepancies between the upper and lower jaws. It provides guidelines for adjusting the positions of the upper and lower incisors based on the ANB angle. A case example is used to illustrate how to predict changes to the ANB angle through growth or treatment and adjust incisor positions accordingly. The document also discusses individualizing treatment proposals based on factors like soft tissue function.
Clinical facial analysis (CFA) is used by clinicians to evaluate a patient's face, defining its proportions, appearance, symmetry, and deformities. CFA is beneficial for orthodontists and maxillofacial surgeons to diagnose deformities, plan treatment, and predict outcomes. The steps in CFA include positioning the patient and then analyzing frontal, profile, and 45 degree views of the face to assess vertical and transverse proportions, lip shape, chin position, smile, dental factors, and soft tissue contours. CFA parameters can vary based on racial background, culture, gender, and clinician preferences, and CFA should be performed at initial observation and prior to establishing treatment.
This document discusses smile design and analysis. It describes analyzing various facial and dental components to design an aesthetic smile, including lips, teeth, gingiva, facial profile, and midlines. Methods of total smile analysis are outlined, such as McLarren's analysis, which examines facial balance, dentofacial relationships, and dental characteristics. Classification systems for smiles based on lip and muscle involvement are also presented. Requirements for an ideal smile are described focusing on individual components and their relationships.
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
This document provides an overview of twin block therapy. It discusses the history, philosophy, design, construction, and stages of treatment using twin blocks. Twin blocks are functional appliances composed of separate upper and lower bite blocks. They are worn 24 hours a day to achieve rapid correction of malocclusions through forces transmitted to inclined planes covering the posterior teeth. Treatment typically involves an initial active phase followed by a support phase to stabilize results.
This document describes Dr. Duane Grummons' posteroanterior (PA) cephalometric analysis for evaluating facial asymmetry. The analysis involves constructing reference lines and planes to compare bilateral landmarks and structures. Measurements are made of linear distances, angles, ratios and volumetric comparisons. The comprehensive analysis evaluates multiple structures and parameters while the summary analysis focuses on key dental and skeletal factors. The analysis is useful for orthodontic-surgical treatment planning to determine the extent and location of asymmetries and surgical corrections needed.
Ricketts analysis /certified fixed orthodontic courses by Indian dental academy 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
This document discusses methods for assessing human growth, including direct measurements like anthropometry and vital staining, as well as indirect measurements like dental casts, photographs, and radiographs. It also covers assessing a patient's age based on chronological, somatotypic, morphologic, dental, sexual, facial, and skeletal age. Key methods discussed include hand-wrist radiographs, cervical vertebrae maturation, midpalatal suture closure, and frontal sinus development. The timing of growth spurts and their clinical importance in orthodontic treatment planning is also summarized.
The general indications for SARPE are skeletal maturity, transverse maxillary deficiency, excessive display of buccal corridors when smiling, and anterior crowding.
A quick overview of all components that make up the aesthetic considerations during orthodontic treatment.
Contents -
Introduction
History
Records for studying esthetics
Smile design wheel
Macro-aesthetics
Mini-aesthetics
Deep Overbite correction
Treatment of gummy smiles
Micro-aesthetics
Elements of a balanced smile
Six horizontal lines
Canine to lateral incisor
Premolar to canine
Influence of extractions on smile esthetics
Conclusion
Canine Impaction and Its Importance in OrthodonticsAnalhaq Shaikh
Canine Impaction, Its Importance in Orthodontics, Etiology, Diagnosis and Management.
by Dr Analhaq Shaikh, 2nd year Postgraduate student, Sharavathi Dental College and Hospital, Shimoga, Karnataka
Canine Impaction can also be termed as Shy Canine.
1. Arch space analysis methods estimate tooth size and jaw size relationships. Space analysis compares available space to required space for proper tooth alignment.
2. Methods are classified by tooth size estimation method, arch length estimation method, developmental stage, and estimation/digitization method.
3. Common methods include measurements from radiographs, prediction tables using erupted tooth sizes, and combinations of methods. Nance analysis accounts for space changes between deciduous and permanent dentitions.
This document contains information about Holdaway's soft tissue analysis. It lists various soft tissue landmarks and measurements used to analyze the facial profile, including the facial angle, nose prominence, lip thickness, H-angle, and chin thickness. The table compares the patient's measurements to normal ranges and indicates inferences, such as a slightly retrognathic lower jaw and increased upper lip thickness. An ideal facial profile according to Holdaway is described, with measurements within normal ranges and no lip strain on closure. The document sources are listed as papers by Holdaway and Athanasiou on soft tissue cephalometric analysis.
Adult psychological considerations in orthodonticspayal ostwal
This document discusses various psychological considerations in orthodontic treatment. It addresses how facial aesthetics influence self-perception and social interactions. Malocclusion can lead to teasing and impact self-esteem. Treatment compliance and pain management are important, and different psychological factors like habits, disorders, and substance abuse may influence orthodontic cases. Headgear use can be embarrassing but patients understand its importance for proper alignment. An orthodontist must consider various psychosocial aspects to provide effective care.
This document lists common skeletal dental measurements and their normal ranges, including the facial angle, angle of convexity, A-B plane, mandibular plane, Y-axis, cant of occlusal plane, interincisal angle, incisor-occlusal plane angle, incisor-mandibular plane angle, protrusion of maxillary incisors. Average values are provided for each measurement.
1. There are several methods for predicting surgical outcomes of orthognathic surgery, including manual tracings, computer software programs, and video imaging.
2. Studies have found that current prediction methods tend to be inaccurate, especially in predicting soft tissue changes like lip and chin positions. Predictions often differ from actual outcomes by 2mm or more.
3. While prediction images can help communicate treatment plans to patients, they may also unintentionally create unrealistic expectations that are not always achieved. More accurate prediction methods are still needed.
COGS analysis (Cephelometrics for orthognathic surgery) / fixed orthodontics ...Indian dental academy
This document provides an overview of the COGS (Cephalometrics for Orthognathic Surgery) analysis. It begins with an introduction to cephalometrics and then describes the various landmarks, measurements, and analyses used in COGS. The COGS analysis examines both hard and soft tissues, including cranial base, skeletal, dental, soft tissue, and facial forms analyses. It uses linear and angular measurements to evaluate features like jaw positions, facial heights and widths, tooth angulations, and overall facial contour. The document outlines the typical landmarks, reference planes, and normative values for each measurement in the COGS analysis.
Moyer's analysis is a commonly used mixed dentition analysis technique. It uses the mesiodistal widths of the mandibular incisors to predict the combined widths of the canines and premolars using probability tables. Several studies have evaluated the accuracy of Moyer's analysis for different populations and found it often overestimates tooth sizes. New regression equations have been developed to more accurately predict tooth widths for specific ethnic groups. Alternative mixed dentition analysis methods use radiographs or formulas to estimate unerupted tooth sizes with varying degrees of accuracy depending on the population.
This document discusses soft tissue analysis in orthodontic treatment planning and diagnosis. It begins by explaining the importance of soft tissue evaluation in addition to traditional hard tissue analysis. It then describes various clinical examination techniques for analyzing the soft tissues of the face, including at the frontal view, lower third of the face, and profile view. It also discusses several cephalometric analyses that can be used to evaluate soft tissues, such as the E-line and H-line. Overall, the document emphasizes the need to consider soft tissue changes during treatment planning to achieve optimal facial esthetics.
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
Steiner developed a cephalometric analysis method in 1953 using landmarks on the anterior cranial base. His analysis consisted of three parts: skeletal analysis measuring angles of the maxilla and mandible, dental analysis of upper and lower incisor positions, and soft tissue analysis using the "S line". The Steiner method provided a way to compensate for skeletal discrepancies by altering incisor positions to achieve normal occlusion. It was most effective for smaller malocclusions and not larger skeletal discrepancies.
