Wassmund osteotomy for excessive gingival display: a case report with three-dimensional facial evaluation

This case report describes the management of an adult patient presenting with a skeletal Class II malocclusion with congenitally missing lower second premolars, maxillary dentoalveolar protrusion, and an excessive gingival display in full smile.

The treatment plan consisted of a combination of a segmental osteotomy to reposition the anterior part of the maxilla after upper premolar extractions and a bilateral sagittal split osteotomy (BSSO) to advance the mandible. Because the upper left permanent second molar required extraction, the upper left third molar was moved mesially during post-surgical orthodontic treatment.

After active treatment, bilateral Class I molar and canine relationships were achieved. Two years after retention, a satisfactory facial profile and dental occlusion remained with optimum overjet and overbite. Treatment also produced changes in the threedimensional (3D) configuration of the face, which was characterised by decreased labial protrusion, increased protrusion of the chin, and increased cheek prominence.

A segmental osteotomy of the anterior part of the maxilla produced favourable treatment results by reducing excessive gingival display, but also by a relative improvement in cheek prominence.