Asymmetrical Non-Extraction Gummy Smile, Gingival Smile, Midline, Scissor Bite Treatment, No-Prep Laminate

#Apgujeong Orthodontic Clinic #No-PrepLaminate #Laminate #GingivalSmile #ScissorBite #LaminateClinic

Hello,

This is Apgujeong Orthodontic Clinic.

Today, I’ll show you how we treated a complex case with a scissor bite, midline issues, a gummy smile, and even peg-shaped teeth using Invisalign.

22.10~25.06

This patient first visited us in October 2022 with asymmetry.

There is midline discrepancy, spacing caused by peg-shaped teeth, and crowded canines.

22.10

The main reasons the patient felt asymmetry were:

One side of the face is larger. The upper dental midline is not aligned with the philtrum.

These two reasons.

It is true that the upper teeth are shifted to one side relative to the philtrum, but in fact this patient does not have skeletal asymmetry.

In orthodontics, asymmetry usually refers to skeletal asymmetry, that is, asymmetry of the lower jaw.

It is quite common for people to think they have facial asymmetry even when the chin point is not shifted, simply because the volume on the left and right sides of the face differs.​

The reason one side of the face is larger is mostly because they chew on only one side.

If the opposite side bite does not chew well or feels uncomfortable, you end up chewing on one side, and over time the chewing muscles develop more on that side.

It would be helpful to refer to the dental Michelin video.

The reason this patient chewed on only one side was because there was a scissor bite on the other side.

The blue arrow indicates a scissor bite, where the upper molar is positioned outward and the opposing tooth tips inward, causing the teeth to interlock like scissors.

The tooth indicated by the blue arrow protrudes outward, causing the scissor bite.

The treatment goal was to bring the dental midline toward the facial midline by moving the teeth backward using the space from the unilateral wisdom tooth; at that time, orthodontic mini-screws would be needed.

And after orthodontic treatment, we planned no-prep laminate restoration for the peg-shaped teeth.

We extracted all the wisdom teeth and started treatment with Invisalign.

The first set consisted of 70 aligners.

23.06

23.12

This is the condition after wearing all of the first set of aligners for 1 year and 6 months, from October 2022 to April 2024.

24.04

The scissor bite has been resolved, but the molar occlusion is still not tight.

The alignment is perfect.

We proceeded with a remake to further correct the midline and other details.

The remake set consisted of 17 aligners, worn from May 2024 to November 2024.

24.11

The upper and lower midlines are aligned precisely, and

The molar occlusion relationship is also Class I.

Everything is good, but because of the patient’s requests and for a better finish, we did one more remake.

After wearing all 11 additional aligners, treatment was completed in June 2025.

Now it is time for the no-prep laminate for the peg-shaped tooth.

For peg-shaped tooth laminate, it is best to match the color of the surrounding teeth.

The treatment turned out naturally and nicely.

The total treatment period was 2 years and 6 months, and we did 2 remakes.

The molar occlusion is good and shows a Class I occlusal relationship.

Let’s look at the before and after.

2022.10~2025.06

22.10~25.06

2022.10~2025.06

The slight forward protrusion of the front teeth, that is, protrusion, has improved.

2022.10~2025.06

By resolving the scissor bite on one side, the left-right occlusal balance has improved, so as the patient practices chewing 50:50 on both sides, the part where one side of the face looked larger due to muscle asymmetry will gradually improve as well.

2022.10~2025.06

Many people worry that the nasolabial folds will become deeper after orthodontic treatment.

Based on a PhD and know-how published in SCI journals regarding changes in nasolabial folds after orthodontic treatment, we carefully perform orthodontic treatment so that there are no nasolabial fold issues.

2022.10~2025.06

The gummy smile and midline have improved.

2022.10~2025.06

A clean and well-organized smile stands out.

The appearance of one side of the face looking larger is gradually improving.

2022.10~2025.04

Over the two and a half years, there was no root resorption, and the unilateral molars moved well into the wisdom tooth space as planned.

The root parallelism is good.

I hope this helps those who are considering Invisalign treatment.