This document discusses Steiner's acceptable compromises for compensating for sagittal discrepancies between the upper and lower jaws. It provides guidelines for adjusting the positions of the upper and lower incisors based on the ANB angle. A case example is used to illustrate how to predict changes to the ANB angle through growth or treatment and adjust incisor positions accordingly. The document also discusses individualizing treatment proposals based on factors like soft tissue function.
Clinical facial analysis (CFA) is used by clinicians to evaluate a patient's face, defining its proportions, appearance, symmetry, and deformities. CFA is beneficial for orthodontists and maxillofacial surgeons to diagnose deformities, plan treatment, and predict outcomes. The steps in CFA include positioning the patient and then analyzing frontal, profile, and 45 degree views of the face to assess vertical and transverse proportions, lip shape, chin position, smile, dental factors, and soft tissue contours. CFA parameters can vary based on racial background, culture, gender, and clinician preferences, and CFA should be performed at initial observation and prior to establishing treatment.
This document discusses smile design and analysis. It describes analyzing various facial and dental components to design an aesthetic smile, including lips, teeth, gingiva, facial profile, and midlines. Methods of total smile analysis are outlined, such as McLarren's analysis, which examines facial balance, dentofacial relationships, and dental characteristics. Classification systems for smiles based on lip and muscle involvement are also presented. Requirements for an ideal smile are described focusing on individual components and their relationships.
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
This document provides an overview of soft tissue analysis for orthodontic treatment planning. It discusses various clinical examinations and cephalometric analyses used to evaluate the soft tissues, including the lips, chin, nose, and facial contours. Key points examined include lip length and position relative to teeth and skeletal structures, as well as how soft tissue proportions may change with tooth movement or orthognathic surgery. A number of commonly used cephalometric analyses are described, such as the Holdaway analysis, that aim to establish soft tissue norms and balance.
This document discusses soft tissue analysis in orthodontics. It covers clinical examination including natural head position and lip posture assessment. Cephalometric analysis and detailed facial analysis from the frontal, profile and other views are described. Factors influencing soft tissue changes from tooth movement, growth, extractions and orthognathic surgery are outlined. The conclusion states that soft tissues are important for treatment planning and outcomes in orthodontics and orthognathic surgery.
Terminologies
Introduction
Reference frames for orientation
Lip lines
Gold proportion
Smile dominance
Perceptual aspects – the art of illusion
Cosmetic Contouring
Smile design: Clinical assessment, analysis and consideration
Porcelain laminates and veneers: Clinical assessment and analysis Colour
Shade selection
Dental bleaching
Esthetics with composites
Metal ceramic and all ceramic restorations
Implant – esthetics
Perio – esthetics
Ortho – esthetics
Recent advances in smile design in prosthodontics
Review of literature
Conclusion
References
This document discusses facial photograph analysis in orthodontic clinics. It begins by defining facial photograph analysis and explaining why photographic records are important. It then describes when analysis should be performed and the necessary clinical equipment. The document provides detailed instructions on the types of extra-oral and intra-oral photographs that should be taken, including frontal, profile, and occlusal views. It explains how to analyze the photographs, assessing proportions, symmetry, deformities, occlusal relationships, and soft tissue levels and contours.
This document discusses soft tissue analysis for orthodontic treatment planning. It begins by explaining the importance of soft tissue examination in addition to hard tissue analysis. It describes various methods of clinical soft tissue examination including natural head position, facial thirds, lip lengths, tooth to lip relationships, and frontal analysis of symmetry and facial levels. Specific landmarks and average measurements are provided. The document emphasizes that soft tissue proportions and relationships should be considered along with skeletal changes when developing treatment plans.
The document outlines the eight major components of a balanced smile: 1) lip line, 2) smile arc, 3) upper lip curvature, 4) lateral negative space, 5) smile symmetry, 6) frontal occlusal plane, 7) dental components, and 8) gingival components. Each component is described in detail, outlining ideal characteristics and how orthodontic treatment can impact them. The goal is to achieve an optimal smile with an aesthetically pleasing relationship between the teeth, lips, and other facial features when smiling.
The document outlines the eight major components of a balanced smile: 1) lip line, 2) smile arc, 3) upper lip curvature, 4) lateral negative space, 5) smile symmetry, 6) frontal occlusal plane, 7) dental components, and 8) gingival components. Each component is described in detail, outlining ideal characteristics and how orthodontic treatment can impact them. The goal is to achieve an optimal smile with an aesthetically pleasing relationship between the teeth, lips, and other facial features when smiling.
HI THIS IS A NICE SEMINAR DESCRIBING ABOUT THE ORTHOGNATHIC SURGERY MAINLY RELATED TO ORTHODONTICS VIEWPOINT AND CEPH TRACING ITS INDICATION AND DIFFERENT TYPES OF SURGERIES. JUST HAVE A LOOK TO IT
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
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
Smile analysis in vertical dimention:- factors to be considered when observed...Dr.Maulik patel
1) The document discusses various factors related to smile esthetics including smile arc, incisal edge contours, midlines, crown torque, and smile line. It emphasizes the importance of the smile arc and monitoring it during orthodontic treatment.
2) Guidelines are provided for analyzing esthetic factors by viewing the patient from the front and evaluating the smile, including factors like crown length and axial inclinations.
3) Variations in smile lines between males and females are discussed, with low smile lines being more common in males and high smile lines in females.
Gummy Smile with Evidence in Orthodontics.pptxsafabasiouny1
1) Altered passive eruption, a short upper lip, bony maxillary excess, dentoalveolar extrusion, and hyperactive upper lip muscles are potential causes of a gummy smile.
2) A gummy smile is defined as more than 4mm of gingival display when smiling. It affects about 12% of the population and can be caused by short clinical crowns due to altered passive eruption or incisor overeruption.
3) Treatment depends on the underlying cause and may include periodontal surgery, orthodontics, orthognathic surgery, or in some cases lip repositioning surgery or Botox injection to weaken the upper lip muscles.
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
This document summarizes the key elements of smile analysis for orthodontic treatment planning. It discusses analyzing the midline, incisor display at rest and during smiling, smile arc, symmetry, and buccal corridors. It also covers analyzing gingival health and contours, as well as dental contacts, embrasures, crown heights and widths, and mesiodistal tooth widths. The goal of smile analysis is to incorporate esthetic evaluation and guidelines to achieve an attractive balanced smile.
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
Smile analysis from the orthodontic perspective.
Major determinants of smile esthetics are discussed based on the discussions of the Proffit and Graber
in Orthodontics, Torque is a vital ingredient in the achievement of optimal esthetics, function and health of teeth and surrounding tissues, as also in stability of the treatment results
In order to solve the serious problems of traditional surgical
orthodontic treatment, a new approach was adopted:
the first step is OGS, and this is followed by orthodontic alignment. This approach is named as Surgery First Orthognathic Approach (SFOA)
This document provides an overview of frictionless mechanics in orthodontics. It discusses various loop and spring configurations that can be used for space closure without tooth movement along the archwire. Advantages include control of tooth movement and known force levels. Disadvantages include more complex mechanics and potential patient discomfort. Factors like loop height and geometry determine the moment-to-force ratio and type of tooth movement achieved. The document defines key terms and principles of biomechanics relevant to frictionless orthodontic tooth movement.
Orthodontic Diagnosis And Treatment In Transverse Dimension
• In orthodontics, among the three planes of space - sagittal, vertical, and
transverse, the transverse is the least studied.
• The transverse facial growth normally completes before the sagittal and
vertical growth.
