Metal Mouth Message Board

Hi all,

Hopefully the title of this post gives you a good idea of what I'm about to ask.

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.

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 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 an upturn in the nose, which is not something I would want, of course. 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, 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 with an impaction with a merely minor gummy smile? I also wonder, if I don't have the impaction and just go ahead with the mandibular advancement and chin advancement, will this make the gumminess of my smile any different at all?

Thanks.

Two bits of possibly information which I didn't mention: (a) I'm 24 years old (b) I do have competent lips.

I personally would not recommend you doing it. Your nose will not only be upturned but also get wider. It can also change your cheeks and affect the height of your face.

Snophik wrote:I personally would not recommend you doing it. Your nose will not only be upturned but also get wider. It can also change your cheeks and affect the height of your face.

Where did you get that? My nose is exactly the same as it was pre-op.

I had a minor maxillary impaction for a slightly gummy smile, and also because my upper jaw was tilted. While my nose didn't get upturned, it is definitely wider.

I agree with Snophik, it doesn't sound like it's really worth it, especially if your doctors are saying it's not necessary. Upper jaw surgery recovery is worse than lower so if you can escape with just lower + chin, I would be inclined to stick to that.

I can sympathize with feeling like you might as well just do it while they've got you on the operating table but IMHO, the risks (numbness, hating your face, longer recovery) probably outweigh the benefits.

snapdresser wrote:

Snophik wrote:I personally would not recommend you doing it. Your nose will not only be upturned but also get wider. It can also change your cheeks and affect the height of your face.

Where did you get that? My nose is exactly the same as it was pre-op.

Okey good for you Snapdresser. I unfortunately speak from my own experience.

Snophik wrote:

snapdresser wrote:

Snophik wrote:I personally would not recommend you doing it. Your nose will not only be upturned but also get wider. It can also change your cheeks and affect the height of your face.

Where did you get that? My nose is exactly the same as it was pre-op.

Okey good for you Snapdresser. I unfortunately speak from my own experience.

That's fine. I just don't think it's accurate to tell OP that his nose WILL be upturned and wider post-op. It may well be the same.

I do not recommend it for you. Impaction when it isn't needed is not a good idea. It can have pretty bad aesthetic results as mentioned above.

If your gummy smile is only slight, I'd leave it be. In the long term it's better for you. Makes you more youthful and will prevent saggy lip later in life. Less is more there IMO. I was in the advanced area of that image you posted and had about 4mm impaction done, and I honestly wish I had left a little more on me. A little gummy smile is a part of who I am (was) and I kind of miss it.

RE: upturned/widened nose. Yes, this happens with fwd movement and/or impaction of the top jaw. Even with the use of an alar cinch my nose still got significantly wider, although the upturn did improve after I got a revision done (as did the widening, but even so it's still significantly wider than what I started with pre op). So, just one thing to consider as a risk when you get work done on the top jaw, especially impaction.