The use of mini screws as temporary anchorage devices has revolutionized orthodontics. The following case illustrates a type of orthodontic correction which was impossible to consider without surgery just a few years ago.
Case history :
- This 25 year old woman had started an orthodontic treatment 2 years earlier before being to Dr. John Graham orthodontist, practicing in Litchfield Park, Arizona.
- One of the patient’s chief complaint was that she didn’t like her gummy smile. The first series of photographs shows the severity of that gummy smile; more than 1 cm (10 mm) of gingiva is visible upon smiling.
- The initial treatment plan included a “maxillary impaction” which is an orthognathic surgery procedure aimed at “moving up” the upper jaw to reduce the gummy smile.
- Having lost her insurance coverage, the patient could no longer afford the surgical fee so the initial treatment plan had o be modified. Dr Graham offered to use temporary anchorage devices (TADs) to intrude the maxillary dentition and correct the gummy smile.
- The photos (A, B, C) below show the patient as she was transferred to Dr. Graham. (D) At the end of treatment, after the use of TAD mini-screws and reduction of the gummy smile.
Although the occlusion and tooth alignment were acceptable at this stage of treatment (transfer), the smile still showed a lot of gingiva because this correction was originally planned to been done surgically. Treatment goals were still aimed at reducing the excessive gummy smile.
Orthodontic mechanics used for the intrusion of the maxillary dentition
Cone Beam Computer Tomography (CBCT) imaging
Cone Beam Computer Tomography (CBCT). Initial and final stages.
To learn more about Cone Beam Computer Tomography imaging (CBCT)
To learn more about soft tissue laser and how it can be used to modify gingival contour and improve esthetics.
To learn more about genioplasties
Thanks to Dr. John Graham for sharing this case.