Orthodontic Management of Vertical Maxillary Excess With Occlusal Cant and Molar Protraction in a Young Adult Female: A Case Report

Vertical maxillary excess (VME) often presents with excessive gingival display, deep bite, and occlusal plane discrepancies that significantly impact smile esthetics. The management of VME in adult patients with compromised dentition poses unique challenges requiring comprehensive treatment planning and precise biomechanical execution. This case report describes the diagnosis and orthodontic management of a 19-year-old female presenting with a VME-induced gummy smile, occlusal cant, increased overjet, and a decayed mandibular molar requiring extraction. The patient exhibited a skeletal Class II maxillomandibular relationship with end-on canine and molar relations bilaterally, excessive gingival display exceeding 4 mm, and a mutilated mandibular first molar (tooth 36) with a mesioangularly erupting third molar (tooth 38). The patient was diagnosed with VME, excessive gingival display, occlusal cant on the right side, a deep bite of 4 mm, increased overjet of 5 mm, Class II molar and canine relations on the left side, a non-restorable mandibular molar requiring extraction, and midline discrepancy. Following the extraction of the compromised mandibular first molar, space was successfully managed through orthodontic molar protraction. The mandibular second molar (tooth 37) was protracted into the extraction space of tooth 36, achieving a bilateral Class I molar relationship. Bilateral premolar extractions in the upper arch created space for simultaneous whole arch intrusion assisted by temporary anchorage devices in the maxillary anterior region and infrazygomatic crest implants in the maxillary posterior region. Comprehensive fixed mechanotherapy corrected vertical and sagittal discrepancies, re-established symmetry, improved smile esthetics, and resolved the occlusal cant. This report highlights the importance of carefully planned biomechanics and vertical smile management in addressing esthetic imbalances without surgical intervention.