• Understanding the transverse growth is important in making proper
diagnosis and treatment planning of the transverse problems.
Clear Aligners in Orthodontics
nvisalign is an orthodontic
technique that uses a series of
computer-generated custom
plastic aligners to guide the teeth
gradually into proper alignment.
• Although the use of clear aligner
treatment is not new, it is a
growing part of the orthodontic
market, and, as a result, many
new products have become
available.
Leveling and Alignment in Preadjusted Edgewise Appliance
The purpose of this initial phase of treatment in the PEA appliance is to
• bring the teeth into alignment and
• correct vertical discrepancies (like deep overbite and open bite) by leveling out the arches.
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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This document provides an overview of wound healing, its functions, stages, mechanisms, factors affecting it, and complications.
A wound is a break in the integrity of the skin or tissues, which may be associated with disruption of the structure and function.
Healing is the body’s response to injury in an attempt to restore normal structure and functions.
Healing can occur in two ways: Regeneration and Repair
There are 4 phases of wound healing: hemostasis, inflammation, proliferation, and remodeling. This document also describes the mechanism of wound healing. Factors that affect healing include infection, uncontrolled diabetes, poor nutrition, age, anemia, the presence of foreign bodies, etc.
Complications of wound healing like infection, hyperpigmentation of scar, contractures, and keloid formation.
Leveraging Generative AI to Drive Nonprofit InnovationTechSoup
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Chapter wise All Notes of First year Basic Civil Engineering.pptxDenish Jangid
Chapter wise All Notes of First year Basic Civil Engineering
Syllabus
Chapter-1
Introduction to objective, scope and outcome the subject
Chapter 2
Introduction: Scope and Specialization of Civil Engineering, Role of civil Engineer in Society, Impact of infrastructural development on economy of country.
Chapter 3
Surveying: Object Principles & Types of Surveying; Site Plans, Plans & Maps; Scales & Unit of different Measurements.
Linear Measurements: Instruments used. Linear Measurement by Tape, Ranging out Survey Lines and overcoming Obstructions; Measurements on sloping ground; Tape corrections, conventional symbols. Angular Measurements: Instruments used; Introduction to Compass Surveying, Bearings and Longitude & Latitude of a Line, Introduction to total station.
Levelling: Instrument used Object of levelling, Methods of levelling in brief, and Contour maps.
Chapter 4
Buildings: Selection of site for Buildings, Layout of Building Plan, Types of buildings, Plinth area, carpet area, floor space index, Introduction to building byelaws, concept of sun light & ventilation. Components of Buildings & their functions, Basic concept of R.C.C., Introduction to types of foundation
Chapter 5
Transportation: Introduction to Transportation Engineering; Traffic and Road Safety: Types and Characteristics of Various Modes of Transportation; Various Road Traffic Signs, Causes of Accidents and Road Safety Measures.
Chapter 6
Environmental Engineering: Environmental Pollution, Environmental Acts and Regulations, Functional Concepts of Ecology, Basics of Species, Biodiversity, Ecosystem, Hydrological Cycle; Chemical Cycles: Carbon, Nitrogen & Phosphorus; Energy Flow in Ecosystems.
Water Pollution: Water Quality standards, Introduction to Treatment & Disposal of Waste Water. Reuse and Saving of Water, Rain Water Harvesting. Solid Waste Management: Classification of Solid Waste, Collection, Transportation and Disposal of Solid. Recycling of Solid Waste: Energy Recovery, Sanitary Landfill, On-Site Sanitation. Air & Noise Pollution: Primary and Secondary air pollutants, Harmful effects of Air Pollution, Control of Air Pollution. . Noise Pollution Harmful Effects of noise pollution, control of noise pollution, Global warming & Climate Change, Ozone depletion, Greenhouse effect
Text Books:
1. Palancharmy, Basic Civil Engineering, McGraw Hill publishers.
2. Satheesh Gopi, Basic Civil Engineering, Pearson Publishers.
3. Ketki Rangwala Dalal, Essentials of Civil Engineering, Charotar Publishing House.
4. BCP, Surveying volume 1
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Philippine Edukasyong Pantahanan at Pangkabuhayan (EPP) CurriculumMJDuyan
(𝐓𝐋𝐄 𝟏𝟎𝟎) (𝐋𝐞𝐬𝐬𝐨𝐧 𝟏)-𝐏𝐫𝐞𝐥𝐢𝐦𝐬
𝐃𝐢𝐬𝐜𝐮𝐬𝐬 𝐭𝐡𝐞 𝐄𝐏𝐏 𝐂𝐮𝐫𝐫𝐢𝐜𝐮𝐥𝐮𝐦 𝐢𝐧 𝐭𝐡𝐞 𝐏𝐡𝐢𝐥𝐢𝐩𝐩𝐢𝐧𝐞𝐬:
- Understand the goals and objectives of the Edukasyong Pantahanan at Pangkabuhayan (EPP) curriculum, recognizing its importance in fostering practical life skills and values among students. Students will also be able to identify the key components and subjects covered, such as agriculture, home economics, industrial arts, and information and communication technology.
𝐄𝐱𝐩𝐥𝐚𝐢𝐧 𝐭𝐡𝐞 𝐍𝐚𝐭𝐮𝐫𝐞 𝐚𝐧𝐝 𝐒𝐜𝐨𝐩𝐞 𝐨𝐟 𝐚𝐧 𝐄𝐧𝐭𝐫𝐞𝐩𝐫𝐞𝐧𝐞𝐮𝐫:
-Define entrepreneurship, distinguishing it from general business activities by emphasizing its focus on innovation, risk-taking, and value creation. Students will describe the characteristics and traits of successful entrepreneurs, including their roles and responsibilities, and discuss the broader economic and social impacts of entrepreneurial activities on both local and global scales.
This presentation was provided by Rebecca Benner, Ph.D., of the American Society of Anesthesiologists, for the second session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session Two: 'Expanding Pathways to Publishing Careers,' was held June 13, 2024.
Beyond Degrees - Empowering the Workforce in the Context of Skills-First.pptxEduSkills OECD
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3. Introduction
• The smile is a complex facial expression that is associated with beauty.
• It has an important role in the determination of the first impression of
a person.
• Facial expressions and the smile are key components for non verbal
communication
• Smile is more than a form of communication; it is kind of socialization
and attraction.
4. • Webster’s dictionary
Smile is a pleased or amused expression of the face, formed by
curling of the mouth upward.
• The evaluation of smile has become an important part of our clinical
assessment with a greater emphasis on dynamic evaluation.
• Among the frontal features; competence of lips, increased incisal show
and gummy smile have become the major concern of the pateints.
5. • Gingiva, lips, and teeth are the 3 major structures that affect smile.
• The alignment, position, and size of maxillary incisors, as well as the
gingival line, affect whether a smile is esthetic.
• Excessive gingival display (EGD) when smiling is commonly termed as
Gummy Smile.
• Also known as: High lip line
Full denture smile
6. Etiology
• Gingival display is a descriptive term rather than a diagnosis which
would mandate the initiation of specific therapy.
• While numerous factors can cause excess gingival display, it is common
for the condition to occur as a result of interplay of several etiologies.
7. Skeletal factors
Vertical maxillary excess
Rotations of maxilla
Dental factors
Short clinical crown
Anterior dentoalveolar extrusion
Loss of torque on the anteriors
Increased overjet and
Increased overbite
Soft tissue
Short upper lip/hyperfunctional
Musculature
Short philtrum
More superiorly positioned upper
lip
Periodontal factors
Gingival problems related to
delayed passive eruption
Gingival hyperplasia
GUMMY
SMILE
8. Clinical Evaluation
❖Facial symmetry and proportions in both frontal and lateral views
Facial Balance:
• Its an assessment of vertical jaw relationship
• Three ratios
9. First ratio: “Vertical thirds”
• Upper third: Trichion to Glabella
• Middle third: Glabella to Subnasale
• Lower third: Subnasale to Soft tissue Menton
• Ratio should be 1:1:1
10.
