Case history :

  • This 25 year old woman had started an orthodontic treatment 2 years earlier before being  to Dr. John Graham orthodontist, practicing in Litchfield Park, Arizona.
  • One of the patient’s chief complaint was that she didn’t like her gummy smile. The first series of photographs shows the severity of that gummy smile; more than 1 cm (10 mm) of gingiva is visible upon smiling.
  • The initial treatment plan included a “maxillary impaction” which is an orthognathic surgery procedure aimed at “moving up” the upper jaw to reduce the gummy smile.
  • Having lost her insurance coverage, the patient  could no longer afford the surgical fee so the initial treatment plan had o be modified.  Dr Graham offered to use temporary anchorage devices (TADs) to intrude the maxillary dentition and correct the gummy smile.
  • The photos  (A, B, C) below show the patient as she was transferred to Dr. Graham. (D) At the end of treatment, after the use of  TAD mini-screws and reduction of the gummy smile.

Sourire gingival de 10 mm diminué par ingression ou intrusion orthodontique avec mini-vis d’ancrage.

10 mm gummy smile decreased by orthodontic intrusion with mini-screw anchorage (TADs). (A, B, C) Occlusion when the case was transfered to Dr. Graham.. (D) At the end of treatment, after the use of mini-screws to reduce the gummy smile.

  •  Although the occlusion and tooth alignment were acceptable at this stage of treatment (transfer), the smile still showed a lot of gingiva because this correction was originally planned to been done surgically. Treatment goals were  still aimed at reducing the excessive gummy smile.

Intrusion orthodontique pour un sourire gingival, Cas traité par John Graham, Phoenix, AZ

Acceptable occlusion prior to orthodontic intrusion using mini-screws.

Orthodontic mechanics used for the intrusion of the maxillary dentition

 Mécanique orthodontique utilisée pour faire l'ingression du maxillaire supérieur

4 mini screws provided the necessary anchorage for the intrusion mechanics aimed at intruding the upper dentition and reducing the “gumminess” of the smile.

Cone Beam Computer Tomography (CBCT) imaging

Tomodensitométrie volumique à faisceau conique (TVFC) montrant la position de mini-vis d’ancrage utilisées pour l'ingression orthodontique d'un sourire gingival. Cas traité par John Graham, Phoenix, AZl.

Images from a Cone Beam Computer Tomography (CBCT) showing the position of the mini-screws (arrows). (A) Views of right, center and left sides. (B) Occlusal view showing the mini-screws positioned between the roots.

Cone Beam Computer Tomography (CBCT). Initial and final stages.

tomodensitométrie volumique à faisceau conique (TVFC) CBCT montrant le résultat de l'ingressionorthodontique à l'aide de mini-vis d’ancrage. Cas traité par John Graham, Phoenix, AZ

Vertical changes in the position of the teeth visible as shown in a 3D scan (Cone Beam Computer Tomography (CBCT)) before and after the intrusion.

To learn more about Cone Beam Computer Tomography imaging (CBCT)

Final results

Correction d'un sourire gingival sévère en orthodontie avec des mini-vis d’ancrage temporaires.

(A) Final profile. (B) Front view and (C) smiling after orthodontics. The gummy smile is gone, no surgery!


Occlusion suite à la correction d'un sourire gingival (gummy) à l'aide de mini-vis d’ancrage TADs. Dr John Graham orthodontist

Final occlusion


Correction d'un sourire gingival en orthodontie. Dr John Graham.

(A) Teeth during treatment, (B) at the end of treatment and (C) after the gingiva has been laser reshaped to give it a better contour. A dental facette was made by the general dentist on the upper right central incisor.

To learn more about soft tissue laser and how it can be used to modify gingival contour and improve esthetics.

Correction d'un sourire gingival en orthodontie par Dr John Graham

(A) Severe gummy smile showing 1 cm of gingiva before treatment. (B) At the end of treatment. (C) After the installation of a dental facette on a central incisor. Note that a surgical procedure was done to modify the chin (genioplasty).

To learn more about genioplasties

Thanks to Dr. John Graham for sharing this case