The application of TADs for gummy smile correction

The achievement of desirable smile esthetics is one of the major goals of clinical orthodontics. An excessive display of gingival tissue on smiling (i.e. “gummy smile”) is often regarded as esthetically unattractive. A gummy smile due to pure muscular activity is seen as normal incisal exposure at rest but excessive gingival display with smiling. An active intrusion of the incisors might produce an aging image by decreasing the incisal display at rest. This type of gummy smile is accompanied by deep bite and/or interference between the tip of the maxillary incisor(s) and lower lip. For the correction of a gummy smile, an intrusive movement of the anterior and/or posterior segments is strongly indicated. Miniscrew-type temporary anchorage devices can effectively eliminate unwanted movement of the anchorage segment. Unlike adult cases, redirecting growth should exert a synergistic effect on the facial profile and extraction of premolars can be replaced by a non-extraction treatment modality.