11. Second ratio:
• Subnasale to U/L Stomion : U/L Stomion to Soft tissue Menton
• The ratio should be 1:2
Third ratio:
• Subnasale to Vermillion cutaneous border of L/L : Vermillion
cutaneous border of L/L to Soft tissue Menton
• The ratio should be 1:1
12. ❖Evaluation of lip posture and incisor prominence
• Excessive separation of the lips at rest is called lip incompetence.
• The general guideline that holds for all racial groups is that lip
separation at rest should be not more than 3-4 mm
• Increased interlabial gap is seen in:
• Anatomic short upper lip
• Vertical maxillary excess
• Mandibular protrusion with open bite
13. • Decreased interlabial gap is seen in:
• Vertical maxillary deficiency
• Anatomically long upper lip
• Mandibular retrusion with deep bite
14. ❖Lip prominence
• Is evaluated by observing the distance that each lip projects forward
from soft tissue points A and B.
• Lip prominence of more than 2 to 3 mm in the presence of lip
incompetence indicates dentoalveolar protrusion.
15. • Lip prominence in the context of the relationship
of the lips to the nose and chin can be assessed by
drawing the E-line (esthetic line) from the nose to
the chin and to look at how the lips relate to this
line.
• The guideline is that they should be on or slightly
in front of the E-line. (Proffit)
• Lower lip should be 0-2mm away (Reyneke)
16. Smile evaluation
Basic Classification of the Smile
• Posed or Social Smile
• Voluntary
• Static
• Not elicited by emotion
• Fairly Reproducible
• Un-Posed or Emotional Smile
• Involuntary & Spontaneous
• Dynamic
• Elicited by joy or mirth
• Hardly Reproducible
• Characterized by more lip elevation than posed smile
17. Three styles of smile - Rubin L.R (Plast. Reconstr. Surg, 1974)
• The cuspid /commissure smile,
• The complex / full-denture smile, and
• The Mona Lisa smile
• The cuspid or commissure smile
• Characterized by the action of all the elevators of the upper lip,
raising it like a window shade to expose the teeth and gingival
scaffold.
18.
19. • The complex or full-denture smile
• Characterized by the action of the elevators of the upper lip and the
depressors of the lower lip acting simultaneously, raising the upper
lip like a window shade and lowering the lower lip like a window.
• The Mona Lisa smile
• Characterized by the action of the zygomaticus major muscles,
drawing the outer commissures outward and upward, followed by a
gradual elevation of the upper lip.
• Patients with complex smiles tend to display more teeth and gingiva
than patients with Mona Lisa smiles.
20. Amount of incisor and gingival display:
Vig & Brundo, J Prosthet Dent, 1978
• A normal gingival display between the inferior border of the upper lip
and the gingival margin of the maxillary anterior teeth during a posed
smile is 1 -2 mm
• The maxillary anterior teeth should be completely displayed during a
full smile .
21. Tjan, Miller and The performed a semi quantitative study of smil-line
variations in 1984
• The study divided the smiles into three categories:
Low smile displaying less than 75% of the clinical crown height of the
maxillary anterior teeth
Average smile revealing 75-100% of the maxillary anterior crown height
High smile exposing a band of contiguous maxillary gingiva
22. • Among these three categories, there was a sex difference in smile-line
frequency;
• Low smile lines were predominantly a male characteristic and
• High smile lines were predominantly a female characteristic
• The prevalence of gummy smile is 10% among the population aged
between 20 and 30 years, and is more common among women than men
23. Allen E P (Dent Clin North Am1998)
• Stated that gum exposure of less than 2-3 mm can be considered
attractive, with overexposure (> 3 mm) generally considered
unattractive;
however, perception of excessive gingival display is also subject to
cultural and ethnic preferences.
24. Kokich et al., J Esth Dent,1999
• In a normal smile, the gingival display between the gingival margin of
the maxillary central incisors and the inferior border of the upper lip is
approximately 1-2 mm.
• Dentists and nonprofessionals believe that smile esthetics are
negatively affected when gingival display between the gingiva and the
lip exceeds 4 mm.
25. Morley ratio (Morley J, 1999)
• The vertical aspects of smile anatomy are the degree of maxillary
anterior tooth display, upper lip drape, and gingival display.
• In a youthful smile, 75-100% of the maxillary central incisors should
be positioned below an imaginary line drawn between the commissures
26. • According to Chang C et.al, (AJODO,2011), the ideal elevation of the
lip on smile for adolescents is slightly below the gingival margin with
2mm of tooth coverage,
The acceptable range of tooth display is from minimal tooth coverage
of 1 mm up to 4 mm coverage of the incisor crown.
Beyond that, the smile appearance is less attractive.
28. 1. Lip Line
• The lip line is the amount of vertical tooth exposure in smiling - ie,
the height of the upper lip relative to the maxillary central incisors.
• As a general guideline, the lip line is optimal when the upper lip reaches
the gingival margin, displaying the total cervicoincisal length of the
maxillary central incisors, along with the interproximal gingivae.
29. • Female lip lines are an average 1.5mm higher than male lip lines,
1-2mm of gingival display at maximum smile could be considered
normal for females.
• Dental professionals have been conditioned to see a “gummy smile” as
undesirable, but some gingival display is certainly acceptable, and is
even considered a sign of youthful appearance.
(Peck S, Peck L and Kataja; AO- 1992)
30. • The starting point of a smile is the lip line at rest, with an average
maxillary incisor display of 1.91mm in men and nearly twice that
amount, 3.40mm, in women. (Vig and Brundo, J. Prost. Dent, 1978)
• With aging, there is a gradual decrease in exposure of the maxillary
incisors at rest and, to a much lesser degree, in smiling.
• This steady decline in maxillary tooth exposure at rest is accompanied
by an increase in mandibular incisor display.
31. • Peck S, Peck L and Kataja; AO- 1992
• To measure the upper lip smile line:
• A vertical axis graduated in millimeters is visualized along the
soft tissue facial midline. A perpendicular, tangent to the cervical
margin of the upper central incisor defines the horizontal axis.
32. • The amount of vertical exposure in smiling depends on the following
six factors.
• Upper Lip Length
• Lip Elevation
• Vertical Maxillary Height
• Crown Height
• Vertical Dental Height
• Incisor Inclination
33. i) Upper Lip Length
• The normal lip length at rest, as measured from Subnasale to the most
inferior portion of the upper lip at the midline is 20 ± 2 mm for females
and 22 ± 2 mm for males (Reyneke J P)
UPPER LIP LENGTHS FROM VARIOUS STUDIES (mm)
Study Male Female
Burstone C J (Am. J. Orthod. 1967) 23.8 ± 1.5 20.1 ± 1.9
Farkas et al. (Am. J. Orthod. 1984) 21.8 ± 2.2 19.6 ± 2.4
Powell and Humphreys (1984) 23.8 ± 1.5 20.1 ± 1
Wolford L M (Plast. Reconstr. Surg, 1988) 22 ± 2 20 ± 2
Peck S, Peck L. and Kataja (Am. J. Orthod. 1992) 23.4 ± 2.5 21.2 ± 2.4
Arnett G.W. and Bergman (Am. J. Orthod. 1993) 19-22
34. • What is significant, however, is the relationship of the upper lip to the
maxillary incisors and to the commissures of the mouth.
