Vertical Maxillary Excess

Q: Dr. Eppley, I have moderate vertical maxillary excess which causes me to have a gummy smile when laughing, a long lower/mid face and slight lip incompetence that causes slight chin dimpling/strain when I close my mouth. My chin is also slightly recessed. I dislike my downwards angled jawline which I think is the cause of the recessed chin and vertical maxillary execss that makes it harder for mandible to auto rotate. I also have a deep overbite and excessive overjet. My orthodontist and jaw surgeon suggested jaw surgery with maxillary impaction with slight advancement along with slight mandibular advancement to fix my concerns. I also had the orthodontic option to intrude my upper front teeth followed by gum laser removal. (although I don’t want my teeth looking long, i like the length of my teeth) I had braces when I was younger. They extracted 4 bicuspids which make my smile more narrow.

I would like to get rid of my gummy smile and long midface and have a relaxed looking mouth when I close it. I know my case is not severe but I would like to fix my concerns the right way. I do not want to look like a whole new person. I think I am good looking but I would just love to fix the things I mentioned that bother me. Would the surgical way make me look too different or would I still look like me?

A: Given all of your vertical maxillary excess symptoms, the best long-term treatment would be maxillary impaction possibly combined with mandibular advancement or a sliding genioplasty.  Whether the lower jaw needs to go with the maxillary impaction depends on what the pre surgical orthodontic workup shows for the skeletal movements based on the needed occlusal changes. This is the long but the right way. Anything short of this approach will produce some partial improvement but will probably always leave you wishing for more improvement.

Dr. Barry Eppley

Indianapolis, Indiana