What Is Vertical Maxillary Excess? (And How It Affects Your Teen’s Smile)

As your teen’s smile starts to develop during their early adolescence, you may begin to notice issues with the shape, length, or symmetry of their jaw or gums. One condition that often goes overlooked—yet significantly impacts both appearance and function—is Vertical Maxillary Excess (VME). This condition can affect your child’s bite, facial proportions, and even breathing. But what exactly is it?

In this blog, we’ll walk you through everything you need to know about what is vertical maxillary excess, how to recognize it in your teen, what causes it, how it’s diagnosed, and the best treatment options available to restore both function and confidence in your teen’s smile.

Understanding Vertical Maxillary Excess

Let’s break it down: the “maxilla” is the upper jawbone. “Excess” refers to overgrowth or an unusually large amount of vertical height in this area. When the upper jaw grows downward too much, it can cause the gums to become overly visible when smiling—what’s commonly known as a “gummy smile.”

In clinical terms, Vertical Maxillary Excess is an overdevelopment of the maxillary bone in the vertical direction. This extra length can change the way the upper and lower teeth fit together, cause imbalances in facial proportions, and sometimes lead to breathing or speech difficulties. It can also affect a teen’s self-esteem, especially if they’re sensitive about their appearance during their formative years.

What Does Vertical Maxillary Excess Look Like?

Many parents assume that irregularities in a child’s smile are just a “phase” that will pass. However, VME is more than a cosmetic issue. Here are some signs that may point to this condition:

1. Gummy Smile

The most telltale sign of VME is when a large portion of the gums is visible when your teen smiles—more than 2–3 mm of exposed gum tissue is often considered excessive. This can give the appearance of short teeth even though the teeth are typically normal in size.

2. Long Face Syndrome

Teens with VME may have an elongated lower face. The distance between their nose and chin appears longer than average, affecting the symmetry of their facial profile.

3. Mouth Breathing

Because the upper jaw may affect the nasal passages and airway, VME can lead to chronic mouth breathing, especially at night. This can worsen facial development over time.

4. Malocclusion (Bad Bite)

The overgrowth of the upper jaw may prevent the teeth from aligning properly, leading to open bites or other bite problems. This is often the reason teens need orthodontics braces in California.

5. Lip Incompetence

Your teen may struggle to close their lips without effort or strain. This could be due to the extended vertical length of the upper jaw.

Causes of Vertical Maxillary Excess

Vertical Maxillary Excess (VME) doesn’t occur randomly—it develops over time due to a combination of genetic, developmental, and environmental factors. Understanding the underlying causes can help parents and teens grasp why this condition happens and how early intervention may help prevent it from worsening.

1. Genetics

Genetics play a major role in facial and skeletal development. If one or both parents have a long face, gummy smile, or required jaw surgery or orthodontic treatment for similar issues, there’s a higher chance their child may inherit those traits. The overgrowth of the maxilla (upper jawbone) can be passed down through generations, much like eye color or height.

2. Abnormal Facial Growth Patterns

VME often develops as a result of disproportionate facial growth during childhood and adolescence. For some teens, the upper jaw grows downward more than it should, resulting in increased vertical height. This isn’t something a teen can control—it’s simply the body’s natural growth trajectory going slightly off course.

3. Mouth Breathing

One of the most overlooked contributors to VME is chronic mouth breathing, especially during early childhood. Conditions like nasal allergies, enlarged tonsils, or adenoids can force a child to breathe through their mouth instead of their nose. Over time, this can affect the position and growth of facial bones, especially the maxilla. The lack of nasal breathing changes tongue posture, which can further disrupt normal jaw development.

4. Poor Oral Habits

Habits such as thumb-sucking, prolonged pacifier use, or tongue thrusting beyond early childhood can apply abnormal pressure on the upper jaw. These habits may interfere with proper bite development and encourage vertical elongation of the midface.

5. Airway Issues

Since facial growth is closely tied to the airway, any obstruction in the upper airway can indirectly contribute to VME. Many orthodontists now use airway orthodontics to assess whether an underlying breathing issue is influencing jaw development. Identifying and addressing these issues early may reduce the severity of skeletal problems later on.