• Lip length should be roughly equal to the commissure height, which is
the vertical distance between the commissure and a horizontal line
from subnasale.
35. • It is not easy to alter commissure height, but lip lengthening is possible
with lip surgery, either as a single procedure or in combination with a
Le Fort I osteotomy.
• In adolescents, a short upper lip relative to commissure height could be
considered normal because of the lip lengthening that continues even
after vertical skeletal growth is complete.
• It is interesting to note that a short upper lip is not always associated
with a high lip line; on the contrary, the upper lip was found to be
longer in a gingival-display group than in a non-displaying sample.
36. Short upper lip
• When lip length is 18mm or less
• In addition there will be:
• Increased interlabial gap
• Increased incisor exposure
• Normal lower face height
37. ii) Lip Elevation
• In smiling, the upper lip is elevated by about 80% of its original length,
displaying 10mm of the maxillary incisors.
• Women have 3.5% more lip elevation than men.
(Rigsbee, Sperry and BeGole; Int. J. Adult Orthod. Orthog. Surg.,1988)
• Actually, there is considerable individual variability in upper lip
elevation from rest position to the full smile, ranging from 2-12mm,
with an average of 7-8mm.
(Sarver D.M. and Weissman S.M. Angle Orthod.,1991)
38. • If a gingival smile is caused by a hypermobile lip, it would be a mistake
to correct it with aggressive incisor intrusion or maxillary impaction
surgery, because that would result in little or no incisor display at rest
and thus make the patient look older.
• Excessive lip elevation should therefore be recognized as a limiting
factor
• Likewise, if a low lip line is due to a hypomobile lip, extensive incisor
extrusion would result in an overbite with excessive incisor display at
rest.
39.
40.
41. iii) Vertical Maxillary Height
• When upper lip length and mobility are normal, a gingival smile with
excessive incisor display at rest can be attributed to vertical maxillary
excess.
• This kind of “skeletal” gingival smile is generally associated with
excessive lower facial height.
• Conversely, a low lip line with no incisor display at rest is “skeletal”
when associated with inadequate lower facial height due to a vertically
deficient maxilla.
42. • The best reference for impacting or lengthening the maxilla is the
incisor display at rest, taking upper lip length and any incisor attrition
into account.
• The full smile does not make a good reference, partly because of the
individual variation in lip mobility.
• A short upper lip should not be treated by shortening the maxilla
unless the facial outline can accommodate such a change.
• It should also be noted that in maxillary impaction, the upper lip
shortens by as much as 50% of the surgical skeletal intrusion. (Sarver
D.M. and Weissman S.M. Angle Orthod.,1991)
43. iv) Crown Height
• The average vertical height of the maxillary central incisor is 10.6mm in
males and 9.8mm in females.
• A short crown can be due to attrition or excessive gingival encroachment.
• If there is little or no incisor display at rest, but the lip line is normal in
smiling, the crown height can be increased incisally with cosmetic
dentistry.
• A gingivectomy or a crown-lengthening procedure with crestal bone
removal is recommended when short clinical crowns are associated with a
gingival smile and a normal incisor display at rest.
44.
45. v) Vertical Dental Height
• A deep bite should be corrected by maxillary incisor intrusion in a pt
with excessive incisor display at rest, but with posterior extrusion
and/or lower incisor intrusion in a pt with a normal lip line at rest.
• The opposite applies to an open bite, which should be corrected by
maxillary incisor extrusion if there is inadequate incisor display at rest,
but with posterior intrusion and/or lower incisor extrusion if the lip
line is normal at rest.
46. vi) Incisor Inclination
• Proclined maxillary incisors, whether in a Class II, division 1 mo or in
a Class III compensation, tend to reduce the incisor display at rest and
in smiling.
• Uprighted or retroclined maxillary incisors, as seen in Class II, division
2 mo or after orthodontic retraction without torque control, tend to
increase the incisor display.
• Maxillary incisor inclination can best be assessed on profile and oblique
smiling photographs, which should become standard orthodontic
records.
47. 2. Smile Arc
• The smile arc is the relationship between a hypothetical curve drawn
along the edges of the maxillary anterior teeth and the inner contour
of the lower lip in the posed smile.
• The curvature of the incisal edges appears to be more pronounced for
women than for men, and tends to flatten with age.
• The curvature of the lower lip is usually more pronounced in younger
smiles.
48. • In an optimal smile arc - described as “consonant”- the curvature of the
maxillary incisal edges coincides with or parallels the border of the
lower lip in smiling.
• In a “nonconsonant” smile arc, the maxillary incisal edges are either flat
or reversed relative to the curvature of the lower lip.
49.
50. 3. Upper Lip Curvature
• The upper lip curvature is assessed from the central position to the
corner of the mouth in smiling.
• It is upward when the corner of the mouth is higher than the central
position, straight when the corner of the mouth and the central
position are at the same level, and downward when the corner of the
mouth is lower than the central position.
51. 4. Lateral Negative Space
• The transverse dimension of the smile is also referred to as “transverse
dental projection”.
• Lateral negative space is the buccal corridor between the posterior
teeth and the corner of the mouth in smiling.
• Orthodontists refer to buccal corridors as “negative” spaces to be
eliminated by transverse maxillary expansion
52. 5. Smile Symmetry
• Smile symmetry, the relative positioning of the corners of the mouth
in the vertical plane, can be assessed by the parallelism of the
commissural and pupillary lines.
• Although the commissures move up and laterally in smiling, studies
have shown a difference in the amount and direction of movement
between the right and left sides.
• A large differential elevation of the upper lip in an asymmetrical smile
may be due to a deficiency of muscular tonus on one side of the face.
53. • Myofunctional exercises have been recommended to help overcome this
deficiency and restore smile symmetry.
• An oblique commissural line in an asymmetrical smile can give the
illusion of a transverse cant of the maxilla or a skeletal asymmetry
54. 6. Frontal Occlusal Plane
• The frontal occlusal plane is represented
by a line running from the tip of the right
canine to the tip of the left canine.
• A transverse cant can be caused by
differential eruption of the maxillary
anterior teeth or a skeletal asymmetry of
the mandible
55. • This relationship of the maxilla to the smile cannot be seen on
intraoral images or study casts, and smile photographs can also be
misleading.
• Therefore, clinical examination and digital video documentation are
essential in making a differential diagnosis between smile asymmetry, a
canted occlusal plane, and facial asymmetry.
• Having the patient bite on a tongue blade or a mouth mirror in the
premolar area during the clinical examination is a good way to
recognize an asymmetrical cant of the maxillary frontal occlusal plane
56. 7. Dental Components
• The first six components of the smile considered the relationship
between the teeth and lips and the way the lips and soft tissue frame
the smile. A pleasant smile also depends on the quality and beauty of
the dental elements it contains and their harmonious integration.
• Dental components of the smile include
• the size, shape, color, alignment, and crown angulation (tip) of the
teeth;
• the midline and
• arch symmetry.
57. 8. Gingival Components
• Gingival components of the smile are color, contour, texture, and
height of the gingivae.
• Inflammation, blunted papillae, open gingival embrasures, and uneven
gingival margins detract from the esthetic quality of the smile
• The gingival margins can be leveled by orthodontic intrusion or
extrusion or by periodontal surgery, depending on the lip line, the
crown heights, and the gingival levels of the adjacent teeth.
• Gingival enlargement
58. Periodontal evaluation
• Altered passive eruption
• Active eruption
• The occlusal movement of the tooth as it emerges from its crypt
in the gingiva. This phase ends when the tooth makes contact
with the opposing tooth in the oral cavity .
• Passive eruption
• A normal condition in which the gingival margins recede apically
to the level of the CEJ after the tooth has erupted completely.
