ArticleThe Angle orthodontist2026
Lip incompetence resolved by active vertical control in nonsurgical treatment of a protrusion case with vertical maxillary excess.
Article in The Angle orthodontist, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
In this case report, we present the treatment of a 28-year-old patient with lip incompetence and vertical maxillary excess (VME), using a combination of a midpalatal miniscrew-anchored cantilever clip appliance and submerged buccal shelf miniscrews. The patient exhibited a convex profile, long face, gummy smile, and protrusion, with a Class II skeletal relationship and mentalis strain. The patient declined conventional orthognathic surgery, leading to an orthodontic camouflage treatment plan involving extraction of four first premolars, maximum retraction, and active vertical control with skeletal anchorage devices. Treatment included the use of infrazygomatic crest miniscrews, anterior subapical miniscrews, and a cantilever clip appliance for molar intrusion, resulting in significant improvement in facial profile, reduction of gummy smile, resolution of lip incompetence, and alleviation of mentalis strain. This case demonstrates the effectiveness of a nonsurgical orthodontic intervention in managing a complex case of VME and lip incompetence.
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