Gummy Smile Correction, Protrusive Mouth Extraction Orthodontics, Lip Incompetence, Walnut Chin Treatment Period: 2.5 Years

Hello, this is Apgujeong Orthodontic Clinic.

A smile that shows a lot of gum when smiling is called a gummy smile. For a long time, orthodontic treatment has often been used to correct gummy smiles by intruding the teeth.

For reference, it would be helpful to look at the non-extraction gummy smile intrusion orthodontic case published as the first author by Dr. Baek Eui-seon, CEO of Apgujeong Yonsei Baro Dental Clinic, in the SCI journal KJO in 2017. Today, we will show the treatment process that leads to improvement of a gummy smile in a patient with severe crowding and protrusion who requires extraction orthodontics.

2022.12~2025.06

This patient visited in December 2022 for orthodontic treatment.

What they wanted to correct was alignment issues such as crowded teeth and protrusion.

2022.12

There is also facial asymmetry, so the midline of the front teeth is shifted by about 2 mm, and on the right side where the lower jaw is rotated, the canine and molars are in crossbite.

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Because the space is narrow, there is also crowding.

2022.12

The alignment of the front teeth also needs improvement.

2022.12

The gummy smile, where a lot of gum shows when smiling, is also severe.

2022.12

The protrusion is severe, so the lips cannot close comfortably, and lip incompetence is also present. When there is lip incompetence, tension is naturally placed on the chin, which causes a dimpled chin appearance, known as a walnut chin (chin wrinkle), to appear as well.

In particular, these chin wrinkles make the chin look blunt, as if the chin were receding, and also make the lower face look longer.

The lower lip protrudes more than the upper lip. Even with the same degree of protrusion, this kind of lip line gives a sullen impression.

There is crowding and the protrusion is severe, so extraction orthodontics involving the removal of four premolars is needed.

2022.12

However, one molar is missing in the area marked by the blue arrow. That area had been treated long ago with a bridge after the molar was lost.

For treatment convenience, extraction of four premolars would normally be needed, but since the bridge itself is old, we decided to cut the bridge in the jaw area on the blue arrow side and use that space for the missing molar without additional premolar extraction. This means the number of premolars to be extracted can be reduced from four to three, and it also has the major advantage of being able to close the space left by the missing molar long ago through orthodontics without an implant. Of course, there is also a downside. Closing the 7 mm or so space created by extracting a premolar takes less time than closing a space larger than 10 mm where a molar is missing, so the total treatment period will usually be a few months longer than when extracting four premolars. However, it is a more beneficial treatment plan for the patient. Rather than prioritizing convenience in treatment, we propose a plan that is more beneficial to the patient in the long term.

This is what it looked like after the bridge was cut.

They chose Clippy-C treatment, and treatment began.

Here is the appearance two years later, in November 2023.

23.11

About 3 mm of extraction space remains on each side.

The abutment teeth of the cut bridge were maintained as temporary teeth during orthodontic treatment, and at the end of orthodontic treatment they were restored with new crowns.

23.11

After that, we further closed the extraction spaces and improved the gummy smile using mini-screws, which are orthodontic anchor screws, and then completed treatment in June 2025. The total treatment period was 2 years and 6 months.

25.06

After completing both orthodontic and crown treatment, the Clippy-C brackets were removed.

To restore the short upper front teeth, gum contouring was performed on the four upper front teeth.

25.06

This is the appearance immediately after gum contouring. The word "contouring" may sound intimidating, but in reality there is no bleeding or anything like that.

This is the appearance after a one-week recovery period following gum contouring.

25.06

The midline was well aligned, and the crossbite caused by lower jaw asymmetry was resolved. Orthodontics cannot change the jawbone itself, but it can at least align the dental midline.

One drawback is the black triangles between the lower front teeth.

If more interproximal reduction were done, the size of the black triangles could be reduced, but the patient did not want excessive interproximal reduction, so we did not proceed with a large amount.

25.06

The bite shows a Class I occlusal relationship and is very tight and stable.

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The space from cutting the bridge was neatly closed through orthodontics, and the temporary tooth used during treatment was replaced with a white crown at the end of orthodontic treatment.

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Now let's compare before and after.

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Let's compare the facial appearance.

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When the protrusion is corrected, the lower lip becomes slightly thinner.

Because the lower lip protruded more than the upper lip, thinning of the lower lip helps improve the sullen impression.

In addition, the jawline area also appears noticeably slimmer.

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The gummy smile improved through orthodontics and gum contouring.

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As the protrusion improved, the chin wrinkles improved and the lips can close much more comfortably.

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Improvement of gummy smile and protrusion

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The chin line, which looked blunt because of chin wrinkles, regained a more attractive line as the protrusive mouth improved, the lip incompetence resolved, and the chin wrinkles disappeared.

25.06

Even during the two-and-a-half-year orthodontic period, there was no root resorption, and root parallelism is good.

Even with the same extraction orthodontics for protrusion, each patient’s situation is slightly different. From choosing which teeth to extract during treatment planning to finishing the treatment while considering each person’s lip line, we always strive for the best result.