59. • In cases in which the gingival margins fail to recede to the level of the
CEJ, the condition is named Altered Passive Eruption.
• Because the gingival tissues are positioned coronal to the CEJ, the teeth
appear short and square
• This condition may involve multiple teeth or an isolated tooth. The
incidence of altered passive eruption in the general population is about
12%.
60. • excessive amount of keratinized
gingiva with normal alveolar
crest–to–CEJ relationship
Type 1A
• excessive amount of keratinized
gingiva with osseous crest at the
CEJ
Type 1B
• normal amount of keratinized
gingiva with normal alveolar
crest–to–CEJ relationship
Type 2A
• normal amount of keratinized
gingiva with osseous crest at the
CEJ level
Type 2B
61. Smile Analysis
• Marc B Ackerman and James L Ackerman; JCO, 2002
• From the video, the frame that best represents the patient’s social smile
is selected, captured with a program called Screen Snapz, and saved as
a JPEG file.
• The smile image is then opened in a program called SmileMesh, which
measures 15 attributes of the smile.
• This methodology was first used manually by Hulsey J M (AJO 1970)
and later modified and computerized by Ackerman J.L., Ackerman M.B.;
Brensinger C.M and Landis J.R (Clin. Orth. Res., 1998)
62.
63. • The diagnostic part of smile analysis begins with the creation of a
problem list.
• The first set of records analyzed is the extraoral photographs
• In addition to the standard frontal at rest, frontal smile and profile at
rest images, Sarver and Ackerman recommend 4 additional views:
• Profile smile
• Oblique smile
• Frontal smile closeup
• Oblique smile closeup
64. • Consideration should be given to the vertical and lateral attributes of
the smile as well as to the cant of the transverse occlusal plane.
• The smile image is a better indication of transverse dental asymmetry
than the frontal intraoral view or even an anteroposterior cephalogram
• Next, the cant of the maxillary occlusal plane relative to Frankfort
horizontal should be assessed visually on the lateral cephalogram and
measured on the tracing.
65. • Vertical and anteroposterior skeletal and dental relationships are noted.
• Panoramic and supplemental intraoral radiographs are also analyzed
• Finally, the plaster study casts are evaluated for static occlusal
relationships and tooth-size discrepancies.
• The smile component of the orthodontic problem list consists of
descriptive terms such as increased maxillary incisor display,
unfavorable Morley ratio, excess gingival show, flat or reverse smile
arc, asymmetric cant of the maxillary anterior transverse occlusal
plane, and obliterated buccal corridors, to name a few.
66. • The clinician should rank these smile attributes in order of their
importance in creating a balanced smile.
• The final problem list will help the orthodontist to assess the viability
of different treatment options and select the appropriate
mechanotherapy for optimal smile design.
67. Altered / delayed passive eruption
• The goal of the crown lengthening procedure is to expose virtually all
of the anatomic crown
• Distance from crest of gingiva to alveolar crest is 5mm -
SUFFICIENT CREVICE DEPTH
• 2mm of gingiva is removed
GINGIVECTOMY
• Distance from crest of gingiva to crest of bone is 3mm
(bone sounding)
• SHORT CLINICAL CROWNS WITH INSUFFICIENT GINGIVAL
CREVICE
APICALLY
REPOSITIONED
FLAP
68. Morphologically short upper lip
• Correction of short philtrum can be achieved with V-Y cheiloplasty
performed as an isolated procedure or along with Lefort I impaction or
Rhinoplasty.
• The V-Y procedure helps in increasing the length of the upper lip but
when combined with rhinoplasty, the amount of tissue available for lip
lengthening is drastically increased
69. • In V-Y cheiloplasty, an incision is made in the anterior maxilla in the
vestibule, with a vertical incision behind the philtrum.
• Mattress sutures are then used to close these incisions, resulting in a
vertical scar closure, and reorientation of the muscles to reduce the
mobility of the upper lip on smile
70. Hyperactive upper lip
• If the facial height, gingival levels, lip length, length of the central
incisors are all within the acceptable limits in a patient with EGD the
likely DD is hyperactive upper lip.
• In a patient with hyperactive upper lip ,the lip may translate 1.5 to 2
times more than the normal distance
71. Lip repositioning technique
• The procedure restricts the muscle pull of the elevator lip muscles by
shortening the vestibule, thus reducing the gingival display while
smiling
72. • Partial thickness incision at muco gingival junction.
• 2nd incision parallel to it at 10-12 mm on labial mucosa.
• Both the incisions are approximated at mesial line angles of maxillary
molars.
• Tissue excision should be double the amount of gingival display.
73. • Effective procedure to reduce gingival display by positioning the upper
lip in a coronal location
• Contraindicated in patients with insufficient attached gingiva
74. Injection of Botox
• Botulinum toxin is produced by the anaerobic bacterium Clostridium
botulinum.
• This toxin acts by cleaving the synaptosomal-associated protein
(SNAP-25) and inhibiting the release of acetylcholine, thus preventing
muscle contraction.
• Among the 7 different serotypes of botulinum toxin, Type A (BTX-A)
is the most potent and the most commonly used one clinically.
75. • Botox is a purified BTX-A isolated from the fermentation of C
botulinum. (Allergan, Irvine, Calif)
• It is a stable, sterile, vacuum-dried powder that is diluted with saline
solution without preservatives.
• Polo M (AJODO, 2005) introduced the use of BTX for patients with
hyperfunctional lip elevator muscles and reported a significant
reduction in gingival display with the use of electromyographic
guidance.
76. • Garcia’s report stated that the toxin can spread through an area of 15
to 30 mm (Garcia A, Fulton JE Jr., Dermatol Surg. 1996)
• Considering the diffusion and the immediacy of the toxin, it is crucial
for the clinician to understand the distribution and morphology of the
target muscles, so that highly selective deactivation of muscles can be
performed while a natural smile is maintained.
77.
78. • BTX-A injections (2.5 units in both right and left overlapping points
LLSAN and LLS, and Zm muscles) are given for the neuromuscular
correction of excessive gingival display caused by hyperfunctional
upper lip elevator muscles .
• It is effective and statistically superior to baseline smiles , although the
effect is transitory.
79. • The mean gingival exposure reduction was 5.2 mm.
• Gingival display gradually increased from 2 weeks post-injection
through 24 weeks, but, at 24 weeks, average gingival display still had
not returned to baseline values. (Polo M, AJODO, 2005)
80. Plaque/drug-induced gingival enlargement
• It is most often related to dental plaque and inflammation but can be
associated with medication such as phenytoin, cyclosporine, and
calcium channel blockers.
• Of all cases of DIGO, about 50% are attributed to phenytoin, 30% to
cyclosporins and the remaining 10-20% to calcium channel blockers.
81. • Treatment:
Treatment of this condition should focus on
meticulous oral hygiene.
Substitution of the drug causing enlargement
Sometimes, periodontal surgery is needed to eliminate
the excessive amount of soft tissues.
83. Loss of torque or palatally tipped maxillary
incisors Loss of torque
class II div 2 After orthodontic
retraction
Poor torque control
Increased incisal
display
MANAGEMENT :
If iatrogenic – incorporation of torque in the wire
84. Anterior dentoalveolar extrusion
• Overeruption of the maxillary incisors with their dentogingival
complex leads to a more coronal position of the gingival margins and
excessive gingival display.
