## 4 Discussion  
This case demonstrates a camouflage-targeted approach in managing a periodontally compromised adult patient with an anterior open bite (AOB) due to dental and habit components. Correction of an AOB is often difficult due to its multifactorial etiology. The patient's open bite was worsened by the pressure of an anteriorly positioned resting tongue against the lingual of the maxillary anterior teeth [9]. Along with weakened periodontal support, the patient was financially unable to afford complex interdisciplinary treatment and was significantly overwhelmed with its process. She also expressed a strong desire not to receive any extraction. Such patient-related important factors complicated the treatment  
Figure 8: Facial and intraoral photographs taken 56 months after debonding. Figure 9: Cephalometric and panoramic radiographs taken 56 months after debonding. planning, so a non-extraction treatment had to be planned. We aimed to primarily maintain the bone levels to those of pretreatment while reasonably enhancing the facial esthetics to meet the patient's expectation. To do so, it was critical to explain the advantages and disadvantages of all available options with direct involvement from other disciplines, so the patient could make an informed decision. The patient was shown animation videos and the results of real cases for the options presented from orthodontic, periodonotic and prosthodontic perspectives. In addition, a wax-up based on a three-dimensional (3-D) digital platform was used to simulate the final occlusion, prediction of incisal display and gingival architecture and for the esthetic difference between implant-based crowns and her existing natural incisors. In AOB cases, the 3-D position of the maxillary incisors should be regarded as a critical factor in deciding the pattern of teeth movement to achieve optimal facial esthetics [8]. During the formulation and execution of the selected treatment, it was critical to balance the esthetic and functional needs. We needed to improve the incisal display without further deterioration at the alveolar bone level. An esthetic and attractive smile includes 2 mm of gingival display with a consonant smile arc [10]. The patient had greater need for incisor \"true\" extrusion over posterior intrusion. She also presented with significant loss of the alveolar bone at the maxillary incisors. With significant bone loss, the center of resistance becomes more apically positioned, which requires the application of a light, controlled and targeted force system [11]. Therefore, it was more appropriate to select and apply mechanics that would minimize the force duration and magnitude on the maxillary incisors [11]. Throughout treatment, using Synergy low-friction brackets with six tie wings, only round 0.012\({}^{\prime\prime}\) and 0.014\({}^{\prime\prime}\) NiTi and 0.016\({}^{\prime\prime}\) SS archives were placed segmentally on the maxillary anterior teeth [12, 13]. Also, application of anterior vertical elastics was minimized in regard to force and duration. It is important to consider the 3-D changes associated with intrusion of the maxillary posterior teeth. In the vertical dimension, a combination of intrusion of the maxillary posterior teeth and relative extrusion of the maxillary anterior teeth provided correction of the patient's AOB with an improved incisal display and smile arc (Figure 5). Although she could have benefited from more incisor extrusion, such \"true\" extrusion would have deteriorated her periodontal status. Furthermore, it might have worsened her smile esthetics given the presence of notable black triangles (Figure 8). According to [PERSON] and colleagues (2014), 2.3 mm of maxillary molar intrusion improves an overbite by 2.2 mm as opposed to the conventionally assumed 4 mm, possibly because of mandibular extrusion [14]. In the present case, mandibular molars were maintained, maxillary molars were intruded \(\sim\)2 mm, maxillary incisors were \"relatively\" extruded \(\sim\)3 mm, and mandibular incisors were slightly extruded.