In adult patients, when the gummy smile condition is skeletal in origin such as the anterior vertical maxillary excess, usually a combined surgical/orthodontic treatment may offer the best solution. Unfortunately, the inherent risks, costs, discomfort and psychological impact accompanying the surgery may be deemed to be too substantial for some patients.

The aim of this presentation is to demonstrate three adult patients with skeletal-origin "gummy smile" concerns, all of them should be treated by traditional surgical-orthodontic approach to reduce the gingival exposure originally. After consultation with patients about the risks and benefits about the surgery, eventually they chose the more conservative method treated with a combination of orthodontic miniscrew anchorage and periodontal plastic surgery procedures. Post-treatment records illustrated successful and dramatic improvement in their smiles compared with the pre-treatment records.