• In cases with deep bite, there is usually discrepancy in the occlusal
plane between the anterior and posterior segments
86. Orthodontic intrusion
• Intrusion refers to the apical movement of the geometric center of the
root (Centroid) with respect to the occlusal plane or plane based on the
long axis of the tooth. (Burstone)
• Factors to determine whether the incisors to be intruded or not:
• Incisor visibility at rest
• Lip length
• Overbite
87. • Three types:
(A)Absolute intrusion
(B)Relative intrusion
achieved by preventing eruption of the incisors while growth
provides vertical space into which the posterior teeth erupt; and
(C)Pseudo intrusion
Labial tipping of the anteriors around the centroid
88. Relative Intrusion
• Can be accomplished with continuous archwires by placing an
exaggerated curve of Spee in the upper archwire and a reverse curve in
the lower archwire.
• With both the 18- and 22-slot appliances, when preliminary alignment
is completed, a 16-mil steel, will be sufficient to complete the leveling.
89. • A possible alternative is a 16-mil “potato chip” A-NiTi wire, preformed
by the manufacturer with an extremely exaggerated curve.
• The extreme curve needed to generate enough force can lead to
problems if patients miss appointments (i.e., the wire does not failsafe)
90. • In patients those who have little if any growth remaining, an archwire
heavier than 16-mil steel is needed to complete the leveling.
• With 22-slot appliance, 18-mil archwire is used.
• With 18-slot, leave the 16-mil wire in place and add an auxiliary
leveling arch of 17 × 25 mil TMA or steel, tied anteriorly beneath the
base arch.
91. • Although the auxiliary leveling arch looks like an intrusion arch, it
differs in two important ways:
• the presence of a continuous base arch and
• the higher amount of force.
• Leveling will occur almost totally by extrusion as long as a continuous
rather than segmented wire is in the bracket slots, and segmenting the
arch makes intrusion possible.
• In the maxillary arch, however, a rectangular wire with an accentuated
curve of Spee would be quite acceptable if lingual root torque of the
upper incisors is needed.
92. Intrusion
• The key to successful intrusion is ‘light continuous force’ directed
toward the tooth apex.
• Can be accomplished in three ways:
(1) with continuous archwires that bypass the premolar (and frequently
the canine) teeth,
(2) with segmented archwires and an auxiliary depressing arch, and
(3) with aligners that have attachments on the posterior teeth.
93. Bypass Archwires
• Most useful for patients who are in either the mixed or early
permanent dentition period.
• Three different mechanical arrangements are commonly used, each
based on the same mechanical principle: uprighting and distal tipping
of the molars, pitted against intrusion of the incisors.
• A classic version of this approach was seen in the first stage of the
Begg technique in which the premolar teeth were bypassed and only a
loose tie was made to the canine.
94. • The same effect can be produced by using the edgewise appliance, if
the premolars and canines are bypassed with a 2 × 4 appliance (only
two molars and four incisors included in the appliance setup) or if
brackets on premolars simply do not have the main archwire tied in.
95. • Ricketts’ utility arch:
formed from rectangular wire; can be placed into the brackets with
slight labial root torque to control the inclination of the incisors as
they move labially while intruding.
• Successful use of any type of bypass arch for leveling requires keeping
the forces light, accomplished by selecting a small-diameter archwire,
and by using a long span ie. b/n the 1st molars and the incisors.
96. • Wire heavier than 16-mil steel should not be used, and a relatively soft
16 × 16 cobalt–chromium wire is recommended for utility arches to
prevent heavy forces from being developed.
• A more modern recommendation would be 16 × 22 β-Ti wire.
• Whether an 18- or 22-slot appliance is used, the bypass arch should not
be stiffer than 16-mil steel.
97. • Two weaknesses of the bypass arch systems limit the
amount of true intrusion that can be obtained:
• Except for some applications of the utility arch, only
the 1st molar is available as anchorage.
• 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
98. • Tying an intrusion arch distal to the midline (b/n the lateral incisor
and canine) moves the line of force more posteriorly and closer to
the center of resistance eliminates the moment that causes facial
tipping of the teeth as they intrude.
99. • An anchor bend at the molar in a bypass arch creates a space-closing
effect that somewhat restrains forward incisor movement, but this also
tends to bring the molar forward, straining the posterior anchorage.
100. BURSTONE’S SEGMENTAL ARCH:
• Triple tube molar attachments are used
• Heavy stainless steel anterior segment (0.021x0.025 ss) with TMA tip
back springs (0.017x0.025) and
• Passive segmented posterior stabilizing units (0.019x0.025) are placed.
101. K-SIR ARCH
• Simultaneous intrusion and retraction of the six anterior by using non-
frictional loop mechanics, which was developed by Dr. Varun Kalra,
based on space closure mechanics advocated by Dr. C. J. Burstone.
• A continuous 0.19" x 0.25" TMA archwire with closed 7mm x 2mm U-
loops at extraction sites.
102.
103. • 90˚ V-bend is placed in the archwire at the level of each U-loop by
placing Centered V – bends which create two equal and opposite
moments.
• A 60˚ V-bend located posterior to the center of inter bracket distance
to augments molar anchorage during intrusion of anterior teeth.
• And 20˚ antirotation bends are placed to prevent molar rotations.
• 0.019" x 0.025" TMA provides sufficient strength to resist distortion,
but enough stiffness to generate required moments.
• At the same time TMA has low forces, low load deflection rate and
high range of activation
104. CONNECTICUT INTRUSION ARCH
• Fabricated from a nickel titanium alloy to provide the advantages of
shape memory, springback, and light, continuous force distribution.
• It incorporates the characteristics of the utility arch as well as those of
the conventional intrusion arch.
• It is preformed with the appropriate bends necessary for easy insertion
and use.
105. • Two wire sizes are available: .016" X .022" and .017" X .025".
• The maxillary and mandibular versions have anterior dimensions of
34mm and 28mm, respectively.
• Although in most cases the wire is not directly ligated into the bracket
slots, the anterior wire dimension is adequate to allow for it.
106.
107. Segmented Archwires for Intrusion
• This approach is recommended for maximum control of the anterior
and posterior segments.
• After preliminary alignment, a full-dimension rectangular archwire is
placed in the bracket slots of teeth in the buccal segment connecting
them into a solid unit.
• In addition, a heavy lingual arch (36-mil round or 32 × 32 rectangular
steel wire) is used.
108. • For intrusion, an auxiliary rectangular arch is used to apply force
against the anterior segment.
• The auxiliary tube should be 18 × 25.
• In it, 17 × 25 steel wire with a 2½ -turn helix or 17 × 25 TMA wire
works well.
• If the auxiliary tube is 22 × 28, 19 × 25 TMA wire without a helix or a
preformed M-NiTi intrusion arch is acceptable, but the range of light
force is lower.
109. • This auxiliary arch is adjusted so that it lies gingival to the incisor
teeth when passive and applies a light force (~10 gm per tooth,
depending on root size) when it is brought up beneath the brackets. and
tied underneath or in front of them.
• An auxiliary intrusion arch can be placed while a light resilient
anterior segment is being used for alignment, but usually it is better to
wait until a heavier anterior segment wire has been installed.
110. • Full-dimension braided rectangular steel wire or a rectangular TMA
wire is usually the best choice for the anterior segment while active
intrusion with an auxiliary arch is being carried out.
• Two strategies can be used to prevent forward movement of the
incisors as they are intruded:
• Creating a space-closing force by tying the auxiliary arch back
against the posterior segments.
• Tying the depressing arch distal to the midline, b/n the central
and lateral or distal to the laterals
111. (C) Intrusion arch tied in the midline as only the central incisors are intruded, so that the incisors will
tip facially as they intrude.
(D) In the same patient later, an intrusion arch now is tied between the central and lateral incisors to
intrude all four incisors while reducing the amount of facial tipping.
