Response to: Gummy smile and facial profile correction using miniscrew anchorage by Masato Kaku, Shunichi Kojima, Hiromi Sumi, Hiroyuki Koseki, Sara Abedini, Masahide Motokawa, Tadashi Fujita, Junji Ohtani, Toshitsugu Kawata, and Kazuo Tanne. Angle Orthod. 2012;82:170–177

To: Editor, The Angle Orthodontist

Because of the lingual movement of the upper and lower incisors, the patient can now easily close the lips and the facial profile is significantly improved. So, all post-treatment extraoral photographs and lateral view cephalograms were taken with the lips in a relaxed position.

Actually, all the first premolars should be extracted in this case. However, the patient declined to remove first premolars because they were intact teeth. So, we made an effort to retract anterior teeth using miniscrew anchorage. Before treatment, the left molar and canine relationship was a full Class II. It was rather difficult to improve these relationships by the third molar extraction. Therefore, we decided to take out the left second molar. The third molar in this case was smaller than the second molar, so the treatment result was a little imperfect occlusion on the left side.

Baek1 showed that most relapse after intrusion of teeth using miniscrew anchorage occurred during the first year of retention and they concluded that the application of an appropriate retention method during this period clearly enhances the long-term stability. Thus, the anterior miniscrews were left and we combined them with a clear retainer at night during retention for 16 months. However, careful checkups will be needed in the future.

The cause of excessive gingival display is multifactoral and can be divided into several categories according to the etiologic factors.2 In this case, N-A was 61.5 mm (mean value of adult Japanese female was 63.7) and FMA was 32.3° which is within the standard for Japanese. We have had many stable results even with an FMA more than 35°. There was no problem with the lip position before treatment. So, we diagnosed the patient had a dentoalveolar gummy smile without abnormal vertical growth of the maxilla and planned to intrude the maxillary anterior region using miniscrew anchorage. The anterior teeth showed 4mm intrusion, resulting in a dramatically reduced gingival exposure.

Thus, it is reasonable to conclude that the application of an appropriate retention method during this period clearly enhances the long-term stability of the treatment. Thus, it is reasonable to conclude that the application of an appropriate retention method during this period clearly enhances the long-term stability of the treatment. Thus, it is reasonable to conclude that the application of an appropriate retention method during this period clearly enhances the long-term stability of the treatment.