IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 13, Issue 10 Ver. V (Oct. 2014), PP 68-74 www.iosrjournals.org www.iosrjournals.org 68 | Page Orthodontic Surgical Treatment of Gummy Smile with Vertical Maxillary Excess Dr. Suma T 1 , Dr.Shashikumar H.C 2 , Dr.Lokesh N.K 3 , Dr. Siddarth Arya 4 , Dr.Shwetha G.S 5 1 Reader, Department of Orthodontics & Dentofacial Orthopedics, Rajarajeswari Dental College & Hospital, Bangalore 2 Reader, Department of Orthodontics & Dentofacial Orthopedics, Rajarajeswari Dental College & Hospital, Bangalore 3 Reader, Department of Orthodontics & Dentofacial Orthopedics, Rajarajeswari Dental College & Hospital, Bangalore 4 Senior Lecturer, Department of Orthodontics & Dentofacial Orthopedics, Rajarajeswari Dental College & Hospital, Bangalore 5 Professor, Department of Orthodontics & Dentofacial Orthopedics, Rajarajeswari Dental College & Hospital, Bangalore Abstract: Clinical entity with several treatment options. Treatment of these cases requires extremely well-co- ordinated orthodontic and surgical treatment planning and execution. This is a case report of 30 year old female adult patient who presented with skeletal class II malocclusion with excessive vertical growth of maxilla. Vertical maxillary excess, thin alveolar troughs, proclined upper and lower anterior teeth, excessive curve of spee and excessive eruption of upper and lower incisors which led to decision of combination of orthodontic and surgical treatment. This case report represents twin jaw surgery. Le Fort I procedure with maxillary set back and sub apical osteotomy in mandibular arch. The presented technique was unique as it shortened the treatment time and resulted in good occlusion, function, and aesthetics. Keywords: Gummy smile, vertical maxillary excess, orthognathic surgery I. Introduction Vertical maxillary excess, clinically recognizable facial morphology is manifested primarily by gummy smile, exposure of the maxillary teeth, with incompetent lips, increased length of lower facial, high mandibular plane angle. Cephalometric and occlusal analysis reveals Angle Class I malocclusion on a skeletal class II base. Such cases of skeletal Class II malocclusion usually require a combination of Orthodontic and Orthognathic surgical treatment. The treatment of severe dentofacial deformities in adult patients is challenging to both the orthodontic and oral surgeons. Treatment is difficult because of the skeletal and facial disharmony cessation of jaw growth and a tendency toward relapse after treatment. The surgical orthodontic correction of vertical maxillary excess via surgical superior repositioning of maxilla is generally acceptable treatment regime on the basis of skeletal stability and aesthetic soft tissue changes but results are not generally satisfactory. This article describes orthodontic surgical management of an adult patient with skeletal class II malocclusion caused by excessive vertical maxillary growth. II. Diagnosis A 32 year adult female patient with a chief complaint of protruding upper front teeth (fig 1) with an excessive exposure of gingiva. Initial examination reveals excess visibility of gingiva at rest and during smiling. Incompetent lip with gap of 12mm suggesting of vertical maxillary excess. She had dolichocephalic, convex profile and posterior divergent and a high lip line with 9 to 10 mm of gingival visibility during smiling. Class I molar and class I canine with overjet of 4mm and overbite of 5mm. Lower midline shifted to left side by 2mm with mild lower anterior crowding( Table 1).