message board VME With Severe Gummy Smile A Townie asks for advice on how to treat a challenging case CliveStaples Member Since: 10/13/14 Post: 1 of 8 Patient is 28 years old. Chief complaint: " I don't like my gummy smile and spaces. " Class I molar, severe Class II dental with vertical maxillary excess and deep bite altered passive eruption. I'm referring her to a periodontist for crown lengthening. I'd like to reduce her vertical excess with TAD-supported intrusion and get some serious lingual root torque on the incisors. I'm thinking two TADs distal to the maxillary 2s. How would you approach this case? little outside my normal comfort zone. Thanks in advance! ■ I'd love to hear your thoughts, because this case is a 5/22/2019 justinudm Member Since: 09/29/14 Post: 2 of 8 To address her chief complaint of a gummy smile, this is a two-jaw surgery case. There has been signifi cant wear to the upper anteriors and there is also a need for perio bone recontouring. I would have a periodontist do bone sounding and determine what needs to be done to get the tissues (soft and bone) at the right height on the upper anteriors. After that, you can determine how much of a VME there is and have another conversation about her gummy smile. Maybe it will be less of a concern after that. But I don't think you are going to get a reduction in the VME by posterior intrusion with TADs. It's going to take a maxillary impaction. ■ 5/22/2019 CliveStaples Member Since: 10/13/14 Post: 3 of 8 I appreciate your feedback, Justin! I sent her to an oral surgeon for a work-up. They agreed the maxillary impaction would have the most " impact. " ■ 5/24/2019 Need help with a case? Head online! In our online message boards, verifi ed members of the Orthotown community share their advice on how to approach challenging cases like this one. If you'd like to make sure your proposed treatment plan is the best path forward, load photos of your case at orthotown.com/messageboards, and ask away! 30 OCTOBER 2022 // orthotown.comhttp://www.orthotown.com/messageboards http://www.orthotown.com