Why It Matters: More Than Just a Cosmetic Issue

At first glance, vertical maxillary excess may appear to be purely a cosmetic problem. But it can have serious functional implications as well:

– Chewing and Bite Problems

Improper alignment of the upper and lower jaws can lead to difficulties in chewing and wear and tear on the teeth.

– Speech Impairments

Overgrowth of the upper jaw can affect how the tongue moves during speech, potentially causing lisps or other speech challenges.

– Breathing Difficulties

Since the upper jaw plays a role in shaping the nasal cavity, VME can sometimes contribute to airway restriction, sleep-disordered breathing, or even mild obstructive sleep apnea.

– Psychosocial Impact

Teens are especially sensitive to how they look. A gummy smile or elongated facial appearance can affect their confidence, leading to social withdrawal or self-esteem issues.

This is why early detection and treatment are essential.

Diagnosis: How Do Orthodontists Detect VME?

If you suspect your teen may have Vertical Maxillary Excess (VME), the first step is to schedule a consultation with an experienced orthodontist or dentofacial specialist. Early diagnosis is key to determining the severity of the condition and planning the most effective course of treatment.

1. Clinical Evaluation

During the initial examination, the orthodontist will carefully assess your teen’s facial proportions, smile arc, lip posture, and gum display. They’ll also evaluate how the upper and lower teeth come together—any signs of an open bite, long mid-face, or excessive gum show may indicate VME.

2. Cephalometric X-rays

These side-profile X-rays provide precise measurements of the skeletal structure. They help orthodontists determine the direction and extent of maxillary (upper jaw) growth. Cephalometric analysis also reveals whether the issue is purely dental or if it’s a deeper skeletal imbalance.

3. 3D Imaging or CT Scans

For moderate to severe cases—or when surgical treatment is being considered—advanced imaging techniques like 3D cone-beam CT scans may be used. These offer a comprehensive view of bone structure, tooth position, and jaw relationships, allowing for accurate surgical planning if needed.

If you’re researching options like affordable orthodontics near me, look for a provider who not only specializes in braces but also has expertise in facial growth assessment, airway evaluation, and comprehensive treatment planning. Early and accurate diagnosis of VME can significantly improve treatment outcomes for your teen.

Treatment Options for Vertical Maxillary Excess

Treating Vertical Maxillary Excess (VME) requires a customized approach based on the severity of the condition, the age of the patient, and how much growth remains. The goal is to correct the imbalance caused by excessive vertical growth of the upper jaw while restoring proper function and aesthetics. Treatment may involve one or more of the following strategies:

a. Braces and Orthodontics

For mild to moderate cases of VME, traditional orthodontic treatment using braces can help improve both bite alignment and smile aesthetics. Braces work by gradually moving the teeth into better positions, which can help reduce the visual impact of a gummy smile.

In adolescents, especially those still in their growth phase, braces are often combined with vertical control mechanics—such as elastics or bite blocks—that help redirect jaw development. Teens in California frequently seek options like teeth braces in California or dentist braces in Oakland, where advanced orthodontic techniques are readily available.

For those who are concerned about appearance during treatment, options like braces behind teeth in Oakland can provide a more discreet alternative to traditional metal braces.

b. Growth Modification in Adolescents

Growth modification is a powerful strategy when VME is diagnosed early—ideally before or during the peak growth spurt of puberty. Special appliances like high-pull headgear, vertical chincups, or temporary anchorage devices (TADs) may be used to control the vertical growth of the upper jaw.

These appliances are designed to redirect jaw development and limit downward growth of the maxilla, minimizing the extent of the gummy smile. When combined with braces and good myofunctional habits (such as nose breathing and proper tongue posture), growth modification can produce excellent long-term results and potentially eliminate the need for surgery.

