TADs to Move Jaw Up?

Question

An orthodontist told me that TADs can be used to shift the jaw/teeth up to slightly reduce a gummy smile (my teeth length is fine but my jaw apparently sits too low). Is this possible?? How much can teeth be moved "up" to correct a gummy smile with TADs? When I smile, I currently show an 1/8" to a 1/4" of gums. What can I realistically expect? Are results permanent?

Clark L. Jones, DDS, MSD · Answer

I would recommend that you talk to several orthodontists if you want other opinions and research it very carefully. T.A.D.s could definitely be used, they would reduce the gum exposure in the smile line and the results should be fairly stable. It is also important however, that YOU decide how you like your smile now, and what you want it to be like later in life. In the photograph the smile shows some gum but looks pretty good to me now. A smile showing more gum is considered more "youthful" up to a point. The fact that you show more gum now may be a significant advantage when you are 50 years old and everybody else needs a face lift because they don't show enough of their upper teeth but you still do and still have a more "youthful" look than they do. As we get older it is normal to show less and less gum and less and less of the upper teeth until when we are old we mostly show only the lower front teeth. Look around at older people and you will see that in many cases you can't see their upper teeth at all or very little. There may be a time in your life when showing a little more gum and a little more teeth may be an advantage. You might delay the aging process a little bit by going with what you have.

Brian Dorfman, MD, DMD · Answer

Dr Kazemi below has does a very good job addressing the issue in very concise fashion. A gummy smile is often caused by a skeletal issue. The upper jaw may sit to low in position compared to what is considered "normal" That being said if you do not mind showing gums when you smile then you do not need to do anything about it. If it bothers you must have a consultation with both a Board Certified Oral & Maxillofacial Surgeon as well as an orthodontist. If you show gums at rest then it is a skeletal issue. A Rest photo would be helpful. Using TADS alone will be very difficult to fix this issue and you will probably be unhappy. Also there are some dentists here advocating the use of Botox and Gum Surgery. Be Very Weary of improperly trained individuals placing botox for high smile lines, also be very weary of "gum surgery" for this issue since you may wind up with very large appearing teeth. You need to address the true issue before going through with treatment. Seek the advice of a board certified oral & maxillofacial surgeon

Bernard Ian Krupp, DDS · Answer

If you show &ldquo;too much gum&rdquo; and want to know what is possible, then you should see both an Orthodontist and an Oral Surgeon for evaluation. Gummy smiles are usually  &ldquo;youthful&rdquo; smiles and it is important to understand what is too gummy or in medical terms, what is a long upper jaw, or Maxilla. TAD&rsquo;s are small bone screws that can be useful to alter a single tooth position but not an entire jawbone. Botox or Dysport will help lengthen an overactive upper lip but is usually not indicated. If the problem is that your teeth are too short then a gum trim may be in order. More than likely, you are maxillary hypertrophic &ndash; long upper jaw, and the answer is Jaw Surgery to shorten the bone and create the correct jaw relationship while keeping a youthful look. See your local Surgeon who does craniofacial or Orthognathic surgery and they will guide you as to the correct diagnosis and a referral to an orthodontist as well.

Michael J. Thomas, DDS · Answer

The new way to fix a gummy smile is with Botox. It will relax the upper lip allowing it to cover your teeth more..if that is not enough then laser gum contouring wil reduce it also. Stay away from surgery to fix this problem. I dont believe that any pushing up of your upper teeth will ever work...

H. Ryan Kazemi, DMD · Answer

There are several reasons why a gummy smile may exist. It is most important that the proper diagnosis is made before recommending a certain treatment approach. Answering the question: "Why is the smile gummy present and what is causing it" will help choose the right treatment

	
		If the cause is excessive size of the upper jaw (vertical excess) then jaw surgery is the only solution
	
		If the cause is excessive gum tissue coverage (altered passive eruption) then crown lengthening may be a good solution
	
		If the cause is an extremely short lip, there is not much of a solution, except to address it by shortening the jaw itself (back to #1)- Botox is unpredictable and very short lived
	
		If the cause super-erupted upper teeth (shifting of teeth downward) then TAD and process of intrusion may be helpful. But this only happens when the opposing teeth are missing. While this is an option, it is not easy to do and results are unpredictable. I have never seen a reported case (lectures or publication) where someone has used TAD to correct the upper teeth problem and its gummy smile.


	
	Please see a good oral surgeon, restorative dentist, and orthodontist and allow them to collaborate on the etiology and best realistic treatment outcome.

	 

	Thanks

	Dr. Kazemi

Wendy S. Spektor, DDS · Answer

Before you do anything drastic, go have a consult with a dentist who does Botox. 

	I have loved the results for my patients and have been doing this treatment for a long time.  The treatment is not permanent but  over time you don't need to do Botox as much because it retrains the muscle.   Botox is a reconstituted protein and works so great to drop that lip!

	You are adorable and that's all you may need.

	 You can do crown lengthening(gum reshaping) and veneers if your teeth have not completely erupted-A Periodontist will help you with that.  I would avoid orthodontics if nothing but the esthetics is wrong.

	Wish you were in Washington State-I would help you in a blink of an eye.  The Allergan company sells Botox, see if you can get a referral to a dentist from them.

Marc Zive, DMD · Answer

TADs to move the teeth upward as a solution to a gummy smile is the wrong approach.  It is not necessarily true that your jaw is too low.  More likely, your lip or smile line is unusually high.  The muscles that surround your mouth in this case draw the upper lip higher than for the average person.

	Assuming that your concern is for the aesthetics of a gummy smile, my recommendation would be to have your dentist trim and re-contour the gum-line, a gingivectomy, to reduce the gummy nature of your smile.  This type of crown lengthening should do the trick.  This can be supplemented later with veneers.

Mitchell A. Josephs, DDS · Answer

No. I recommend crown lenghening surgery or gingivectome with a laser, followed by veneers if needed.

Olga Kharevich, DMD, PhD (in memoriam) · Answer

You have beautiful teeth, very classy anatomy, shape and a pleasing color. And you also have overdeveloped maxilla - maxillary excess. There are 3 types of maxillary excess according to the height of the over-developed alveolar ridge. At some minor degree of overgrowth it can be corrected with crown lengthening or some minor cosmetic involvement like Botox injections. In your case this approach is not going to be helpful and providing with stable long-trerm esthetic and functional results.

	You have a classic smile that requires orthognathic surgery. TAD are not going to help in this case- they have very limited degree of success and moving the teeth. In your situation the maxillary excess/ gingival display can be corrected only with orthognathic surgery. You should get opinion from the orthodontist who closely works with oral surgeon specialized in orthognathics and carefully review all the options of your treatment that will provide you with stable esthetic and functional results.

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