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Vertical skeletal dysplasia can lead to excessive lower facial height and maxillary teeth elongation with gum exposure. Patients usually have long face, steep mandibular plane angle, often with mandibular retrognathism. The clinical manifestations include narrow nose, narrow upper dental arch, excessive incisal display, a significant backward and downward rotated mandible as well as vertical maxillary excess (VME). Traditional classifications which mainly based on sagittal jaw relation is inadequate in describing the vertical skeletal discrepancy. In this report, a VME case who also suffered from multiple missing posterior teeth, requires an interdisciplinary dental care. The main treatment objectives are to normalize overjet and overbite, improve chin projection, reduce the gummy smile, and establish satisfactory occlusion with stable posterior support. A three-pieces Le Fort I with a unilateral posterior segmental maxillary impaction was done to correct the over-erupted molars. In the mandible, sagittal split osteotomies with genioplasty were performed. An esthetic improvement and balanced oral function were both achieved after all teeth being restored. The benefit of this comprehensive approach among orthodontist, oral surgeon and prosthodontist to correct a severe dentofacial deformity were also discussed.

Vertical Maxillary Excess Complicated with Mutilated Dentition Treated by an Interdisciplinary Approach