Interdisciplinary Management of Severe Excessive Gingival Display: A Case Report

Excessive gingival display (EGD) associated with hyperdivergent skeletal Class II malocclusion represents a complex clinical condition requiring comprehensive interdisciplinary management. Successful treatment depends on accurate identification of the underlying skeletal, dentoalveolar, periodontal, and soft-tissue etiologic factors, combined with close coordination between orthodontic, orthognathic, and periodontal procedures. This case report describes the interdisciplinary management of severe EGD in an adult patient using presurgical orthodontics, bimaxillary orthognathic surgery, secondary genioplasty, and adjunctive gingivectomy, highlighting the benefits of a multidisciplinary approach in achieving favorable functional and esthetic outcomes with long-term stability. A 26-year-old female patient presented with hyperdivergent skeletal Class II malocclusion, associated with severe EGD resulting from vertical maxillary excess, a short upper lip, and localized gingival hypertrophy, and was treated using a sequential interdisciplinary approach. Treatment began with presurgical orthodontics, followed by bimaxillary orthognathic surgery consisting of Le Fort I maxillary impaction combined with bilateral sagittal split mandibular advancement osteotomy. Secondary advancement and vertical reduction genioplasty was subsequently performed to optimize lower facial balance and compensate for the anatomical limitations of mandibular advancement. Because localized gingival hypertrophy persisted after correction of the skeletal component of the EGD, an adjunctive 2-mm periodontal gingivectomy was performed, increasing the clinical crown length of the maxillary central incisors from 7 mm to 9 mm and further improving smile esthetics. Treatment resulted in a reduction of the gingival display from 8 mm preoperatively to ≤3 mm post-treatment, improvement of ANB from 9° (presurgical) to 5° (post-treatment) and GoGn/SN from 48° to 43°, establishment of a stable bilateral Class I occlusion, and satisfactory smile esthetics. The three-year and eight-month follow-up confirmed favorable esthetic and functional stability, with no significant relapse observed. An interdisciplinary approach combining orthodontic treatment, orthognathic surgery, and adjunctive periodontal management represents an effective treatment option for complex cases of EGD, allowing predictable esthetic and functional outcomes with long-term stability.