This early intervention is especially helpful for parents seeking braces without extraction of permanent teeth, as space can be created through guided growth rather than removal of teeth.

c. Surgical Correction for Severe Cases

In more advanced cases of VME—especially when the upper jaw is significantly overgrown and cannot be corrected with braces alone—orthognathic surgery is often the most effective solution. This surgical procedure involves repositioning the maxilla to reduce its vertical length and improve the overall balance of the face.

The surgery is typically performed after skeletal maturity (around 17–18 years of age) and is planned carefully in coordination with orthodontic treatment. Braces are usually worn before and after surgery to ensure optimal alignment of the teeth and bite.

While surgery may sound intimidating, it can produce life-changing results—both functionally and aesthetically. Many patients report better breathing, improved self-confidence, and more harmonious facial proportions after recovery.

d. Orthodontic Camouflage: Is It a Viable Option?

For teens or adults who aren’t candidates for surgery—or who prefer a less invasive route—orthodontic camouflage may be considered. This involves using braces or aligners to reposition the teeth in a way that masks the skeletal imbalance, making the gummy smile less noticeable.

However, it’s important to note that camouflage doesn’t fix the underlying bone discrepancy. It simply enhances appearance without changing jaw structure. It’s typically used for mild cases or when surgery is not desired.

Choosing the right treatment for VME depends on an accurate diagnosis and a clear understanding of your teen’s growth timeline. A qualified orthodontist will help you decide which path offers the best long-term outcome.

Can You Straighten Teeth Without Braces in VME?

You might wonder if clear aligners or alternative treatments can be used instead of traditional braces. While many teens are drawn to the idea of straightening teeth without braces, this depends entirely on the severity of the case.

Clear aligners work well for mild crowding or spacing issues but are usually not effective in addressing skeletal issues like vertical maxillary excess. That’s why a professional diagnosis is key before committing to any treatment plan.

Are There Any Alternatives to Surgery?

Yes—and this is an important point for many parents and teens. Not every case of VME requires surgery. Orthodontic camouflage techniques, which reposition the teeth to mask the jaw discrepancy, can be effective in mild cases.

These options are often explored when teens or parents are hesitant about surgery. However, it’s crucial to understand that camouflage doesn’t correct the underlying bone issue—it only improves aesthetics.

Early Detection: The Best Path Forward

The earlier VME is detected, the more non-invasive your treatment options become. Ideally, your child should see an orthodontist by age 7 to assess jaw growth and bite development. Early screening makes it easier to plan treatments that prevent more invasive procedures later on.

In some cases, early intervention could eliminate the need for surgery altogether, particularly when combined with airway orthodontics and growth-modifying appliances.

Cost Considerations and Accessibility

A common concern for parents is the cost of treatment. The good news? Many clinics offer payment plans or sliding scale fees. Options like affordable and quality braces or community health programs can help ease the financial burden.

If you’re located in Oakland or nearby areas, searching for terms like dentist braces in Oakland or affordable orthodontics near me can help you find reputable clinics that balance quality with cost-effectiveness.

Confidence Beyond Cosmetics

Correcting vertical maxillary excess isn’t just about achieving a Hollywood smile. It’s about ensuring your teen has:

• Proper jaw function
  
• Unobstructed breathing
  
• Clear speech
  
• Balanced facial aesthetics
  
• And most importantly, confidence in themselves
  

Whether it’s through braces, appliances, or surgery, restoring function to the jaw and balance to the face can have lasting effects on your teen’s social, emotional, and physical well-being.

Conclusion: Helping Your Teen Smile Freely Again

To sum it up, Vertical Maxillary Excess is a condition where the upper jaw grows excessively in a vertical direction, often resulting in a gummy smile, bite issues, and facial imbalance. While it may sound daunting, modern orthodontics offers several effective ways to manage it—especially when diagnosed early.

If you suspect your teen is dealing with this condition, don’t wait. A proper evaluation can make all the difference. At Welcome Orthodontics, our team specializes in identifying and treating complex jaw conditions like VME, using the latest techniques in braces, growth guidance, and airway-focused care. We’re here to help your teen rediscover their smile—strong, healthy, and confident.