Nonsurgical treatment of skeletal maxillary protrusion with gummy smile using headgear for growth control, mini-implants as anchorage for maxillary incisor intrusion, and premolar extractions for incisor retraction.

INTRODUCTION: An adolescent girl, aged 12 years 11 months, was evaluated for orthodontic treatment. Her chief complaints included a difficulty with keeping her lips passively closed and excessive gingival exposure upon smiling. Her treatment plan included (1) restriction of maxillary growth with cervical headgear, (2) extraction of the maxillary first premolars to reduce the maxillary protrusion and the mandibular second premolars to facilitate Class II dental correction, and (3) management of maxillary incisor intrusion via anchoring with mini-implants. When indicated, even in the absence of large space discrepancies, extractions can be beneficial to the patient. The final results showed an attractive smile, passive lip seal, and a more esthetic and balanced facial profile. Retention records confirmed the stability of the treatment. The 5-year follow-up visit revealed that the treatment results were quite stable.