Maxillary Impaction for Minor Gummy Smile

[Sethl]

Hi all,

I will soon be having orthognathic surgery. As it stands, the plan is to advance my mandible and chin, as I have a significant overbite.

Now, as it happens, I have a slight gummy smile. If you look at this image, http://www.kurpisdentistry.com/images/fig_2.gif , I would suggest that the amount of gum I show with a natural, not-too-over-the-top smile is very similar to that in the first image (labeled 'mild'). If I really try to do my cheesiest smile, though, I show a bit more (I'm not really sure how big one's smile should be when assessing its gumminess). I have had some gum recession on my upper incisors, so there'd probably be even more gum if it weren't for that. I also seem to show more incisor than the ideal when at rest/talking, although I cannot be specific with how many millimetres that is. My ortho surgeon did, nonetheless, describe me as showing correct incisor amount at rest.

I have discussed a maxillary impaction with both my orthodontist and surgeon, who both said more or less the same thing to me: that they would not recommend that I have one because, although I may show more gum than the ideal amount when smiling (and more incisor than the ideal amount than at rest), the problem is not too significant to warrant an impaction. They also suggest that given my size (I am a 6'4" male), it is less of an issue than if I were only a petite person. My teeth, too, are quite large so the gum that shows does not look too disproportionate. Further, they mentioned the typical aesthetic side-effects of an impaction, namely a widening and an upturned tip of the nose, which is not something I would want, as my nose is already slightly upturned and bulbous. They also pointed to the drooping of the upper lip with age. They have said, though, that they will do an impaction if I really want it.

I am inclined to go with the advice of my orthodontist and surgeon, and I don't want to significantly worsen my nose, or lose too much incisor show, but since this operation is more or less a once in a lifetime thing, I want to be sure I'm not missing out on a chance to make the most of this.

What do you guys think about this? Has anyone had experience of an impaction with a merely minor gummy smile?

Thanks.

[Sethl]

I will work on getting a front and profile picture up for you guys. In the meantime, I think this girl (in the before image) shows a similar amount of gum to me when smiling. Perhaps 0.5 mm more.

http://drrichardjoseph.com/photos/124.php

(Coincidentally, she also seems to have the same issue of a long lower face as me - a recessed mandible such that it needs a BSSO and genioplasty)

[PloskoPlus]

Vertical changes have the most impact on one's face for better or worse. If you like your face, I wouldn't do it. The forums are littered with distraught over impaction patients (albeit mostly women). I'm probably talking out of my arse, but I think it's probably too imprecise in many case and should only be done when the benefit is obvious. for example, say you need 2 mms, yet the osteotomy line itself removes 1 mm. How do you remove the other 1 mm? I can see how impacting 5 mm can be done - 2 osteotomy lines with 3 mm in between.

[Sethl]

Vertical changes have the most impact on one's face for better or worse. If you like your face, I wouldn't do it. The forums are littered with distraught over impaction patients (albeit mostly women). I'm probably talking out of my arse, but I think it's probably too imprecise in many case and should only be done when the benefit is obvious. for example, say you need 2 mms, yet the osteotomy line itself removes 1 mm. How do you remove the other 1 mm? I can see how impacting 5 mm can be done - 2 osteotomy lines with 3 mm in between.

Thanks for the response Plosko. I'm really banging my head against a wall with this one. I want to get the most out of this, as it's the only time I intend to have orthodontic/orthognathic treatment, lol. And I definitely show more incisor and gum than would be optimal, but it's definitely not as bad as some of the gummy smiles that you see. I don't want to end up with a horrible result, especially since my surgeon is hesitant to impact in the first place.

To all: Here's another case I've found of a seemingly successful maxillary impaction in a guy with a minor gummy smile (unless he's not smiling widely, it's hard to tell):

Before: http://www.seortho.com.au/wp-content/uploads/2015/07/Andrew-Before.jpg

After: http://www.seortho.com.au/wp-content/uploads/2015/07/Andrew-After.jpg

(Again, he has the recessed mandible/chin like mine. In fact, he looks frighteningly similar to me, my nose is very similar.)

[PloskoPlus]

Lots of men even in old age show plenty of gum when smiling - clooney for one.
https://goo.gl/images/KKrBOS