Treatment Review for Gum Smile, Invisalign, Gummy Smile, Buck Teeth, No-Prep Laminate, and Crossbite Correction

Hello,

This is Apgujeong Orthodontic Clinic.

There are people whose gums show a lot when they smile, right?

Today, I’ll explain intrusion orthodontic treatment for people who show a lot of gums when smiling and want to address a gummy smile.

When the front teeth are intruded, if the molars are intruded as well, the lower face becomes shorter, the face looks smaller, and the lips can close more comfortably.

How can lip protrusion be clearly improved without extraction?

Rather than simple posterior movement using wisdom tooth space, treatment is more effective when it is accompanied by intrusion of the entire dentition.

I’ll show you how full-arch intrusion treatment is carried out with Invisalign.

This patient came from far away, from a provincial area, for orthodontic treatment in December 2023.

23.12

What the patient wanted to correct was alignment, bite, gummy smile, and lastly asymmetry.

X-ray examination showed that the skeletal asymmetry was mild, but the upper and lower dental midlines were deviated, so the patient wanted improvement in that area.

23.12

As for the bite, there was a molar crossbite where the bite was reversed, some open bite areas, and one front tooth had become discolored after root canal treatment.

A premolar was positioned toward the palate, so it was in a crossbite state.

Because the patient was coming from far away, the interval between visits was important, so we decided to treat with Invisalign.

The first set consisted of 30 aligners, and the plan was to intrude and move the entire dentition backward, not just the upper front teeth, but also the molars.

We carried out the treatment according to a careful treatment plan using orthodontic screws and elastics.

24.08

24.08

This is what it looked like after wearing 30 aligners for 10 months, from January to October.

24.10

The front teeth alignment had improved, but the midline still needed work, and further improvement in the height difference between the front teeth was needed.

24.10

The molar bite is good.

24.10

The alignment was also mostly completed.

Let’s look at the facial changes after 10 months.

23.12~24.10

The gummy smile improved, and you can already see that the lower face became shorter.

23.12~24.10

The gummy smile, protrusion, and especially gingival protrusion, where the gums stick out, improved a lot.

23.12~24.10

As the front teeth moved back, the nasolabial folds disappeared.

The lips now close more comfortably than before.

After confirming the clear improvement in facial appearance, additional aligners were made, after discussion with the patient, to improve the midline and the bite.

November 2024

25.08

The midline is now precisely aligned.

After finishing orthodontic treatment, the patient visited another clinic for no-prep laminate veneers.

25.08

For a front tooth that turned dark after root canal treatment, it is better to remove the discoloration from inside the tooth first with internal bleaching for a non-vital tooth, and then proceed with no-prep laminate veneers.

Otherwise, the dark area will show through between the gums and the laminate veneer.

The veneer thickness and transparency are also somewhat disappointing.

25.08

Now, let’s compare before and after.

The total treatment period was 1 year and 7 months, and there was one remake.

23.12~25.08

23.12~25.08

You can see the corrected midline and improved alignment.

23.12~25.08

The crossbite improved.

23.12~25.08

23.12~25.08

The improvement in the gummy smile and gingival protrusion is striking.

23.12~25.08

The nasolabial folds disappeared, the lips close comfortably, and the jawline looks better.

Based on the upper front teeth, approximately 2 mm of intrusion was achieved.

The upper molars also underwent approximately 2 mm of intrusion.

In other words, the entire upper arch was intruded by 2 mm and moved backward by about 2 mm.

Not only the front teeth but also the molars were moved backward and intruded across all 14 upper teeth, causing the lower jaw to self-rotate and the chin tip to become shorter.

In cases of a weak chin, full-arch upper intrusion orthodontic treatment brings about major changes not only in the teeth but also in facial form.

The chin moved forward, so it was a two-for-one benefit.

In this way, full-arch intrusion treatment is also relatively well handled with Invisalign.

Recently, during new patient orthodontic consultations, there was also a patient who had come after hearing from another clinic that a simple molar intrusion open-bite case could absolutely not be treated with Invisalign.

25.08

The root parallelism is good, and no root resorption is visible.

I hope today’s post was helpful for those of you who are considering orthodontic treatment.