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Effective approach for improving a gummy smile

Upward movement of the maxillary occlusal plane using midpalatal miniscrews and a modified transpalatal arch

Effektiver Behandlungsansatz für ein Gummy Smile

Verschiebung der Oberkieferokklusionsebene nach kranial unter Verwendung von palatinalen Minischrauben und einem modifizierten Transpalatinalbogen

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Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie Aims and scope Submit manuscript

Abstract

Purpose

Correction of a gummy smile by orthodontic treatment alone has recently become feasible with the use of miniscrews. However, the optimal treatment mechanics remain unclear. Here we cephalometrically evaluated jaw and tooth displacement in cases where a gummy smile was improved using a level anchorage system (LAS).

Methods

Sixteen patients underwent orthodontic treatment using an LAS consisting of a modified transpalatal arch and midpalatal miniscrews. Cephalometric pretreatment and posttreatment measurements were compared using the paired t‑test to determine significant skeletal and dental changes. The Mann–Whitney U test was used for nonparametric data. Spearman’s rank correlation coefficient was used to evaluate correlations between different variables and the vertical change in prosthion position which was used to indicate the amount of gingival exposure.

Results

The changes noted after treatment were intrusion of the maxillary first molars (P < 0.001) combined with only minor extrusion of the mandibular first molars. Suppressed extrusion of the mandibular first molars was significantly correlated with greater upward movement of the prosthion (r = 0.676, P < 0.01). Upward movement of the prosthion was also significantly correlated with intrusion of the maxillary and mandibular incisors, anterior upward movement of the maxillary occlusal plane, and an increase of the SNP angle.

Conclusions

Treatment involving the combined use of miniscrews and a modified transpalatal arch resulted in intrusion of the maxillary first molars and maxillary incisors and consequently elevated the maxillary occlusal plane. The results of this study suggest that intruding the maxillary occlusal plane and minimizing mandibular molar extrusion were effective to induce autorotation of the mandible and to improve a gummy smile.

Zusammenfassung

Zielsetzung

Die Korrektur eines Gummy Smile durch eine rein kieferorthopädische Behandlung ist in letzter Zeit durch die Verwendung von Minischrauben möglich geworden. Die optimale Behandlungsmechanik bleibt jedoch unklar. Hier haben wir anhand kephalometrischer Messungen die Kiefer- und Zahnverschiebung in Fällen untersucht, in denen ein Gummy Smile mit einem LAS (Level Anchorage System) verbessert wurde.

Methoden

Sechzehn Patienten unterzogen sich einer kieferorthopädischen Behandlung mit einem LAS, das aus einem modifizierten Transpalatinalbogen und mittpalatinalen Minischrauben bestand. Die kephalometrischen Messungen vor und nach der Behandlung wurden mit dem gepaarten t‑Test verglichen, um signifikante skelettale und dentale Veränderungen festzustellen. Für nichtparametrische Daten wurde der Mann-Whitney-U-Test eingesetzt. Der Spearman-Rangkorrelationskoeffizient wurde verwendet, um die Korrelationen zwischen den verschiedenen Variablen und der vertikalen Veränderung der Prosthionposition zu bewerten, die als Hinweis auf das Ausmaß der Zahnfleischfreilegung diente.

Ergebnisse

Die nach der Behandlung beobachteten Veränderungen waren eine Intrusion der ersten Oberkiefermolaren (p < 0,001) in Kombination mit einer nur geringen Extrusion der ersten Unterkiefermolaren. Die verringerte Extrusion der ersten Unterkiefermolaren korrelierte signifikant mit einer größeren Aufwärtsbewegung von Prosthion (r = 0,676, p < 0,01). Die Aufwärtsbewegung des Prosthion korrelierte auch signifikant mit der Intrusion der oberen und unteren Inzisiven, der anterioren Aufwärtsbewegung der oberen Okklusionsebene und einer Vergrößerung des SNP-Winkels.

Schlussfolgerungen

Die Behandlung mit der Kombination aus Minischrauben und einem modifizierten Transpalatinalbogen führte zu einer Intrusion der oberen ersten Molaren und der oberen Inzisiven und damit zu einer Anhebung der oberen Okklusionsebene. Die Ergebnisse dieser Studie deuten darauf hin, dass die Intrusion der oberen Okklusionsebene und die Minimierung der Extrusion der Unterkiefermolaren eine effektive Methode sind, um die Autorotation des Unterkiefers zu induzieren und ein Gummy Smile zu korrigieren.

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Acknowledgements

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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The authors declare that they have no funding for this research article.

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Authors and Affiliations

  1. Department of Orthodontics, School of Dentistry, Aichi Gakuin University, 2–11 Suemori-Dori, 464-8651, Chikusa-ku, Nagoya, Aichi, Japan

    Ken Miyazawa DDS, PhD, Yuka Tamada DDS, Masako Tabuchi DDS, PhD, Misuzu Kawaguchi DDS, PhD, Momoko Shibata DDS, PhD, Takuma Sato DDS, PhD, Kyoko Okamoto DDS, Natsuki Saito DDS & Shigemi Goto DDS, PhD

Authors
  1. Ken Miyazawa DDS, PhD
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  2. Yuka Tamada DDS
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  3. Masako Tabuchi DDS, PhD
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  4. Misuzu Kawaguchi DDS, PhD
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  5. Momoko Shibata DDS, PhD
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  6. Takuma Sato DDS, PhD
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  7. Kyoko Okamoto DDS
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  8. Natsuki Saito DDS
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  9. Shigemi Goto DDS, PhD
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Contributions

Ken Miyazawa: Conceptualization, Methodology, Writing—original draft. Yuka Tamada: Investigation, Data curation, Writing—original draft. Masako Tabuchi: Methodology, Validation, Writing—review and editing. Misuzu Kawaguchi: Validation, Resources. Momoko Shibata: Investigation, Data curation, Formal analysis. Takuma Sato: Software, Validation. Kyoko Okamoto: Investigation, Data curation. Natsuki Saito: Investigation, Data curation. Shigemi Goto: Supervision, Project administration. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Masako Tabuchi DDS, PhD.

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Conflict of interest

K. Miyazawa, Y. Tamada, M. Tabuchi, M. Kawaguchi, M. Shibata, T. Sato, K. Okamoto, N. Saito and S. Goto declare that they have no competing interests.

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The procedures followed the statement rules defined by the institutional review board of the Aichi Gakuin University, Nagoya, Aichi (approval number: 11).

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Written informed consent for publication was obtained from the patients.

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Miyazawa, K., Tamada, Y., Tabuchi, M. et al. Effective approach for improving a gummy smile. J Orofac Orthop 85, 167–180 (2024). https://doi.org/10.1007/s00056-022-00417-3

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