112. • With careful attention to appropriate forces and moments with this
approach, approximately four times as much incisor intrusion as molar
extrusion in nongrowing adults is possible
• To intrude asymmetrically, adjust the teeth that are placed in
stabilizing and intrusion segments and tie the auxiliary intrusion arch
in the area where intrusion is required.
• If intrusion is desired on only one side, either a cantilevered auxiliary
wire extending from one molar or a molar-to-molar auxiliary arch can
be used.
113. Intrusion using TADs
• Many patients with present with moderate to deep bites requiring pure
intrusion of the anterior teeth to level the occlusal plane.
• Unless the deep bite is so extreme that absolute anchorage is needed, it
may be inadvisable to place miniscrews simultaneously in both arches
in young patients.
• In these instances miniscrews can be used to reinforce conventional
orthodontic mechanics.
114. 1) Bilateral implants for en-masse intrusion of anteriors:
• The implants used are 1.3 mm in diameter and 8 mm in length.
• Bone contacts at insertion influences the primary stability of the
implants.
• Increasing the diameter and length of the implant allows greater
surface area contact between the bone and implant.
• It’s important to have a mechanical interdigitation between implants
and cortical bone
115. Placement Site:
• the alveolar bone between lateral incisor and canine bilaterally at the
level of attached gingiva
116. Clinical set up
1. The maxillary dental anterior segment should extend from distal of
canines on either side.
A 21x 25 stainless steel arch is placed in all the three segments.
In the anterior segment, hooks are placed between lateral incisor and
canine bilaterally.
This is followed by placement of mini implants which are loaded
immediately.
117. 2. A calibrated Dontrix gauge is used to measure the amount of
intrusive force being applied.
45 gms of intrusive force is applied per side using a pre-stretched
elastic chain i.e. a total of 90 gms of intrusive force is applied to the six
anterior teeth.
3. A ligature wire lace back is tied extending from the maxillary molar
hook to the tag incorporated distal to canine in the anterior segment.
118. • True intrusion takes place when forces are directed through the center
of resistance.
• If the intrusive force is applied anterior to the center of resistance of a
segment, it results in flaring of the teeth.
• The implants are placed between the canine and the lateral incisors
bilaterally so the point of application of force is closer to the center of
resistance of anterior segment.
119. • However, directing the force through the center of resistance is not
possible in a clinical set up.
• As a result some amount of flaring is inevitable with any intrusive
mechanics.
• To prevent a steel ligature lace back from the molar hook to distal of
canine should be placed.
• This is just enough to prevent flaring, without having any reciprocal
mesializing effects on the molars and also directs the resultant force
vector close to the center of resistance.
120. 2) Mid-implant for intrusion of maxillary incisors
• The implants used are 1.3 mm in diameter and 8 mm in length.
• A stainless steel archwire with utility design engaging four incisors and
two molar, bypassing the canine and premolar is used made of
0.017x0.025
• Passive segmented posterior stabilizing unit (0.019x0.025)
• A closed coil spring or a E-chain can be used to deliver force of around
60-70 grams
121. • There are certain cases where only incisors are extruded and need
intrusion or a clinical situation where the canines have been retracted
and the incisors need intrusion, in such cases a mid-implant below the
anterior nasal spine is placed.
122. • Creekmore T D and Eklund published a case report was using a
vitallium implant for anchorage while intruding the upper anterior
teeth.
• The vitallium screw was inserted just below the anterior nasal spine
and after a healing period of 10 days, an elastic thread was tied from
the head of the screw to the archwire. .
123. • Ohnishi et al described the correction of significant deep bites using
mini-implants as anchorage for the intrusion of the upper anterior
segment.
• Miniimplants were placed in between the roots of maxillary central
incisors
• Kim et al presented a case report wherein they corrected a Class II,
Div. 2 deep bite malocclusions by using a mini-implant placed below
the anterior nasal spine.
• 4mm of incisor intrusion was achieved in 6 months
124. Vertical maxillary excess
GROWING
PATIENT
High pull
headgear with or
without maxillary
splint
Vertical pull chin
cup with bite
blocks
NON GROWING
PATIENT
Orthognathic
surgery
Orthodontically /
using mini
implants
125. High pull headgear
• Restrains growth of the maxilla with extraoral force
• In a growing patient, headgear must be worn regularly for at least 10
to 12 hours per day to be effective in controlling growth.
• The current recommendation is a force of 12 to 16 ounces (350 to 450
gm) per side.
• When the force is applied anterior to the key ridge;
counter clockwise rotation
• When force is applied along the Cres; translation
• When distal to the Cres, clockwise rotation of the maxilla
126.
127. Vertical pull chin cup with bite blocks
• Vertical pull chin cup with headgear produces significant favorable
skeletal and dental alterations by inhibiting maxillary molar eruption
and descent of maxilla and redirecting mandibular growth in a more
horizontal direction.
It provides:
1. Decreased gonial angle
2. Redirection of condylar growth
3. Increased posterior height.
128. Extractions and space closure mechanics:
• Extraction site : Suggested that extraction be considered with the
purpose of protracting the posterior teeth in to the extraction site,
thereby allowing the mandible to auto rotate.
• Mechanics of space closure : Should avoid extrusion of the posterior
teeth.
• Avoid running Class II elastics which extrude the posterior teeth.
129. • Normal horizontal chains or coil springs used , while the teeth are
engaged on a light wire do not apply defined moment to force ratio,
hence result in tipping of the teeth into the extraction site.
• Implant assisted retraction and intrusion
130. Surgical correction
• Maxillary impaction with or without
genioplasty
• Surgery, comprising total or segmental
maxillary osteotomy, can improve the relation
between the maxillary arcade and the upper
lip
• Lefort I osteotomy is usually performed,
consisting in mobilizing the entire maxillary
plate by resecting a band of bone tissue so as
to achieve maxillary intrusion.
131.
132. Conclusion
• Although moderate gummy smile can be quite acceptable and
esthetically pleasing if the gum is healthy, more pronounced cases are
less well tolerated and require treatment.
• When gummy smile is basically due to strong vertical alveolar growth
at the incisors, isolated orthodontic treatment can provide satisfactory
results, especially with the development of bone anchorages, extending
the potential of classic orthodontics.
133. • Maxillofacial surgery, however, is indispensable when etiology is basal,
related to excessive vertical growth of the maxilla as a whole.
• According to the type of treatment, esthetic, dento-alveolar and
skeletal consequences differ.
• It is therefore essential to set treatment objectives in agreement with
patient expectations as of the first examination, so as to select the most
appropriate form of treatment.
134. References
• William R proffit. Contemporary orthodontics,6th edition
• Proffit, white & sarver.Contemporary treatment of dentofacial deformities .
• Peck S, Peck L, Kataja M. The gingival smile line. Angle Orthod 1992;62:91–
100
• Orthodontic treatment of gummy smile by using mini-implants : Treatment
of vertical growth of upper anterior dentoalveolar complex. Tae-Woo Kim,
Benedito Viana Freitas.Dental Press J. Orthod. 2010.
• J Williams Robbins. Differential diagnosis and treatment of excessive
gingival display;Pract Periodont Aesthet Dent 1999;11(2).
135. • Arthur Dolt, J William Robbins.Altered Passive eruption:an etiology of
short clinical crowns. QUINTESSENCE INTERNATIONAL 1997
• Coslet JG, Vanarsdall R, Weisgold A. Diagnosis and classification of delayed
passive eruption of the dentogingival junction in the adult. Alpha Omegan
1977;70:24–28.
• Eliminating a Gummy Smile with Surgical Lip Repositioning. Simon,
Rosenblatt, Dorfman, The Journal of Cosmetic Dentistry •
• Botulinum toxin type A in the treatment of excessive gingival display. Mario
Polo, AJODO