Large skeletal discrepancies are sometimes only minimised but not eliminated by orthognathic surgeries. Administration of Botox has been advocated as an effective minimally invasive procedure to tackle aesthetic compromises like gummy smile and the like. This article elaborates on the surgical management of a case of severe vertical maxillary excess with Botox as an adjunct therapy.

Background:Maxillary labial frenum is a dynamic structure with a diverse morphology. Although an abnormal labial frenum is associated with syndromic and nonsyndromic conditions, it is often been neglected during the routine intraoral examination. The significance of various types of frenum (normal to abnormal), based on the attachment site and morphology in different skeletal patterns, has not been studied yet.Materials and Methods:A cross-sectional study was conducted in a clinical setting on 150 participants (50 each in Class I, Class II, and Class III skeletal pattern) within the age group of 13–30 years. Frenum was examined by direct visual method and intraoral photographs were taken for all the participants.Results:Chi-square and Fisher's exact tests were used. No gender-wise differences were found among the various frenum typologies. Mucosal type was the most prevalent in Class I and II and gingival type in Class III. Simple frenum was the common type in all the three groups. However, abnormal frenum categories based on its location and morphology were more in class III and found to be statistically significant. Papillary and papillary penetrating types are significantly associated with skeletal class III pattern and midline diastema (P < 0.05).Conclusion:The prevalence of papillary and papillary penetrating types of frenum are significantly more in Class III skeletal pattern. A labial frenum that is attached close to the gingival margin could be an etiological factor in midline diastema, mucogingival problems, and affect the growth of the alveolar process. Hence, an early diagnosis of abnormal frenum prevents the emergence of periodontal as well as orthodontic problems.

The Dumbbell separator would be ideal for situations where in rapid separation is needed, and also in cases where in the patient comes with the loss of separators.

Objectives Contemporary preadjusted edgewise appliance is all about the precision in bracket design, prescription and positioning in addition to the orthodontist’s skill and training. However, achieving it is a bigger challenge as the anatomy of the lingual surface of a tooth is uneven, dissimilar, and moreover the tooth alignment on the lingual surface is variant. Thus, the need for an accurate method of bracket positioning with predetermined torque and angulation incorporated in the brackets according to the patients’ need is of key importance. Materials and Methods A TAD- BPD machine used to enhance the accuracy of bracket positioning and bioplast accurate tray transfer technique was used. Results A step-wise procedures in bracket positioning and fabricating an indirect bonding tray for lingual orthodontics using the torque angulation device-bracket positioning device. Conclusions This technique facilitated unhindered bonding even in severely crowded cases and easy rebonding during mid-treatment stages.