Case Report Figure 15. Change in clinical crown height (top and bottom) been intruded (Figure 15). I suspect ongoing mouth breathing and poor oral hygiene may contribute to this. Ultimately, it becomes necessary to perform a gingivectomy to reveal the full clinical crown after intrusion. Retention photographs taken at 21 months reflect a pleasing smile and a stable occlusal result (Figure 16). I believe earlier attention to her airway issues may have prevented or minimized the aberrant maxillary growth pattern that led to the excessive gummy smile and the increase in the lower face height. Her overall VME changes and profile changes can be assessed with serial photographs (Figure 14; lateral cephalograms were unavailable for ages eight and ten years). Editor's Comments The reviewer appreciates Dr. Pair's effort to share this case with our members. This case demonstrated the importance of communication with the patient and parents. It is paramount to address the patient's chief complaint at the beginning of the treatment planning. Worth mentioning is that Dr. Pair used 1.8 mm × 10 mm miniscrews (Ace Ortho Bone Screw). These miniscrews were inserted slightly angled, upward in the maxilla or downward in the mandible, instead of perpendicular to the alveolar bone surfaces. The selected length might offer additional primary stability when appropriately inserted and increase the versatility of posterior teeth intrusion, especially for patients with VME. Figure 16. Extra- and intraoral photos after 21 months of retention (age 16 years and six months) Dr. Jason W. Pair Dr. Pair received his dental education at the University of California San Francisco and his orthodontic residency at the University of California Los Angeles (UCLA). Dr. Pair is an ABO-certified orthodontist specializing in orthodontics and dentofacial orthopedics. He is also a Southern California Angle Society member and a clinical instructor at the UCLA Section of Orthodontics. He runs Pair Orthodontics in Northridge and Calabasas in California. 52 PCSO Bulletin Winter 2023