Treatment of dentoalveolar protrusion with customized lingual appliances and template-guided periodontal surgery

• The dentoalveolar protrusion was treated with customized lingual appliances. • Digitally designed templates were used for periodontal surgery. • Lingual dehiscence would recover at an early stage of retention. This case report describes a 34-year-old female with dentoalveolar protrusion. Maxillary second premolars and mandibular first premolars were extracted. Customized lingual appliances combined with long lever arms and highly positioned miniscrews were applied to achieve bodily retraction of the anterior segment. After orthodontic treatment, the patient's gummy smile and shortened anterior teeth were magnified. Moreover, a bony spicule showed on the maxillary labial alveolar bone because of insufficient alveolar bone remodeling. Crown lengthening surgery and alveoloplasty were performed under the guidance of a digitally designed template to further improve the gummy smile and the alveolar bone profile. The 14-month follow-up revealed that lingual alveolar dehiscence caused by maximum retraction had self-recovered.