露牙齦及骨性暴牙

    露牙齦視為矯正治療中很困難的原因，主要多是因為常伴隨上顎骨的發育過度而造成前牙過度向下，和向前的位置。如果此時又有缺牙的問題，而希望矯正醫師一起解決，那真的是難上加難了。

    過去，筆者已經分享了許多露牙齦的矯正成果，因為病患本身害怕手術，而折衷採用非手術的純矯正治療。雖然移動速度，及其範圍，遠不及正顎手數來得改變快與大，但適用於希望獲得改善而會受限於本身骨骼結構，而願意對本身骨骼結構退讓的非手術患者。再次強調筆者本身樂於幫助患者選擇正顎手術的矯正治療，而且幾乎有五成的患者仍然 是願意手術的。

    我們將上顎前牙往後、往上移動以改善露牙齦及前凸問題，下顎則採『全齒列移動』（未拔牙）往後以改善咬合，讓下巴的形狀更為明顯。由於該患者因為受限於矯正治療的時間，和本身下顎骨第一大臼齒的長久缺失造成的齒槽骨萎縮，不適合將缺牙區完全關閉。但將第二大臼齒扶正，以利有朝一日未來植牙或牙橋的理想置放。

    Usually it will be thought as tough case with excessive maxilla and the patient wants to be treated by pure orthodontics alone. In those kind of patients, we often can see their excessive downward and forward teeth. However, if the patient also has missing molar, it will be more than difficult case to be treated.

    We demonstrated different kinds of gummy smile correction in this blog. Frankly speaking, it is far more slower and less amount of movement compared to orthognathic surgery. However, when patients have the concern of surgery and try to avoid it, after compromise to the outcome of their own bony structure. We will suggest the non-surgical way. Again, we reinforce it is after full explanation of the difference. Dr. Yeh actually likes to do the both ways.

    

    After moving the upper front teeth backward to upward to correct gummy smile, the lower teeth also were moved backward without  extraction. With the backward movement of the dentition, actually we made the profile more prominent and nicer. However, due to the time issue and the missing teeth area with long time atrophy, we decide to not close the space instead. On the other hand, it will be better result for the future prosthetic doctor to place dental implant or the bridge.