Case Report Camouflage of Severe Skeletal Class II Gummy Smile Patient Treated Nonsurgically with Mini Implants Irfan Qamruddin, 1 Fazal Shahid, 1 Mohammad Khursheed Alam, 2 and Wafa Zehra Jamal 3 1 Orthodontic Department, Baqai Medical University, Karachi 74600, Pakistan 2 Orthodontic Unit, School of Dental Science, Universiti Sains Malaysia, Kubang Kerian, 16150 Kota Bharu, Kelantan, Malaysia 3 Dow University of Health Science, Karachi, Pakistan Correspondence should be addressed to Irfan Qamruddin; drirfan andani@yahoo.com Received 14 August 2014; Accepted 28 October 2014; Published 7 December 2014 Academic Editor: Pelin Guneri Copyright © 2014 Irfan Qamruddin et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Skeletal class II has always been a challenge in orthodontics and ofen needs assistance of surgical orthodontics in nongrowing patients when it presents with severe discrepancy. Difculty increases more when vertical dysplasia is also associated with sagittal discrepancy. Te advent of mini implants in orthodontics has broadened the spectrum of camoufage treatment. Tis case report presents a 16-year-old nongrowing girl with severe class II because of retrognathic mandible, and anterior dentoalveolar protrusion sagittally and vertically resulted in severe overjet of 13 mm and excessive display of incisors and gums. Both maxillary central incisors were trimmed by general practitioner few years back to reduce visibility. Treatment involved use of micro implant for retraction and intrusion of anterior maxillary dentoalveolar segment while lower incisors were proclined to obtain normal overjet, and overbite and pleasing sof tissue profle. Smile esthetics was further improved with composite restoration of incisal edges of both central incisors. 1. Introduction Te most common reason to approach an orthodontist is esthetic concern which is compromised by malocclusion [1]. Malocclusion, which can be skeletal or dental in origin [2], is present in every society but with variable prevalence [3–5]. Class II div 1 is the most prevalent malocclusion in Pakistani population [6]. Depending on the severity, class II div 1 not only causes esthetic and functional problems but also results in psychological disturbances [7]. Te treatment of class II involves growth modifcation in growing patients and camoufage in adults, if the skeletal discrepancy is mild to moderate. Complexity of treatment increases with the severity of sagittal discrepancy particularly when it coexists with maxillary vertical excess [8]. Maxillary vertical excess, which also can be skeletal or dentoalveolar type, presents with excessive visibility of upper incisors and excessive display of gingiva on smiling (gummy smile) [9]. More than 4 mm of gingival display is considered excessive and unattractive by patients and also by general dentist [10]. Irrespective of the cause, gummy smiles are rarely corrected with conventional mechanics and ofen orthognathic surgery is recommended [10]. However skeletal anchorage system has now widened the spectrum of ortho- dontics and is also very well accepted by patients [11, 12]. Mini screws can provide maximum anchorage to retract and intrude dentoalveolar segment simultaneously. Te following case is a severe skeletal class II with anterior maxillary dentoalveolar extrusion, which was treated with orthodontic camoufage rather than orthognathic surgery. 2. Case Report A 16-year-old female patient came to the Orthodontic Depa- rtment of Baqai Medical University with the presenting com- plaint of protrusion along with excessive visibility of upper incisors and excessive display of gums on smiling. Tere was no signifcant medical history while dental history revealed Hindawi Publishing Corporation Case Reports in Dentistry Volume 2014, Article ID 382367, 7 pages http://dx.doi.org/10.1155/2014/382367