Management of an Adult with Class III Malocclusion, Gummy Smile, and Spaced Dentition

This case report presents an interdisciplinary approach to achieve functioning occlusion and an aesthetically pleasing smile. This patient’s concerns were spacing between upper front teeth and a gummy smile. The case was evaluated, and treatment was planned using a multidisciplinary approach. The patient rejected the option of orthognathic surgery to correct a skeletal problem. Treatment included orthodontics, osteoplasty, gingivoplasty, and porcelain veneer restorations to achieve the desired aesthetic result. Comprehensive orthodontics resulted in a functionally stable occlusion. Space distribution between maxillary anterior teeth with adequate overjet and overbite relationships allowed for conservative preparation to receive porcelain veneer restorations.

Key points

  • This case report presents an interdisciplinary approach to achieve an aesthetically pleasing smile with a functioning occlusion in a patient with a class III malocclusion and a maxillary tooth/jaw size discrepancy.

  • Using such adjuncts to treatment planning as a smile evaluation form, radiographs, and initial study casts, a plan for multidiscipline treatment was designed, sequenced, and carried through so that the final treatment objectives were realized with good aesthetics and a functional occlusion.

  • Minimal Orthodontic movement was provided to allow equal distribution of space allowing conservative preparation for eventual restorations and Laser removal of excessive soft tissue addresses gummy smile.

Patient background and chief concerns

The patient is a 27 year old African American man ( Figs. 1 and 2 ) and is a self-described actor/model. He presented to New York University College of Dentistry (NYUCD) for dental evaluation to improve his smile and facial appearance (see Figs. 1 and 2 ).

Fig. 1
( A , B ) Patient at initial evaluation.

Fig. 2
( A , B ) New York University College of Dentistry smile evaluation form.

Medical history had no significant findings, no allergies reported, and no current medications.

Blood pressure was 110/70. Pulse was 71 beats per minute, and respiration was 19 breaths per minute. Weight was 200 lbs, and height was 6’ 1’’. Body mass index was 24.6.

Patient background and chief concerns

The patient is a 27 year old African American man ( Figs. 1 and 2 ) and is a self-described actor/model. He presented to New York University College of Dentistry (NYUCD) for dental evaluation to improve his smile and facial appearance (see Figs. 1 and 2 ).

Fig. 1
( A , B ) Patient at initial evaluation.

Fig. 2
( A , B ) New York University College of Dentistry smile evaluation form.

Medical history had no significant findings, no allergies reported, and no current medications.

Blood pressure was 110/70. Pulse was 71 beats per minute, and respiration was 19 breaths per minute. Weight was 200 lbs, and height was 6’ 1’’. Body mass index was 24.6.

Dental history

Regular dental care reports indicated “dark teeth, large spaces, too much gum showing.”

The patient had a class III malocclusion with a class III skeletal pattern. A smile evaluation form ( Fig. 2 ) and other treatment planning adjuncts ( Figs. 3–7 ) were performed to help formulate what specialty disciplines would be involved in the case work-up.

Oct 28, 2016 | Posted by in General Dentistry | Comments Off on Management of an Adult with Class III Malocclusion, Gummy Smile, and Spaced Dentition
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