Before & Afters
Dr. David Sarver is committed to documenting cases for as long as possible. This led him to create video morphographs that show patients’ progress over decades. See where cases started and where they are now, as well as the impact of aging on soft tissue.
This patient had a significant open bite resulting in functional issues such as an inability to bite into sandwiches. Esthetically, he had a nice smile, but not a great smile. Our task was to close his open bite first, which was significant enough to warrant or orthognathic surgery (better known as jaw surgery), but because of insurance complications, that was not an option.
This patient was first brought in at age 6 because of the severity of his underbite. When you think of an underbite, you generally think of a big lower jaw which needs to be "pushed back." In this case, variables such as how little upper incisor he showed when smiling and the chin neck contour all entered into the orthodontic/surgical plan-maxillomandibular surgery with a clockwise occlusal plane rotation.
A 12-year-old female was treated with expansion of the arch form to accommodate the canines, and of particular interest is the attainment of ideal axial inclination of the posterior buccal segments. Also, in the finishing phase of treatment, crown lengthening was performed, resulting in an ideal smile presentation.
This case underscores several essential principles: the importance of preserving a consonant smile arc, initiating treatment with bracket placement from the outset to efficiently address malocclusion and achieve ideal esthetic goals, utilizing a diode laser in orthodontic practice, and the necessity for a custom fixed orthodontic appliance system to facilitate ideal bracket placement and the creation of brackets tailored to torque requirements derived from a standard straight wire appliance, followed by subsequent standardized bracket placement.
Treatment commenced when the patient was 11 years old, capitalizing on her available leeway space and the absence of her 12-year molars in the maxillary arch. This presented an opportunity for maxillary expansion with molar distalization to create space for the eventual eruption of her maxillary canines. To expedite the treatment process, once the canines were positioned just beneath the surface of her gingival tissues, they were exposed using a diode laser. This allowed for the placement of buttons to guide them into alignment with the rest of her teeth.
As you observe the progression of her smile, you'll notice its remarkable transformation, characterized by the enhanced width and harmony of her smile arc. This final result can be described as a beautiful smile that fully realizes the objective of smile design—projecting her smile.
The key takeaways from this morph transformation are the various factors contributing to a gummy smile. These factors encompass the concepts of active and passive eruption, which result in reduced incisor crown height. Furthermore, the observation that the amount of gingival display in a smile decreases over the following nine decades is noteworthy.