Metal Mouth Message Board

I have a prominent bimaxillary dentoalveolar protrusion. Noticeable enough that I *hate* people taking pictures of me. I look horrendous on my wedding pictures because I'm constantly smiling. Added to the protrusion itself I also have a receded chin.

I've consulted with several doctors on treatment options. It started with the possibility of getting a chin implant, only to find out later that maxillofacial surgery would create more desirable results without having to do anything to my chin (Le Fort I and bilateral sagittal split ramus osteotomy). The problem is that I've been referred to different specialist for what essentially are cosmetic reasons. I have no medical necessity (that I can tell) to get oral surgery. My bite is fine, no breathing problems, no TMJ pain, or lip incompetence, etc. The oral surgeon I consulted referred me to an orthodontist, to see other less invasive treatment options. The orthodontist thinks that with 4 teeth extractions, and braces (for retraction), can be a good start in dealing with the cosmetic issues I have. As well as gum re-contouring, teeth bleaching, veneers for two front teeth, and finally a sliding chin genioplasty (not an implant).

I've been trying to keep any cosmetic changes on myself modest, however I'm finding out that I "need" a lot of work. I try to find out as much as I can about each and every procedure that is being suggested to me, in case there is something I really should not go through with. I've read about people who are happy with their tooth extractions and those who regretted them. I think it's a case to case basis and bad decisions can be made. Of course, I'd rather keep my teeth, but then I could also just not have anything done at all. Since the teeth I have a pretty good in themselves. I just have an ugly mug.

Anyhoo, everyone has very subjective perceptions of their face and the qualities of it. So pictures are really a necessity.

(I tried hyperlinking images onto this post of myself, but as a new user I'm not authorized. I do have an account in photo bucket under the username "spacepotat0." s403 dot photo bucket dot com slash albums slash pp115 slash spacepotat0)

My question(s) to other members here is:

Has anyone had issues with a prominent gummy smile and took a course of treatment for it? Has anyone had tooth extractions and braces for it? If there is a professional member in the message board, what would be their preferred course of action (if any)? I appreciate any responses in advance.

I have a case of dental bimaxilliary protrusion. I have removed 4 first premolars and i'm still retracting my teeth backwards. I have seen a slight change in my profile for the better...but i'm expecting more changes because i'm just at month 10 out of a sentence of 18 - 24 months. Hopefullly retraction will be done around like april or so,...at least for the top, then straightening.

From looking at your pics, my guess is that you may need surgery. Mostly because of the gumminess of your smile . I think premolar extractions alone + retraction will cause more gumminess.

I am not sure to what extend gum reshaping can reduce the gummy smile. You definitely have a lot Looking at your front pic, looks to me that if you reshape it enough to make your smile completely pleasing cosmetically, you will have no gum left to hold your teeth. But, I am assuming you can definitely reduce it by at least half of what would be ideal, so it all depends if you are looking for perfection or not. If you are ok with the fact that you will have a little of gummy smile left anyway, I think the option of teeth removal + gum reshaping may be a viable alternative for you.
I personally am cautious with the surgeries of any kind due to their invasive nature and irreversibility of the results. If I had no functional issues, I would have been very cautious with orthognatic surgeries. Plus, it is usually costly and no med necessity usually means that 100% of the cost will be coming from your pocket...
I also think that your chin looks weak because you have protruding teeth and lips. You may find out that when your teeth are not protruding anymore, your chin will look ok. Again, it all depends on whether you strive for perfection or are willing to compromise a little. In any case, sliding genioplasty is much less invasive than the real orthognatic surgery - if you decide you want it...

You need to actually ask if you have any functional problems; don't assume all your issues are cosmetic. I thought my bite was peachy-keen until my general dentist sent me to a periodontist for gum recession. The perio told me that my severe (but well-integrated) lateral crossbite was causing gum recession due to excess tilting of the teeth and abnormal lateral pressure. I cannot imagine how noticiable jaw deformation could have you end up with a proper bite. Being able to effortlessly bite and chew does not mean your bite is correct, as I have learned. In my case, I didn't even notice any significant cosmetic issues!

My case is bad enough that it took the ortho about 2 1/2 hours of staring at my ceph and models to even come up with a vague treatment plan. He came up with Plan B that involved one extraction, a TAD, and a whole bunch of elastics. But his preferred Plan A (and the one that I'm going through with) is the LeFort/BSSO/Genio combo (no extractions.)

As a side note, if you don't have any bite problems now, pre-surgery ortho prep will create them for you!

sirwired wrote:You need to actually ask if you have any functional problems; don't assume all your issues are cosmetic. I thought my bite was peachy-keen until my general dentist sent me to a periodontist for gum recession. The perio told me that my severe (but well-integrated) lateral crossbite was causing gum recession due to excess tilting of the teeth and abnormal lateral pressure. I cannot imagine how noticiable jaw deformation could have you end up with a proper bite. Being able to effortlessly bite and chew does not mean your bite is correct, as I have learned. In my case, I didn't even notice any significant cosmetic issues!

This is actually very true! I have a crossbite on my molars due to some eruption/developmental problems (not due to space limit, I seem to have enough bone), and because my molars did not integrate properly (actually, not at all - my uppers used to bite completely outside of the lowers), premolars had an extreme pressure on them. They also were tilted. As a result, I have lost one upper premolar on each side and others are root-canaled (also on each side). This being said, I though I had no functional issues whatsoever - until I had a dental bridge done to replace one of my missing premolars. That started the whole chain reaction of TMJ pain and bite problems that I am trying to solve with braces now. I wish my parents were more attentive to my posterior crossbite and assessed my bite more in depth compared to just straight front teeth!

First of all, thank you for the thoughtful responses. This process and research has been confusing, and I was tempted to just drop everything and give up.

I came back from the ortho diagnostic, with the orthodontist first telling me that the extractions and braces could be enough to retract the gummy protrusion, only to later have his assistant tell me that the treatment he is willing to give me is just braces for straightening my teeth (which is so minimal, it's not even necessary). She offered to recommend a good periodontist in the area to reshape my gums. Another orthodontist in that firm apparently also concluded that I shouldn't go through something as invasive as oral surgery, just gum reshaping. No one has observed any functional problems (which may lead to future issues) with my bite.

I don't even know if I should seek out second and third opinions. I want to be really sure about what to do with myself before I have some form of irreversible procedure. A lot of people feel that I would get the best results if I had maxillofacial surgery (Le Fort + jaw surgery), but the cost is prohibitive for just cosmetic reasons (and an insurance company won't cover it). The braces option, at least for moderate effect, sounded good enough that I would have jumped at it. However, it seems that if I were to have the very minimal in treatment, I could just get gum reshaping and a sliding genioplasty (to deal with the receded chin). These last treatments would just make my teeth taller and less gummy, but the upper gum will still protrude if I smile to widely.

In any case, I need to find experienced oral surgeons in San Diego. I would even travel to Los Angeles if necessary, with a good referral. If anyone has suggestions, I would appreciate it.